What is Therapy Worth?
Posted by Dr. Vollmer on September 24, 2010
Priceless and too expensive, that is what psychotherapy is worth. Geraldine received a large inheritance, a windfall for her, yet paying money to see a therapist feels “extravagant” to her. Harold, age twenty-three, desperately wants to change his life; he is willing to pay a large percentage of his income for psychological help. How do people place a dollar amount on an experience which may be their life boat, but could be part of their sinking ship. Cultural acceptance-is this the answer? Geraldine comes from a family where there is a strong value on “independence”. Geraldine’s parents came through the Depression of the 1930’s, and through that, Geraldine says, they instilled in her a strong belief that one has to handle their own problems; others will not be there for them. Harold, by contrast, comes from a family where having what he calls a “staff” of people to help is the way of life. Depending on others for advice, counsel, support is commonplace among his relatives and his friends.
Understanding the meaning of paying for therapy for each person, and for each family, in the case of a child patient, is my job. The nature/nurture understanding applies here. Sure, I can see that family values have a lot of weight when people decide about psychotherapy, but so do genes. Some people seem to feel more free to spend money than others; regardless of their economic circumstance. Money, like time, is measurable, and as such, some people like to control it, whereas others like to lose track of it. My impression is that the need to control, as with most behaviors, is in part a biologically based. The control of money often binds anxiety, which is also partly biologically based. In other words, Geraldine has anxieties about aging, about getting sick, about dying. She binds her anxiety by controlling her money. It reassures her to know that she will have more than enough money for her old age. The more she can hold on to her money, the better she seems to feel about the uncertainties of aging.
What is therapy worth? The answer stymies everyone. Nature and nurture help navigate these waters. Understanding how one approaches this question leads to a rich understanding of an individual’s psyche. There is no simple answer. In fact, there may not be any answer.
Shirah Vollmer MD 
Kristin said
As a therapist, how do you avoid getting offended when patients wonder if the cost of therapy is “worth it”? And don’t your patients worry about hurting your feelings in bringing up this question?
Dr. Vollmer said
As with so many things, the “offense” is a combination of message sent and message received. The content is usually less important than the tone.
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Melanie said
“Priceless and too expensive” — the story of my pyschoanalysis or rather the struggle with my legitimizing vs. deligitimizing my psychoanalysis from day 1. That translates into I am so lucky and privileged to be able to do this for myself at this point in my life vs. I am being extravagant, not practical, a spendthrift and should be saving the money that I have “earmarked” for psychoanalysis for the future. When I am feeling happy about my analysis, I think about what I spend every week, month, or year as tuition on myself — to “better” myself for the future and the awesomeness of learning about my mind. When I am not feeling so happy about my analysis, I think about what I spend there yearly as day care for a child (potentially giving up my analysis when I have to send an unborn child to day care) and on a broader scale, a downpayment on a house that I will need one day (money that I could have saved after all of the years of seeing my analyst). So to me, there can be no answer as to whether therapy/analysis is worth it — I hope I just know the answer when it is all said and done. 🙂
shirah said
Hi Melanie,
Psychoanalysis is definitely an investment in yourself, as you say, in a similar way, that going to school is, as well. Like school, there is a point of diminishing returns: a desire to move forward and leave the security of education to the adult responsibilities of work and family. Hopefully, you will find your path such that you will feel that you are better prepared to use your money in a way that makes sense to you because of your analysis. If that happens, then it is a priceless experience.