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.