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Wednesday, March 25, 2015

Question 13

Hi Dr. Trachtman,

    I am a psychotherapist with 30 years experience. For quite some time I have been experiencing frustration and anxiety due to financial stressors. Because I accept patients on managed care it has become increasingly difficult to make a "living wage." It is very stressful to deal with the constraints of insurance companies, which seek to dictate how I should do treatment and demand increasing amounts of paperwork and documentation, leaving less time for the actual work of doing therapy, while rates of compensation stay stagnant or in some cases are even reduced.
    In my own history, I grew up in a family situation in which there was little financial stability, and I feel a sense of shame and regret that I am repeating these patterns of financial limitations with my own children. I note that most of my peers, particularly those in other professions are able to provide more for their families, and do not have to deal with feeling demoralized and anxious about not being able to meet their financial obligations. This has caused me to intermittently fantasize about leaving our very noble profession, although I can't imagine doing anything else. The fact is, I truly love "the work" of being a psychotherapist. I consider it a true privilege and honor to be invited so intimately into other people's lives and to be able to act as a compassionate witness as we journey together toward healing and growth.
    How can I reconcile the conflict of feeling like a success in doing work that I find meaningful with the sense of feeling like a failure as an earner and model for my children?
    I look forward to your response.



Dear Discouraged.

    Thank you for sharing your dilemma and allowing me to share it with others. This reply will be somewhat long and detailed. You are in the good company of so many other professionals, including therapists, who love what they do but are being squeezed by economic forces. I have noticed that many therapists who have attended my money and psychotherapy workshops find it hard to get past being stuck in their anger at managed care companies in order to focus on other feelings and solutions. But your question shows that you are recognizing the reality with which you are faced but stuck in what psychologists call an approach – approach conflict. You have two seemingly incompatible desires. You want to be able to continue doing the work you love but you also want to find a way to be rid of the external pressures that limit your ability to do that work and still make a "living wage." There is also an approach-avoidance type of conflict apparent when it comes to your profession and your role as a parent. You want to continue being a therapist despite your low level of income (an approach impulse) but you also want to avoid being what you think of as a failure as an earning model for your children. Remaining in this field, in your mind, may cause  you to do just that. Unless you can find a third way or see things in a new way you are stuck with two choices, each of which has an undesirable outcome.

    If I were counseling you I would have lots of questions such as the following. In the family in which you grew up, was an expectation of financial doom passed on to you because of your parent's fears and expectations? And, were their fears and expectations purely rational? Did your parents give you the idea that, if you didn't earn a certain amount and live a certain lifestyle, you would be a failure, as perhaps they felt they were? Were they unable to teach you how to think positively about money? And, despite their struggles to make ends meet, were you ever truly deprived of basic material security (go hungry, homeless, no warm clothing in winter?)because of the actual financial situation, or was your insecurity generated by questionable messages about money which you learned from them? Your parents may have struggled financially but you nevertheless grew up to be a skilled professional with the knowledge and empathy to help others. So they must have provided you with something of value that supported such growth.
    I would also want to know a great deal more about your financial situation, your beliefs about money and how you handle it and what kind of lifestyle you feel you should have, to understand what you mean when you refer to "a living wage." Some very poor families seem content with limited income yet provide their children with a sense of security and good self esteem which can carry them a long way. Some rich families never seem to feel they have enough and fail to provide their children with the emotional climate which leads to a sense of self worth and confidence. Most social workers are very poorly paid  relative  to other professionals and even to some blue collar workers. So, unless you have a higher earning partner, wealthy parents or some other form of independent income, you are likely facing a difficult dilemma. But, unless you are unable to provide your children with adequate food, clothing, shelter, education and medical care, how you approach and deal with financial problems and how you communicate with your children about your situation and your beliefs and values, is more important in defining your role as a parent than how much money you actually make. But, if you really can't provide adequately for your children and are not able to provide for your own needs (health care, a retirement plan) you may need to make some changes.

    You write, "I note that most of my peers, particularly those in other professions, are able to provide more for their families, and do not have to deal with feeling demoralized and anxious about not being able to meet their financial obligations." It is a common tendency to compare ourselves to those in our peer group.  As a therapist I'm sure you understand that the public face people display and what other people believe about them may or may not match what things are really like for them. The only good reason comparing yourself to others would be to see if you can learn something that might help you. Don't compare yourself with others as a measure  of self worth. That should be measured in terms of your values and how you live up to them. It may be that many families can provide more material things than you can but, if it is primarily things they provide, and not guidance and nurturing, this may undermine the children's character and emotional development.
Yes managed care companies usually pay very low fees and many of us undoubtedly feel that we can not earn what we deserve as a result. On page 22 of my book Money And Psychotherapy: A Guide for Mental Health Professionals, I write, "Taking into account the level of their education and the difficulty of their work many therapists are poorly remunerated for what they do. Therefore, to be satisfied within the profession, therapists need to feel that their work is their calling rather than just a job. Unless they have other sources of income, they may be required to sacrifice in order to follow their calling." In the current climate it seems unlikely that managed care companies will raise what they pay us anytime soon. We, as a profession do try to make our lot better. Our professional society has a Managed Care Committee working on our behalf. Some of our colleagues offer workshops on how to build a successful practice. Some of us carve out specialty areas such as treatment of eating disorders, victims of childhood abuse, overspending, working with couples, or Money and Relationship Psychotherapy. We may run workshops or write books to let our colleagues know of our expertise. But, while these efforts are all worthwhile, they do not guarantee that we will increase our earning very significantly. You sound like you are committed to helping others as you were trained to do. I hope you will be able to either adjust your expectations or find some way to boost your income to meet them. I hope that you will be able to pass on to your children a legacy of  passion for meaningful work and empathy toward them and others, rather than one of income related anxiety. I hope you find these thoughts helpful.

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