I can’t afford therapy!

Sometimes people cannot afford therapy. Other times, this concern may be a defense to avoid the feelings and anxiety triggered by depending on someone else. For instance, a patient says he cannot afford therapy but just returned from an expensive vacation. Or a woman says the therapy fee is too high, yet she just bought some Gucci shoes.

Pt: This is too expensive.

Th: Yet your shoes were not too expensive.

Pt: Are you criticizing me for buying shoes?!

Th: Not at all. They’re beautiful. It’s just that you are willing to spend money on shoes but not on yourself, your depression. Is this part of a pattern of valuing things more than yourself? Are you having trouble valuing yourself sufficiently?

Perhaps the patient spends money readily on others but not on herself, feeling guilty about making her inner life a priority. She may say that therapy is self-indulgent.

Pt: I can’t afford to pay for therapy.

Th: Yet you were able to afford an expensive vacation for your niece and nephew. Is it hard for you to treat yourself as well as you treat others? Could delaying treatment for your depression be a form of self-neglect?

Often patients feel angry about having to pay to have someone listen or care for them. Rather than explore their anger over depending, they may want to quit, claiming therapy costs too much.

Pt: I just resent the fact that I have to pay to have someone listen.

Th: I wonder how that could be happening here.

Pt: Definitely. I hate having to pay you to listen.

Th: What is the feeling here toward me?

Sometimes when you have explored the patient’s difficulties, the patient will still say:

Pt: I can’t afford to pay for therapy.

Th: Can you afford not to?

Pt: It just costs too much.

Th: You’re right. Therapy does cost a lot. And to calculate these costs accurately, how much will it cost you not to be in therapy, if we factor in your anxiety, depression, separation from your husband, and job probation?

Sometimes the patient complains about how much the therapy costs but then resists collaborating with the therapist.

Pt: How much is this going to cost?

Th: It depends on how long you want to wait until you collaborate with me. The longer you wait, the more expensive the therapy will be. Why make it more expensive for yourself?

In this example, we help the patient see that therapy is not costly, his defenses are.

Or the patient may have described a number of ways that she puts herself down and devalues herself.

Pt: I can’t afford therapy. It’s very expensive.

Th: Are you worth it? Are you worth this investment in yourself?

I know therapy is expensive, having been in therapy for many years myself. But, in the end, my defenses cost me much more.

Pt: I don’t know if I can afford therapy.

Th: Can you afford more suffering?








2 responses to “I can’t afford therapy!”

  1. Jill Avatar

    The ‘can’t afford not to’ is no answer to someone who genuinely can’t afford it. So unhelpful and dismissive.

  2. istdpadmin Avatar

    Of course, if someone really cannot afford it, that is another matter. And that is where a reduced fee or a referral is in order. If the inability to afford therapy is real, it would indeed be dismissive to ignore reality. Often, however, people who have the money say they can’t afford it. Sometimes it is because they have trouble valuing themselves enough to spend money on themselves to lessen their suffering.

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