Shirah Vollmer MD

The Musings of Dr. Vollmer

The Cost of Therapy

Posted by Dr. Vollmer on January 15, 2013

Alexander, seventy-two is spending his retirement money on therapy. His friends and family tell him he is “crazy”. “They don’t understand that I have very strange and bothersome thoughts and I have no one to talk to about that.” Alex explains to me, even though I know that. He is feeling defensive and misunderstood by his village. “On the one hand I know these people care and they are trying to help me so that I don’t run out of money, but on the other hand, they have no idea what I struggle with internally.” He tells me, again, even though we have discussed this many times. I hear the loneliness of someone who has such invisible suffering that no one, other than a mental health professional, can understand. The torture of brain suffering is beyond the comprehension of most people, even beyond some trained in the helping profession. Plus, friends and family presume to know his financial situation and this presumption hurts Alex’s feelings since he feels demeaned that they do not respect his decision-making. “Maybe you have lead them to believe that you have financial problems so they are confused why you invest so much of your resources into psychotherapy.” I say, knowing that he does need to be careful with his money, but at the same time, therapy, for Alex, is a life-line. “Yes, I do complain about money, but this expense is not optional for me. At least it does not feel that way.” Alex explains, mostly to himself. I am left feeling privileged with my medical training. Years of seeing how the brain can cause so much invisible misery has sensitized me to Alex’s issue. He suffers in ways, if he were to explain to his loved ones, would only alienate them and scare them away. Understanding goes a really long way, particularly for Alex.

7 Responses to “The Cost of Therapy”

  1. Jon said

    There is always a trade between resources and expenses. This trade can become a delicate balance when resources are tightly constrained can. However, there is another trade that must be considered in Alexander’s situation – a trade of costs. The economic cost of therapy must be balanced against the emotional costs of not having the outlet that therapy gives him. Although he has given his friends and family reason to question his decision, it sounds as though Alexander is of sound mind (albeit one tortured with “brain suffering”) to make that trade. Given that situation, it appears that Alex makes well the trades he needs.

  2. Ashana M said

    I find people often would prefer you deal with problems in the same unhelpful way they are dealing with theirs. No one has ever told me to quit therapy, but people I know care about me have told me to do lots of things I know I shouldn’t be doing and that don’t work. I think it’s both they would like me to be in less pain so that they can feel more comfortable and that approaching things differently casts doubt on how they cope. If at 72, with limited resources, he is investing in his mental health, maybe they should be too. But they aren’t. I wonder sometimes if it’s not just that people don’t understand the degree of suffering, but that they understand all too well.

  3. Shelly said

    It makes sense to me that if Alex complains to friends and family that he has very limited means, that he shouldn’t be spending his retirement funds on therapy. It should be spent on the basics like food, electricity, and medications. Therapy to most people is an indulgence. If however, Alex’s financial situation isn’t really as frail as he leads on, then he should be truthful to everyone and then his family and friends will stop harassing him about his choices. That should put an end to everyone’s intrusive statements and an end to his guilt and defensiveness about spending the money.

    • Oh, Shelly, I think it is a bit more nuanced. He does have limited means and he does suffer in this invisible, brain distressing way. He can’t explain to hisr friends and family because if he did then they would become scared of him. For some, therapy comes after the basic necessities, but for others, therapy is the first necessity. I would not say therapy is an “indulgence” for Alex. He would likely not survive without it, as his distress would cause him to make harmful decisions and thereby cause him to put himself in scary situations. Perhaps I did not adequately describe the internal distress that Alex experiences. It is hard to understand if one has never felt that they cannot trust their own brain.

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