Thursday, July 10, 2008

Money and Therapy: How Do You Feel About That?

I found this article fascinating:
Challenges of $600-a-Session Patients

Wealth reminiscent of the Gilded Age has encouraged a thriving business for a small and highly specialized group of therapists in New York and elsewhere. Their daily work gives them an intimate view of an elite who differ in some ways from their predecessors, and who can test the therapists who treat them.

More than a dozen therapists who are respected by their peers in the counseling of extremely wealthy patients said in interviews that... it can be hard to resist the temptation to sycophantically adopt their point of view.

In some cases, the patients treat their therapists as but another member of their entourage of servants. Some therapists also cited a heightened difficulty with frustration and setbacks for people used to getting what they wanted. And they are resistant to opening up, to showing vulnerability.

Dr. Karasu said the past few years had felt different to him.

“The problems are the same, but the scale is different now,” he said. “Hedge funds — there is no product, only wealth. It is flabbergasting to my patients, too. They can make so much money at once and then lose it.”

Dr. Michael H. Stone, a psychiatrist affiliated with Columbia, said that the preponderance of patients with self-made fortunes, many made at a relatively young age, marked a striking shift.

“It used to be that my patients were the children of the rich: inheritors, people who suffered from the neglect of jet-setting parents or from the fear that no matter what they did, they would never measure up to their father’s accomplishments,” he recalled. “Now I see so many young people — people in their 30s and 40s — who’ve made the money themselves.”


It is the extremely rare member of this circle who does not acknowledge struggling with complicated and contradictory feelings about superrich patients. The therapists admitted to feeling jealous or contemptuous on occasion, and though Dr. Karasu said of his patients, “They are, almost all of them, smarter than I am, and certainly more competent,” he rarely missed an opportunity in interviews for a joke or aside about the absurdity of talking about wealth as an affliction.

Janet L. Wolfe, a Park Avenue psychologist and the co-author of a paper about difficulties in counseling “women of the ‘upper’ classes,” said she considered a rich person’s unhappiness or emotional anguish no less serious than anybody else’s, but acknowledged how trivial some of her patients’ problems could sound.

“One of the things that drew a very wealthy woman to see me was that she was an inadequate tennis player,” Dr. Wolfe recalled. “She was very serious about this. She felt that the other wealthy women she played with would think she was an inadequate person. It’s easier for rich patients to take problems like this seriously.”

The rest of the article is well worth reading if you like amusing stories of rich people's misbehavior. But what about the costs of therapy for just regular folks?

I did a stint of it, about 10 years ago when I was going through a breakup. If I remember correctly, my individual sessions cost $55 an hour, only part of which was covered by my insurance. In addition to that, we did a few months of couples therapy, which may have cost even more. The couples therapist acknowledged that her job was sometimes not to help people stay together, but rather to help them break up, which was what happened in my case. After the break up, my ex- and I had to work out a lot of financial details since we'd owned a home together, etc. We each tried to estimate how much money I should get to be bought out of my share of our home, factoring in other expenses and money we owed each other. My ex- tried to say I should get less because I should have covered not half, but ALL of the couples therapy expenses, because it was "my fault" we were having problems in the first place!
I won't get into all the intimate details of why that relationship ended, but do you think who pays for couples therapy should be determined by who wants to leave the relationship, or who behaved badly in the relationship, or what the outcome of the therapy turns out to be?

Nowadays, I don't think I need therapy: I can use this blog to tell you about my mother!


Noel Larson said...

Sign #34 It is OVER...

He askes that your half of the assets are reduced by the amount that therapy costs...

Thank goodness you got out! Now you just have to put up with half of NYC hitting on you :)

lisak said...

What struck me was how much those therapists must be making at $600 a session twice a week. Good heavens! They may not be ultra-rich, but I think they're sitting pretty.

Anonymous said...

Lisa - being rich in New York is very hard to define. If you assume the therapist is working 40hrs/week that would mean he makes $1.2MM per year (before any costs/splits he might have). A million dollars per year is good money anywhere in the country but its much less meaningful in NYC when you have tons and tons of people who make that much and way more. NYC is also a city that attracts wealth from all over the world, pretty much every rich foreigner of the jet-set variety has a home in Manhattan (and other global cities). So it is easy to make one million a year in New York and not feel at all rich. I have a good job and make mid to high six figures but I still feel squarely middle-class here.

Escape Brooklyn said...

Holy cow, anonymous, you make mid to high six figures and still feel "middle class" here??? I really have to move.

I enjoyed the article but agree that a blog is a much more affordable form of therapy. ;)

Anonymous said...

because of the intensity of doing therapy, many if not most therapists do not work 40 hour weeks.
~ a therapist