Money Matters in Psychoanalysis:

The Analysts Co-participation in the Matter of Money

George Whitson, Ph.D.
(Working Copy)

Did you hear the one about the two analysts sitting on the bench? They are discussing the
advisability of extending credit to a patient in financial crisis. They agree to certain factors. It
probably shouldnt be done though they have both done it. They agree that it has to be
established that there is a real crisis. The patient should have a capacity to pay the balance at a
later time and there should be some very specific agreement as to the timetable and amounts of
payment. They both add strongly that if they did extend credit they would constantly be alert for
any indications of secondary gain in the patient, any indications of intensified positive and
negative transference and would be quick to point them out to the patient.

At the conclusion of the discussion one analyst decides to extend credit to his patient. He
reasons that it would be deleterious to the well being of the patient to terminate, that it might
instill a sense of trust and worth in the patient and it was not an uncommon transaction in our
society that two people, having an established business relationship, would extend credit during
certain periods.

The other disagrees. She says that it would indulge infantile needs of the patient, create a
sense of owing the analyst something, therefore inhibiting angry negative transference from
emerging. Finally she feels that the patient could always return to treatment when the financial
crisis was over.

A third analyst overheard the entire debate. At its conclusion, she turns to one and says I see
youre very anxious about meeting your new mortgage. To whom was she speaking? While the
more obvious choice would be the therapist who extended credit, its also possible that the other
analysts awareness of her desires influenced her choice to not extend credit. From the
perspective of this paper the content of the answer is immaterial. Instead, this paper attempts to
address the influences money matters have on the interactions in the therapeutic dyad. It is the
premise of this paper that the unconscious and conscious meanings of money to both the
therapist and patient are often in interplay in the sessions. Further, the therapists attitudes toward
money are much more apparent to the patient than is often recognized by the therapist and
frequently becomes entwined within the transference and countertransference matrix.

I believe that the conscious and unconscious effects of money are underaddressed as major
issues. The therapists anxiety about money is often acted out instead of discussed due to a sense
that ones fears, greed, and generosities are interferences with the work and should be purged.

Review of the Literature

The meaning of money in psychoanalysis has historically been examined from two points of
view. First has been the exploration of conscious and unconscious meanings of money to the

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individual. Secondly, practical issues of technique for the management and exchange of money
within the therapeutic relationship have been explored. It should be noted here that these two
issues have often been seen as separate. In addition, the conscious and unconscious meanings of
money for the analyst and its effect on the dyadic relationship and the analysts choice of
technique have been largely overlooked. Let me review some of the major concepts found in the
literature beginning with the meaning of money.

Meaning of Money
The classical view relates money to the anal period. Using mythology, history, clinical
experience and his personal psychology, Freud developed his belief that people equated money
with feces. This led to the belief that money was dirty. The original association of money with
feces was based on word association. Freud felt that this unconscious belief that money was dirty
was the reason people did not discuss money more openly. He acknowledged the importance of
money for self-preservation and power but also emphasized the sexual aspects of money matters
for people. Freud began to emphasize the connections between toilet training, anal eroticism and
character development. He saw ones attitudes toward money as a reflection of the nature of
ones toilet training. A strict training led to traits such as obstinacy, parsimony and miserliness.
Overly promiscuous toilet training could lead to poor controls in money matters such as
excessive generosity.

Furthermore, Freud included his idea that in the course of toilet training, and the consequent
suppression of the pleasure of defecating at will, the child developed associations between
toileting and gift giving to the parents, further enhancing the connection between money and anal
eroticism. The case of the Rat Man was used by Freud to further expound these ideas.

Freuds themes have been extended and refined by others (Jones, Ferenzi, Abraham) with an
increased emphasis on the characterological rather than the particular symptomatic picture.
Fenichel, in his paper on the amassing of wealth (1938), made significant contributions to the
expansion of money issues from exclusive focus on anal eroticism. While he allowed for the
importance of instinctual factors he suggested that social pressures make use of instinctual
forces.

His thoughts had two distinct elements. He felt that the childs inability to gain control of the
satisfaction of his/her instinctual desires caused the child to experience them as dangerous. While
classical theory considered this the cause of repression, Fenichel saw it only as an opportunity
for repression. He thought that reality strongly influenced the ultimate development of
repression. In addition, while anal eroticism might lead a child to want to collect something,
what he/she collects will be decided by his/her life experience. Fenichel also introduced the idea
that the social forces within a generation have a great impact on societal attitudes, here
specifically toward money. Thus it would be pathological for an individual to have no drive to
accumulate money in a capitalistic society. Additionally Fenichel suggested that anything that
could be given or taken away could be an expression of money symbolically.

Fenichels two pronged argument separated the money=feces equation. He was thus a
transitional thinker, bridging the differences between Classical positions and the ideas developed
by the Interpersonal school. To extend these ideas, Fromm emphasized repeatedly the influence

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of social attitudes on an individuals relationship with money. Singer pointed out that there are
many rational needs for money in our society. These seminal Interpersonal/cultural writers,
together with thinkers such as Fromm-Reichmann and Thompson, emphasized the meaning of
money within the context of the family and culture and focused on both the rational and
irrational meanings and uses of money.

Contemporary writers have continued to move away from the equating of money and anal
eroticism and instead focus on the ways money can be used to express and cope with issues of
identity. Kohuts theory of the development of a sense of self has led some writers to illuminate
ways in which money can be used by individuals with disorders of the self. Krueger (1986) states
that individuals with faulty self-esteem may use money in self-reparative efforts. To the extent
that those patients are dependent on external validation of their worth, money may become an
effective tool in modifying this anxiety. Additionally, Krueger points out that from a Self
Psychological point of view patients with pathological narcissism can use money to regulate
envy and admiration from others, thereby giving them some control in their own struggles.

In line with this view I saw a young man who had broken away from the family business and
successfully created a good-sized corporation by his thirtieth birthday. He could sink into terrible
depressions when he noticed that some other business had expanded their physical plant.
Although unrelated to his own business, the success of others was used as an emotional yardstick
of his own worth.

The Technical Management of Money

Freuds statement that money matters generate considerable anxiety and need to be dealt with
honestly and directly is the cornerstone of all psychoanalytic attitudes toward the management of
money. Most analysts also accept the need for a standard policy toward money matters for both
the protection of the analyst and the patient.

This is where agreement in the field ends. Rather than reviewing the literature on the
management of money in therapy let me offer an observation. Whichever position you want to
take there are theoretical justifications both anecdotal and empirical to support your view. There
are articles to support myriad attitudes toward all issues involving money including vacation
policies, setting fees, insurance reimbursement and fee collection.

For example, Freud and most classical writers have strongly supported charging for missed
sessions. Freud used the metaphor of leasing the hour whereby the patient was responsible for
payment whether they used the hour or not. Fromm-Reichmann disagreed, strongly arguing that
analysts were not exceptions to the general social more, that one is not paid for services not
rendered (Fromm-Reichmann, l950). Freud and many of his followers believed that a fee, in fact
a significant fee, is necessary. This was justified by Freud primarily to provide for an adequate
living for the analyst.

Other theoretical justifications developed later including Menningers idea that the patient
must sacrifice in order to gain. While this rationale of the necessity of a substantial fee has been
modified, it is still commonly accepted as true. As recently as 1986 Rancy, in reviewing the

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literature on fees, concluded that while therapies...with modified fees can have symptomatic
improvement, when the standard adequate fee arrangement is used...optimum ego structural
change is the result. (Krueger, l986) In the same book Lorand & Console, Paolino Chodoff and
Bruch all support the concept that consideration of fee as a primary motivator in growth is
simplistic and minimizes the powerful influence that suffering and the desire for growth have on
motivation.

And while I can go on with other examples of theoretical support for varied policies let me
just summarize: there are theoretical positions to support whatever policy choices you might
make.

Setting the Frame

The discussions of the fee and other related financial policies are often the first place that
analyst and patient discuss money matters. It is generally agreed that once one establishes a
policy or frame there are good theoretical rationales for following it closely. In particular, the
frame establishes for the patient the boundaries within which they work. Theoreticians as diverse
as Levinson and Langs both attach significant meaning to any modification or desire to modify
the frame by the analyst. Levinsons position suggests strict adherence to the frame and states
that any deviation from the frame will be perceived and responded to by the patient, with the
meaning to the patient varying with the patients way of structuring his/her experience (1983).
Langs position also emphasizes the importance of maintaining the frame; however, he asserts
that any modification of the frame by the analyst is experienced by the patient as reflecting deep
pathological conflict in the analyst. Regardless if one agrees with Langs, it does seem probable
that having consistent and clear policies serves important functions for both the analyst and
patient.

Therapist Co-Participation in the Issue of Money

The actual question of how a particular analyst chooses and presents his/her financial policies
and its subsequent impact on the dyadic relationship has received relatively little attention apart
from the theoretical polemics of correct procedure.

For most analysts, professional policies are actually derived from a conglomeration of the
experience with ones own analyst, supervisors, colleagues, filtered through ones own
personality and theoretical predilections. Regardless of what you choose to do, there probably is
ample theoretical justification not to mention collegial support for your position. This can add to
a sense of security but also can help us unattend to other reasons for what we do. The danger
exists that theoretical explanations can be used to maintain a sense of correctness which limits
therapist exploration of how their policies also reflect their personal attitudes toward money.
This use of theoretics as a defense against knowing ones own money complex can lead to a
reifying of the theoretical aspect of the decision.

Even the identical policies of different analysts may have very different effects on their
patients, due to the differing meaning the frame has for the particular analyst. For example, one
analyst, who Ill call Dr. T, charged his patients for sessions missed unless he was able to fill
their hours. This had been the policy of Dr. Ts analyst. Dr. T, as a patient, had never had to pay

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for a session because his analyst always filled the hours. In contrast Dr. T had rarely been able to
fill more than an occasional session necessitating his patients paying for their missed sessions.
The application of this policy had very different effects within each practice.

Over time certain policies such as charging for missed sessions have become so generally
accepted within the field that they can take on a sense of validity quite divorced.from connection
to the analysts needs. For example, I have a policy of charging for missed sessions unless I can
reschedule them, regardless of the reason. After I explained that to a new somewhat
unsophisticated patient she asked me whether I charged for sessions missed due to an illness of
mine. I thought that was outrageous because I had an internal sense of differentiation in terms of
fairness between charging for sessions I missed and those the patient missed. This was
obviously not shared by my patient. Regardless of the hostility in her naivete, her comment
served to point out to me how insulated my policies had become from their origins. This
insularity on my part was facilitated by the consensual validation that I received from my
colleagues.

The Nature of Recommendations to Analysts

In examining the recommendations to analysts, a review of the literature reveals that there
are many recommendations toward the management of money that are proscriptive and serve to
keep the therapists attitudes hidden. The effects that attitudes and behaviors involving money
have on the therapeutic dyad are rarely discussed except from the perspective of the
consequences of breaking the therapeutic frame. For example, Langs recommends that analysts
stamp their checks for deposit only. This recommendation is based on his belief that this is a
way to assure patients of our integrity that then provides them with a safe holding
environment. I suggest it also implies to patients that the area of finances, specifically ones tax
ethics, is not to be fantasized about and certainly not open for discussion. This is not to
recommend not marking the checks for deposit only. It is to refocus our attentions on the
purpose it serves for the analysts, possibly his/her need to be seen as ethical. This is a valid
reason. I believe that the more anxious therapists are about their financial practices the more their
patients will perceive this anxiety and make adjustments to it.

I had a consultation with an upper middle class woman in her forties some years ago. She
was dependent on her spouse for the payment of the fee and her husbands only condition was
that the fee be paid in cash. I explored what she knew of why he insisted on this arrangement.
She stated that his business was cash based and that he was wary of any debt and prided himself
on owing nobody nothing. Further, she expressed considerable anxiety about not adhering to
her husbands plan. Her compliance seemed to be simultaneously an expression of her
submission to his will, as well as her own need to remain helpless and dependent. At the same
time, her inability to seek employment seemed to be an angry demand to be taken care of. I made
a decision to treat her accepting her conditions of payment, making one of my goals the
understanding of this arrangement instead of forbidding it. I made this decision in part since one
of the reasons that she sought treatment was to examine whether to stay in her marriage or not.
After some introspection I thought that I could tolerate my own discomfort and work with her
within this arrangement.

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 When the fee was paid there were numerous issues of how to handle the money. On a
number of occasions we spoke about her fantasies about what I did with the cash and how I felt
about having it. She talked about what she felt about all the people she paid in cash. She noted
that most people seemed uninterested. She wondered why I was making something out of
nothing.

Her payments were always prompt and accurate. She put the money in an envelope with my
name and the amount on it and handed it to me unsealed. After about eight months of cash
payments she looked at me as I took the envelope and asked, Whats the matter? apparently in
response to my body language. I noticed that I was anxious and spontaneously said It feels like
dirty money. She equally spontaneously said with an anxious smile It is dirty money. By now
we both had big anxious grins on and I said, Are you going to tell me whats going on with
this? She explained that the money was drug money and that she had always known it though
she had rationalized it by saying it was mostly from her husbands legitimate business and that
the drug business was only soft drugs. She then suggested that I probably wanted to be paid by
check now. I asked her why she thought I would now change our agreement to which she had no
answer.

She didnt expand on it at that time but paid me in cash the next three months. What was
significant was that for the first time she started to speak in the first person about the origins of
her difficulties. She addressed some of the issues of entitlement, that is, that she deserved
something due to her suffering and life circumstances. It seems to me in retrospect that if I had
agreed to being paid by check I truly would have been bought off, and cut off fruitful analytic
work for this patient.

One factor that emerged after this incident was her contempt for all the professionals she paid
in cash. She delighted in how they acted nonplussed but she swore she could see the greed in
their eyes. It became clearer how she was constantly proving her belief in the hypocrisy of
others. This justified her cynicism and hopelessness, as well as legitimizing her dealing with
others in an exploitive way.

As Benedek stated in 1953 and others have echoed (Singer, Racker and Hoffman), the patient
is quite capable of understanding the preconscious of the analyst and is able to develop an
awareness of the analysts personality and problems.

Indeed, patients may often react to their intuitive experience of the analyst in ways that
remain unrecognized by the analyst. If the patients reaction to the analysts behavior is seen
solely as transferential, rather than rooted in the patients actual experience with preconscious
elements in the analyst, then the material will often lose important dimensions of its meaning.
This could lead to what Hoffman calls deleterious forms of transference-countertransference
enactment. I believe that money is a powerful agent for this kind of enactment given its ever-
present place in the analysis, as well as the myriad of meanings it has to the patient and analyst.

Freud, as the rest of us, occasionally broke his own rules. In the case of the Wolfman not
only did he treat him for free, but he also went so far as to collect and solicit money from friends
and colleagues to support him and his family for over six years.

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 Sullivan accepted considerable financial supports outside the fee from at least one patient,
Dorothy Shiff, later the publisher of the New York Post. Perry (1982) reports that she made
contributions of $22,500 while she was an active patient of Sullivans. She reported Sullivan
discussing the ethical issue and the reasons why he shouldnt accept it, as well as his final
decision to accept the money. It is an interesting issue beyond the scope of this paper to examine
the effect this had on both Freud and Sullivans patients and the course of these treatments.

It speaks to the intensity of the anxiety for the analyst that surrounds money matters that the
gap or discrepancies between theoretical justifications and therapeutic reality are often
unattended to.

The Ways Therapists Attitudes and Anxieties are Communicated

There are numerous opportunities for patients to see their therapists attitudes, both directly
in terms of the therapists management of the financial aspects of the relationship and indirectly
by the therapists responses and interpretations concerning money matters. Regardless of the
policies and frame that one establishes the patient will make dynamic assessments of the
analysts attitudes toward money. And, while the patient will filter this through his/her own life
experiences, he/she still will be working with the analysts attitudes as a foundation for their
perceptions. As Wolstein (1983) states: ...the psychoanalyst, possessing a total psyche, is not
only present as conscious (that is, adaptive and consensual) in a particular field of psychoanalytic
field of inquiry, but, accepted or not, also as unconscious and preconscious (that is unadaptive
and unisensual) in the same field of therapy.

The patients initial contact with their analysts attitudes toward money generally takes place
during the first session where the fee and the monetary policies are discussed. Additionally, the
therapist indirectly reveals attitudes in their actual management of money, the related issues they
raise in the therapy, even in the manner in which they dress or decorate their office.

By way of example lets consider some common structural elements in fee payment. Some
therapists bill by mail, some in person. Some include envelopes while others prefer payment in
person. Some therapists require payment the first session of the new month, some the last and
some have no stated policy. All these issues will influence the work. Some analysts write
balances due on the bill and dont discuss them with their patients. Others deal more directly
with unpaid balances. More subtly, when receiving payment checks some fold the checks
quickly, some check the amount, and some write a notation in their ledger. Some say thank you
and some dont.

Another example: during the last session prior to a vacation an analyst gives the patient a bill.
The patient inquires whether the analyst, who is usually paid in two weeks from billing, would
like a check now. Not only will the analysts verbal response affect the issue but so will the
analysts felt response to the question. Wolstein notes: The patient... begins to experience
distinct cues arising from the unconscious and the preconscious processes and patterns of
countertransference and counterresistance (1983).

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 Thompsons discussion of countertransference is relevant to the topic. She traces our fears of
emotional response to our patients to Freuds concern that therapist countertransference reactions
would impede the work and his exhortation that any feeling that the analyst has toward the
patient is suspect and bears careful examination. This concern caused analysts to become overly
anxious about any warmth and friendliness they might feel toward a patient as well as any
negative feelings. This may also be part of the analysts anxiety about money matters. Singer
points out that analysts become dependent on their patients for income as well as the
satisfactions of the work (1965). He believed, as did Freud, that analysts needed to acknowledge
to themselves their own needs and desires concerning money. I believe we can hypothesize that
the extent to which an analysts personal financial needs and attitudes effect policy-making is the
extent to which the analyst needs to be aware that the experience of the patient is larger than the
money issue itself.

Ms. J., a 24 year old pregnant, mother of three came to treatment because she had been
caught stealing jewelry from her close friend and neglected to pay her rent for the past four
months. These actions resulted in her family being evicted as well as a report being issued to the
police. The first session indicated that she had a current history of shoplifting. Despite these facts
she felt she was a good friend, wife and mother and was curious as to why she was acting like
this. Her affect was for the most part flat but she showed some indications of high intelligence
and a spirited quality. I decided that I would work with her only if she came twice a week and
paid me after each session. I was aware that I did not want to spend too much time between
sessions wondering if she was going to pay me or developing a negative countertransference due
to her lack of payment. I didnt want to count on her making me the exception to her monetary
patterns with people. In fact, if we were to work well together, I anticipated that the acting out
was likely to occur around fee payment in some manner. She claimed to be unable to pay in
advance for the part not covered by her insurance and asked if I would agree to wait for that
portion. I said no. Finally she agreed to my conditions. There still were issues of money but I
didnt have to concern myself with her trustworthiness as a practical matter.

My reason for handling the case in this matter was in part due to an experience I had my first
year in practice when I treated a man who had embezzled a considerable sum of money. During
the initial interview he casually mentioned that his girlfriend was furious because he used her art
collection as collateral to avoid arrest without telling her.

I listened to this and chose to bill him monthly as was my usual policy with some sense that I
should proceed according to my frame. I did not listen to a more inner sense. A pattern of
behavior emerged which included bounced checks, frequent apologies, more bounced checks and
assurances that it was nothing personal. One session after the third bounced check I again
suggested that this issue had meaning. He stated that he bounced lots of checks. I asked him how
many and in the course of this conversation it became hard for him to deny that there was
something to what I said. He missed the next two sessions and left a message on my tape
machine saying that he was discontinuing therapy. I attempted to reach him by phone but he did
not return my calls. It may be said that it would have been better to immediately terminate him
for lack of payment or to explore it dynamically, analyzing the symbolic meaning of his acting
out. I later realized that my unacknowledged investment in his working out this particular issue
interfered with the therapy. In addition I believe that I wanted to work with his money issues

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dynamically while working with my own as if they were a practical matter. This limited my
freedom to understand how our individual psychologies were interacting in the work. However
with Mrs. J., the pregnant mother of three I discussed above, I sensed the same anxiety and my
decision was based on how I thought I could best work with her. Now I can quote theoretical
rationales for my decision, but the fact is they played less of a role in my decision than my
awareness of my anxiety. I think this is what Wolstein is referring to when he states: ...if the
patient touches the nub of some painful blind spot, the psychoanalyst may actively, even angrily,
counter it in defense for security.
Fee Collection Policies
Fee collection policies are another area where co-participation is evident. As a byproduct of
working on this paper I discussed with colleagues who were owed money and in what amounts.
It became clear that analysts problems in collecting money seemed heavily dependent on patient
variables. While there were general characterological issues present so that some analysts were
more able to deal directly with fee issues and debt collection and others were more anxious about
fee collection altogether, it became clear that different patients generated different levels of
anxiety for their analysts. There was something in the unique therapy dyad which seemed to
influence the therapists success in collecting their money.

Through numerous discussions three main interacting dynamics emerged. In the most
frequently occurring situation unpaid fees were often pursued slowly or ineffectively when the
therapist felt there was something inadequate in their work with this particular individual.

Secondly, difficulties arose when the patients behavior, such as delayed payment, generated
a strong affective response in the analyst, and the analyst felt unable to acknowledge or examine
these feelings. Feelings of anger and intimidation seemed to be the most common ones. Most
frequently issues of anger at the patients led to a fear of discussing and pursuing these matters,
which were then delayed, adding to the analysts anger and frustration.

Finally, in many situations some central dynamic of the patient was not/recognized by the
analyst. For example, in one case a woman who terminated due to financial pressure had still not
paid her balance six months later. The therapist rationalized this as a reasonable response since
she had lost her job, just started a new one, and was under a great deal of financial stress. Upon
closer examination the therapist realized that it had been eleven months, not six, since
termination, and that the amount owed was more than he realized. The therapist had sent a few
gentle reminders but was still colluding with this patient in order to ignore his sense of being
exploited by her. In discussing the case he realized that he had accepted her sense of
victimization and had been unable to see her exploitiveness and sense of entitlement, major
themes in her life. To pursue the collection of the fee would have forced him to address his own
rage, as well as the question of why he did not examine her exploitiveness in the therapy. He
therefore had to collude with her and create explanations for the delay in payment to maintain
their agreed upon belief in her goodness.

The Value of Money: Cultural Implications for the Analytic Relationship

The cultural values attached to money have subtle and not so subtle effects on the analytic
relationship. For example, it should be noted that we often accept the equation of financial
success to therapeutic success, perhaps linking financial health with mental health. How often

9
have we heard about cases wherein the initial presentation lists financial irresponsibility as a
symptom and later financial success as an indication of the success of the treatment. Ben Avi
states that we, as analysts, are often supporters of the status quo of middle class values, so it
would seem quite understandable if we equated financial success with health in other than
obviously pathological cases.

I am not suggesting that financial success isnt often a sign of increased interpersonal
effectiveness and intrapsychic freedom, but rather I want to focus on the fact that to the extent
that we believe in this financial health=mental health equation our patients know it, and that it
influences the meaning of money to them and the ways in which it is brought up in our work
together.

As noted earlier, I agree with Wolstein that patients are unconsciously if not consciously
aware of our attitudes and can integrate them into the work including their resistances and
transference. Hoffman and Wolstein both have suggested that patients express their particular
life issues in unique ways depending on the personal psychology of their analyst. My concern is
that when these issues are discussed, the analyst may hide behind a cloak of clinical theory, not
personal reality. Since a theoretical explanation exists for most financial policy choices, the
theory can often be used to obfuscate our own conscious and unconscious motivations from our
patients, our colleagues, and ourselves.

I think we consistently underestimate how embedded we are in our culture and its attitudes
and values. I dont believe a wave of repression has been lifted. Rather, I think society has
legitimized our increased awareness of money matters because its to its benefit for survival in
l980s America. Some financial writers peg the change to the late 70s and early 80s when the
use of money market funds became common, due to the broad fluctuation of interest rates and a
need for active money management as opposed to the passive safety of savings accounts.

I think there is a high degree of discomfort with our vulnerability to the volatile financial
markets of our day. As with other issues that raise anxiety we utilize our own coping skills
whether they are avoidance, passivity or attempts at mastery. I believe that to a great extent we
identify with our cultures current values, and without conscious awareness they become ours.
Summary
I would like to close this with some thoughts on the nature of anxiety concerning money
matters in psychoanalysis. The central issue is for me the individuals life experiences with
money not just within the context of their family history but also in the ways they have come to
view money as adults. In addition I would like to consider two other possible contributors to the
ways the analyst and the patient facilitate or resist understanding of money matters specifically
within the treatment situation.

While money is often equated with sex in its taboo quality, I think money is a more difficult
issue for our time. Unlike sex, money permeates the therapeutic relationship. Fees, frequency of
sessions, insurance reimbursement with the onerous forms are all money-based issues. The
choices we make concerning each of them are present in the work. Money matters can crowd the
consulting room both concretely and symbolically.

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 In matters of money policy how often do our personal financial situation and stresses effect
what we are willing to accommodate? The danger in my mind is that our anxieties are
unacknowledged. If its unconscious or needing of being selectively unattended to, then it will
have a much more destructive effect on the work. Patients react to our conscious and
preconscious attitudes. Some help us steer clear of the issue, some will use it in aggressive ways
that increase our anxiety, and some will address it directly allowing us to do what we can with it.
Moreover, I think a greater danger than the complications it creates for the particular patient is
how it affects the therapists sense of self.

When a patient touches an area of unconscious anxiety in the analyst the analyst frequently
responds with counteranxiety and counterresistance, both of which are depleting to the analysts
sense of self worth and competence. As was seen earlier in the example of the therapist who
missed his patients exploitiveness, there are both practical consequences of financial loss and
intrapsychic consequences of experiencing unconscious guilt, anger and self-depreciation.

In summary I am arguing for a growing dialogue among analysts about the role that money
plays in our work. Any increased awareness we might gain will illuminate aspects of our work
that until now may have been only known to our patients.

References
Abraham K. (1923) Contributions to the theory of the anal character trait. International Journal
of Psychoanalysis 4: 400-418.
Benedek, T. (1953) Dynamics of the countertransference. Bulletin of the Menninger Clinic 17:
201-208.
Fenichel, O. (1938) The drive to amass wealth. Psychoanalytic Quarterly 7: 69-95.
Freud, S. (1913a) On beginning the treatment (Further recommendations on the technique of
psycho-ana1ysis I). Standard Edition, 12, 121-144, 1958.
Fromm-Reichman, F. (1950) Principles of intensive psychotherapy. University of Chicago.
Hoffman, I.Z. (1983) The patient as an interpreter of the analysts experience. Contemporary
Psychoanalysis 19, 389-422.
Jones. E. (1955) The Life and Work of Sigmund Freud, Vol.2, New York: Basic Books.
Krueger, D.W. (Ed.). (1986) The Last Taboo: Money as symbol and reality in psychotherapy and
psychoanalysis. New York: Brunner/Mazel.
Langs, R. (1982) Psycho-therapy: A Basic Text. New York: Jason Aronson.
Levenson, E. A. (1983) The Ambiguity of Change. New York: Basic Books.
Menninger, K. (1958) Theory of psychoanalytic technique. New York: Basic Books.
Perry, H. (1982) Psychiatrist of America. Massachusetts: Harvard University Press.
Racker, H. (1968) Transference and Countertransference. New York: International University
Press.

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Raney, J. (1986) The effect of fees on the course and outcome of psychotherapy and
psychoanalysis. In D.W. Krueger (Ed.), The last taboo (pp. 88-101). New York:
Brunner/Mazel.

George Whitson Ph.D.

Office: 76 South Lewis Place
Rockville Centre, New York 11570
(516) 766-8627

An earlier version of this paper was presented at the New York University Post Doctoral
Symposium in October, 1988, and the Spring Meeting of the American Psychological
Association, Division of Psychoanalysis, as part of a panel entitled Money Matters in
Psychoanalysis, April 1989.

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