Money, Context, and Choosing a Clinician

Although I haven’t posted here in a longtime I have been writing, slowly making strides towards authoring a longer piece. I’ll even dare to call it a book! Right now it’s mostly outlining and it’ll be awhile until that comes to fruition. I’m returning to my blog because I wanted to provide some context around economics and therapy.  A book I frequently recommend to clients is Dr. Emily Nagoski’s Come As You Are: the surprising new science that will transform your sex life. One of the key concepts she presents is this: context is crucial.

To explain context she gives the example of how a 70-degree indoor space can feel cool or warm depending on if you’re entering from the freezing cold or the blistering heat, or, how a pungent smell can be positive when associated with a fine cheese and repellent when it’s body odor. To give a money example imagine you have around a thousand dollars in your account. The experience of that money will be very different if your bills are already paid versus still needing to cover rent. 

Sex and money share several things, including: being everywhere yet totally taboo; being notoriously hard to talk about; evoking high emotions and deep survival strategies; and having a lot to do with context. When it comes to the economics of therapy context is often something that clients, and even clinicians, aren’t well enough informed about or consciously connected to. Below, I provide context to consider when navigating a search for a clinician, which I realize may be one reason you’re on my website. 

The two areas I encourage prospective clients to consider when choosing a psychotherapist is logistics, such as: date, time, frequency of appointments, location, and, of course, fee; and the match, such as: does the clinician’s experience and area of specialization align with hopes and needs, and, is there a comfort and good relational fit. Both of these areas ought to be considered because if one is neglected it can easily negatively impact the effectiveness and outcome.

Therapy is an experiential process that, when works well, brings about new states and emotions, creates new mental cognitions, and yields life-changing discoveries. In this way it can be invaluable and impossible to put a price on. We do, however, live in a society where money matters. I have experienced in my own life, observed through clients, and heard countless examples of how an effective therapy can actually save and make us money.

Freud named love and work as the two primary pillars of our lives, (later Winnicott who you can see from my previous post I’m a fan of added play), and therefore areas that therapy aims to address. Relationships and occupation have a lot to do with money. When therapy helps us know our needs and truths we’re often guided and empowered to make better more beneficial choices and actions in our lives directly related to spending, income, and our overall relationship to money.

When it’s not the right approach or not the right match, however, and therapy isn’t proving effective, the time it takes getting to the appointment and even paying a very low fee will not be a good investment of money or energy. Personally, I once had a promising experience with a provider on the phone but when I went into their office the space (no window and weird smell) I knew wouldn’t work for me. Less humorous when I was in graduate school I endured an awful (and expensive) therapy not yet trusting my gut to get me out.

There has been immense data to support that the leading factor to a high level of efficacy and a successful outcome to therapy is how well the client and clinician work together. This largely will have to do with the clinician’s unique training, experience, and approach to meeting a clients needs – as well as if the logistics, practice policies, and procedures, work for both client and clinician – as well as personalities meshing and overall relationship compatibility. All of these areas are important when choosing a clinician, and, that’s a lot of context to consider!

There’s some good news, bad news, and more good news.

The good news is that there are a ton of clinicians out there, each offering unique services, and with so much variety it’s definitely possible to find the right fit for you. The bad news is that it is often overwhelming and daunting to be faced with such a variance of settings (private practice, group practice, clinic, etc.), fee structures (rates, policies around payment, in-network, out-of-network, etc.), approaches (psychodynamic, behavioral, somatic, and so forth). The more good news is that it’s a field of helpers and talking directly about these issues will give you good information going-in and a great basis for starting the therapy.

When it comes to all these considerations, along with having a direct dialogue with a prospective clinician where there’s a spirit of mutual curiosity and hopefully a helpful exchange of information, I strongly encourage you to pay attention to your own internal thinking and feeling about the logistics and fit.  Get curious about what draws you to a setting or person, how you’ve gone about understanding your financial spending plan around this investment, and what hopes and needs you’re prioritizing in your choice of clinician.

Another parallel between sex and money is we live in a society where there’s a lot of negativity associated with both. Shame and scarcity are pervasive in cultural messaging about money. Moreover, because money is also so tied up in our survival it can and does hit on past experiences, traumas, issues of trust, and how we go about negotiating our autonomy and dependency needs. With many clients working on relationship to money is an area that gets addressed because it is central to our experience.

So to sum up: context matters and it is worthwhile to consciously connect to logistical and fit considerations when choosing a clinician. Get a sense through your own self-inquiry and reaching-out to prospective clinicians a plan for frequency and duration of therapy, what the goals of the therapy will be, the specific gains and losses of the setting for you, what you can reasonably plan to spend given your unique financial circumstances, and other experiential, relational, and logistical needs you may have. If you want to know my thoughts on your unique situation I welcome you to be in touch or use the link on my website to schedule a complimentary 15-minute phone consultation.

Mari Andrew, Donald Winnicott, and How We Artfully Mend

Permission to post  @bymariandrew

Permission to post @bymariandrew

It is in playing and only in playing that the individual child or adult is able to be creative and to use the whole personality, and it is only in being creative that the individual discovers the self.
— D.W. Winnicott, Playing and Reality

Mari Andrew shares words and illustrations that resonate to many. Her relatable messages are so resounding I had heard mention of Mari with the endorsement that her work offers snapshots of sentiments, sensibilities, and sharing of experience that could be helpful during heartbreak and on the path of healing. When I looked at her @bymariandrew page on Instagram I too felt how her simple doodles slip right in, stirring the spirit, soothing the heart, and providing affirming often funny fresh perspectives. On her website she candidly shares she began drawing during a difficult time because she "[...] needed a new fun form of self-expression."

This need, not necessarily to draw rather to creatively express with freedom for something we all share. It is crucial for our development and key to mental health and healing traumas and hurts. Clinician and influential theorist in the field of psychology, Donald Winnicott, said “Artists are people driven by the tension between the desire to communicate and the desire to hide.” He also poignantly proclaimed, “It is a joy to be hidden, and disaster not to be found.” 

Working as a pediatrician and psychoanalyst with children Winnicott saw how creativity is crucial to our development, and, how accessing it has everything to do with ones faith and security in being found. That is to say, when a child experiences what Winnicott has called living "in a circle of love and strength" there is the security and space to explore, express, tryout, change, be a witness, and be witnessed. 

A depth, analytic, or psychodynamic approach to therapy understands that the relationship between the clinician and client can become like that circle of love and strength Winnicott speaks of. Room for authentic, playful, generative, finding, sharing, and discovery happens. Healing happens. There is recognition that as terrifying as it is to be seen it is by far more agonizing going unseen.

When we find truly fun (meaning genuinely enjoy), truly safe (meaning overtime trust has been established), relationships and/or activities where we can truly feel (meaning laugh with love and weep with sorrow as well as hangout in a range of whatever emotions arise) we are also found. We are given opportunity to heal, strengthen, and continue our self discovery and emotional development. I thank Mari Andrew for her courage of showing and telling and encouraging and supporting others in her messages. I believe creativity is a relational process of connecting to oneself and to an-other, and it shows us that we are, each and because of others, artists. 

Every child is an artist. The problem is how to remain an artist once he grows up.
— Pablo Picasso

Happy Pride, this June 2017 and Everyday!

June, chosen to commemorate the Stonewall riots, is a month of honoring, advocating for, and affirming sexual and gender diversity. Though I knew I wanted this blog to be about Pride, specifically the revolutionary act of self inquiry along with speaking out socially, I was myself having a hard time finding my voice and struggling with what to say. It was helpful that also throughout the month of June I've been participating in an online course through the San Francisco Zen Center with Zenju Earthlyn Manuel.

Manual expresses the importance of living with our whole self, our tender self, with our emotions and embodied experience present. She describes how it is in this place we access relatedness and how interrelationship is at the core of Buddhist teachings. She explores aspects of her book, The Way of Tenderness, which offers an invitation to awaken within the challenges of race, sexuality, and gender. She gets to how this radical personal act is also socially relevant and revolutionary. 

Self-inquiry and integrating our emotional experience is part of both wisdom traditions and depth psychology. This process and practice is full of paradox: experiencing surrender along with victory; being both brave and vulnerable; feeling humbled and empowered. Manuel gives voice that we must not silence, bypass, or steer away from our embodiment and conditioning in all of this. Indeed when we are safe enough and supported and able to speak, delve into, and turn to face these aspects of ourselves we are given access to so much.

I have grappled a great deal with issues around my body, gender, and sexuality. I’m also aware (and at times undoubtedly unaware) of how my presentation as a white, femme, cis-gendered person, has meant my path, though not easy or entirely straight, has had certain shelters and paved ways. What we look like, what we desire, what we’re able to do, is full of feels and friction for us all. We are each challenged to explore and express our embodied experience. For our own psychological wellbeing and for our larger social wellbeing it is paramount we give voice to the hushed, quieted, suppressed, and persecuted.

Audre Lorde, the writer, activist, and poet who famously warned, "your silence will not protect you," also promised "[...] the speaking will get easier and easier. And you will find you have fallen in love with your own vision, which you may never have realized you had. And you will lose some friends and lovers, and realize you don’t miss them. And new ones will find you and cherish you.  And at last you’ll know with surpassing certainty that only one thing is more frightening than speaking your truth. And that is not speaking.” May we speak and may our voice benefit and heal our own selves and ultimately offer benefit and support to all. 


In this inaugural post I wanted to name a few of my intentions with beginning to blog: it seems a wonderful way to share and chronicle resources for clients, colleagues, and the passerby; I appreciate the process and practice of writing; I like that it gives relational continuity to those I already know and prospective clients a sense of me and my approach. 

Writing is also challenging. Something we all know, and a reality psychotherapist and client must grapple with in every session, is how words can be both maddeningly limiting and incredibly liberating. Fitting the experiential, so full of paradox and physicality, into a symbolic language structure is a gift we humans get to bear. 

I appreciate how poetry offers us a space large and containing enough to unwrap this gift for ourselves and others, and play. Poetry has been a great source of solace when I've most needed it, provided me a sense of connection when I've felt alone, and given me a voice when I've had none. I wanted to share a poem new to me that when I read recognized as indeed therapy. 

Poem by: Nayyirah Waheed

the hard season


split you through.

do not worry.

you will bleed water.

do not worry.

this is grief.

your face will fall out and

down your skin


there will be scorching.

but do not worry.

keep speaking the years from 

their hiding places.

keep coughing up smoke

from all the deaths you have


keep the rage tender.

because the soft season will


it will come.




both hands in your chest.

up all night.

up all of the nights.

to drink all damage into love.

- therapy