What Money Can’t Buy & The Case of Therapy
I recently read Michael Sandel’s “What Money Can’t Buy.” This book makes an appeal to readers that the be wary of the spread of markets to areas of our lives not traditionally placed in the realm of commodity exchange. Sandel uses over one hundred examples to give readers a sense of disquiet. There are markets for surrogate mothers. Are we okay with this? What about the selling of children by parents who do not want them to parents who are looking for a child?
In a favorite example of mine, a police department in North Carolina debated putting NASCAR-like ads on their patrol cars in order to generate revenue to keep up their fleet of patrol cars. While it is certainly the case that departments are strapped for cash, their are moral reasons why this may not be a good idea. Let me qualify, I mean their are descriptively normal reasons why people may be uncomfortable with adds on police cars. Police are expected to render services impartially and with only just fairness in mind. To sell a patrol car as signage to the highest bidder will seem demeaning to a position of office that is generally held as elevated and motivated by high principles. Likely, ads on patrol cars will be taken as a moral injury. After all the job of the police is to separate and purify, an organization that functions as a kind of collective negative rite, and to be able to purchase the work, car surface, or body of patrol is likely to be seen as debasing. For these reasons, I contend, I suspect people will have a moral problem with ads on patrol cars.
Now, not discussed in Sandel’s book, but brought up recently in discussion group with other social scientists, is what it means to by human connection in clinical therapy. Therapy is often a place where intense human bonds are cultivated specifically to increase the wellness of clients and patients. Should we be paying for this human bond and how?
In my recent discussion with social scientists who also have experience in therapy, I noted a large amount of discomfort with putting a price on human ties and bonds that often feel as real, meaningful, and authentic as the bond between friends. In other words, the kind of relationship established in therapy is intense, intimate, and personal. Money, on the other hand, is impersonal, universal, and leveling of qualitative difference in favor of quantities, namely price. Intimate exchange and commodity exchanges seem at odds with one anthers, hence the discomfort with the bringing together of money and the interpersonal intimacy of therapeutic confession.
Nonetheless, therapy is done as part of a business (therapists need to make money to eat!). But the industrial model of therapy is also changing and becoming more commodified and driven by a market logic. A recent article in the New York Times, “What Brand is Your Therapist” by Lori Gottleib, raises the specter that commodificaiton of therapy has continue and is potentially becoming corrosive to the very tenets of therapy.
For example, a good therapist doesn’t talk about themselves. This is long been held to be a central pillar of good therapeutic practice. Yet this may be changing for market reasons. Traditionally, therapists could rely on networks of interpersonal and professional ties between therapists, doctors, psychiatrists, mental health clinics, and insurance company panels, to provide a steady client or patient base. These are what we think of as “referral networks.” But as insurance companies draw back on funding talk therapy and government health subsidies are reduced, referal networks are no longer as viable. In fact, competition for fewer and fewer clients has taken over. In this context, Gottlieb describes the need to market, sell, and brand herself to gain clients.
It is not just that referal networks have declined. I suspect that consumers are also using their consumption habits and new technologies such as the internet to “shop” for therapists. That is, therapists are squeezed on the supply side and the demand side and they are being forced to adapt to both pressures at the same time. But should a therapist “sell” themselves to clients? It is seems as if it is poor practice, but how else to gain new clients. Gottlieb describes it thus,
Many people admit that a sense of connection is more important in choosing a therapist than the clinician’s reputation or training. One woman told me that she chose her therapist because “she looked relaxed” in the photos on her Web site, “and I didn’t want anybody too intense, because I’m really high-strung.” A man explained that he found his therapist via referral, but “the Web site sealed the deal, because I discovered that her father was a Holocaust survivor, and I knew that was territory I needed to visit.” Another woman chose her therapist because her blog revealed that she had successfully overcome “food issues” in college, something this client was struggling with.
But disclosing this sort of personal information has always been tricky for therapists — in graduate school, psychology students are instructed not to display family photos in their offices and even to choose carefully the types of magazines they place in their waiting rooms — yet savvy branding specialists encourage just those kinds of subtle revelations. If you’re a parent, if you’re gay, if you’ve suffered from chronic illness, if you’re a child of divorce, if you’ve lost a loved one: sharing this, they say, makes clients with a similar history feel that you “get it.”
Another therapist Gottlieb spoke to described the cost of tailoring therapeutic practice to consumer demand in the following way,
“It used to be that if somebody asked about your personal life, you’d reflect that back and interpret why they’re asking and what it means,” she said. “People don’t put up with that anymore. If you’re that way, they’ll say: ‘That therapist was so aloof. I felt so uncomfortable. It was such a weird interaction.’ But as therapists, we lose useful material we used to get in the transference.”
Here commodification can be seen to have a corrupting potential. It is not necessarily the case that therapy has to respond to market pressures by playing the market game, but it is unlikely that a specifically therapeutic style of market can be established without some kind of professional consensus or regulation of how business can be ethically drummed up.
For the therapist, I imagine this all feels very alienating. After all most therapists go into their line of work not to make money but to help others. But I think it is also likely a source of dissonance for clients as well. I recently heard one person report of their talk with a therapist, “I feel uncomfortable paying you when talking to you is like talking to a good friend.” The therapist replied, “Well don’t think of it like you are paying me for friendship or connection. Think of it as you are paying me for my expertise and interpretation. Does that work for you.” Not surprisingly the client said, “No!” What alienates therapists from their work is that they have to make a living and the monetization and marketization of the profession means that more and more, just to stay out of poverty, they have to engage in branding, building websites, and life-coaching, simply to make ends meet. This is in spite of the fact that they know that what they are doing may not be best therapeutic practice.
But of course, money can buy many things that we normally think of as being without a price. Money is as Marx put it, the “radical leveler.” Simmel wrote of money that “With its colorlessness and indifference… [money] hollows out the core of things… their specific value, and their incomparability.” Money is meant for exchange. It is not like a chair that has useful value even when it is not being exchanged or traded. Money can bring different uses together for exchange, and this, in part, is what problem of commodification of a field like therapy: it brings together opposing values (what the consumer wants and what is best practice) and makes them equivalent in the setting of prices.