In online psychodynamic psychotherapy, the therapeutic relationship extends beyond the confines of the virtual session. One often overlooked aspect of this relationship is the issue of payment, particularly when clients fail to pay for their sessions on time or require constant reminders. This seemingly administrative concern can have deep roots in both conscious and unconscious processes within the client’s psyche, posing unique challenges for the therapist.
Understanding the Client’s Conscious and Unconscious Processes
Clients who consistently delay payments or require reminders may not simply be forgetful or financially constrained. While these can be contributing factors, psychodynamic theory suggests that such behaviour may also reflect underlying unconscious conflicts. Here are some of the potential dynamics at play:
1. Unconscious Resentment or Resistance: Delaying payment can be a form of passive resistance. The client might unconsciously harbour feelings of resentment towards the therapist or the therapy process, viewing the act of paying as a symbolic surrender to the authority of the therapist. By withholding payment, the client may be expressing a need for control or autonomy in the therapeutic relationship.
2. Guilt and Shame: Clients may experience unconscious guilt or shame related to receiving help. Paying for therapy can trigger feelings of unworthiness or internalised beliefs that they do not deserve care. The act of not paying on time might be an unconscious attempt to devalue the therapy or to punish themselves for seeking help.
3. Transference Issues: In psychodynamic therapy, transference is a key concept, where the client projects feelings about significant others onto the therapist. Payment issues can be a manifestation of transference dynamics. For example, if a client has a history of difficult relationships with authority figures or has unresolved issues with a parent, they may unconsciously reenact these dynamics with the therapist through the act of not paying.
4. Dependency and Fear of Abandonment: Some clients may unconsciously use the delay in payment as a way to test the therapist’s commitment. By pushing boundaries, they may be seeking reassurance that the therapist will not abandon them, even if they are “difficult” or non-compliant.
Psychoanalytic Insights for Therapists
Psychoanalytic theory provides a robust framework for understanding these unconscious dynamics and making therapeutic interventions that protect and preserve the therapeutic process. Here are some ways therapists can approach this issue:
1. Exploring the Meaning of Payment: The therapist can invite the client to explore what paying for therapy means to them. This can open a dialogue about issues of value, worth, and the client’s relationship with money, authority, or care. Understanding these associations can provide insight into the unconscious conflicts that might be driving the behaviour.
2. Interpreting Resistance: If the therapist recognises that payment delays are a form of resistance, they can gently interpret this to the client. This might involve bringing attention to the pattern and linking it to other areas of resistance within the therapy. By doing so, the therapist can help the client become aware of their unconscious defences and work through them.
3. Addressing Transference: When payment issues are linked to transference, the therapist can use this as an opportunity to explore the client’s feelings towards the therapist and how these might relate to past relationships. This exploration can deepen the therapeutic work and help resolve longstanding relational patterns.
4. Setting Boundaries and Consistency: While it’s essential to explore the unconscious meanings of payment issues, the therapist also needs to maintain clear boundaries. Consistency in addressing payment delays is crucial. The therapist should communicate the importance of timely payment as part of the therapeutic contract, which reinforces the structure of the therapy and models healthy boundaries.
Risks for Both Client and Therapist
Leaving payment issues unaddressed can have significant risks for both the client and the therapist:
• For the Client: Unresolved payment issues can reinforce unhealthy patterns of behaviour, such as avoidance or passive aggression. It can also perpetuate feelings of guilt or shame, undermining the therapeutic process. If not addressed, these issues can lead to a breakdown in the therapeutic relationship, potentially causing the client to prematurely terminate therapy.
• For the Therapist: Unpaid bills can lead to financial strain, which may unconsciously affect the therapist’s feelings towards the client. The therapist might experience resentment or frustration, which could interfere with the therapeutic alliance. Additionally, failing to address payment issues can erode the therapist’s authority and the structure of the therapy, weakening the effectiveness of the treatment.
Conclusion: Protecting and Preserving the Therapeutic Process
Payment issues in online psychodynamic psychotherapy are not merely logistical concerns; they are deeply intertwined with the unconscious dynamics of the therapeutic relationship. By using psychoanalytic theory to understand and address these dynamics, therapists can make interventions that not only resolve the immediate issue of payment but also enhance the overall therapeutic work.
The key is to approach the issue with empathy and curiosity, using it as an opportunity to explore deeper unconscious conflicts while maintaining clear boundaries. In doing so, the therapist protects and preserves the therapeutic process, ensuring that both the client and the therapist can continue the work of healing and transformation.
By Ari Sotiriou M.A. psychodynamic psychotherapist co-founder Online Therapy Clinic