Exploring Our Financial Countertransference

One of my business practices is to examine my finances practically and psychologically. This consists of reviewing my financial progress on a weekly basis and exploring my countertransference in my own individual therapy. My early experiences with money shape the way I react in the present and examining those responses informs my clinical work. As therapists we are faced with the task of collecting our fees while simultaneously helping our clients explore their feelings and processing our own financial countertransference. This is not easy!

When I started my practice, my desire to help a potential client sometimes superseded my own monetary needs. I hadn’t yet learned how to tolerate my empathic responses during business transactions and sometimes the fees I set were too low; fortunately, my private practice supervisor helped me deepen my awareness of what was happening for me during these calls.

The choice to offer a reduced fee or lower a client’s existing fee can impact our clinical work. A therapist may feel resentful when their fee is too low and the client reports that they just returned from a two-week trip to the Bahamas. Or the client may end up feeling infantilized or indebted to the therapist which could be a reenactment of their relationship with a parent. These are two extremes, and a wide range of possibilities exist in between.

Unexamined financial countertransference can impact a therapist’s economic wellbeing and deprive the client of the opportunity to explore their uncomfortable feelings about money and experience the increased self-esteem that is a byproduct of investing in one’s own mental health. There are countless opportunities to discuss money with our clients including: late cancellations, fee increases, declined credit cards, and missed payments.

In group therapy we discuss late or missed payments with the entire group. I’ll say something like “Is anyone aware of not having paid for group this month?” Members have a chance to explore their reactions in the moment and the process sometimes evokes historical feelings or anger toward me. Sometimes members’ late payments could be an indirect expression of their desire to leave the group.

The discussion of payment in group offers members an opportunity to talk about a subject that our culture tries to politely avoid. We take the time together to explore what the client may be communicating with their late payment. Often this leads to a highly fruitful group discussion. The last time I raised my group fees one of my clients reacted so strongly that she later realized she needed to ask her boss for a long overdue raise.

In his book Difficult Topics in Group Therapy: My Journey from Shame to Courage, Jerome Gans, MD, advises therapists to prioritize the exploration of clinical material over managing financial transactions. He explains that so much can be gained by discussing the client’s feelings about money, especially if it’s done in the moment. Gans writes that managing the transaction first can shut down clinical discussion, whereas waiting to process the charge creates space for the client to express their feelings about the possibility of being charged.

In the example of a late cancellation for an individual session, I don’t charge my clients until we see each other at our next appointment. I’ll mention that I noticed they did not send their payment for last week; Then I wait. Sometimes this leads to an expression of anger toward a partner who failed to come home on time and care for their child while the client was in session. Other times we end up talking about their credit card debt, or feelings of resentment toward me for charging them for the missed appointment. If it’s relevant, I’ll ask my client how they are feeling about our work and our progress toward meeting their goals. In some cases, they simply forgot to pay me and there is nothing to explore.

Talking with our clients about money should be just like talking about any other topic we discuss in therapy. We must be willing to do our own money work so we can feel comfortable exploring financial issues with our clients.

References
Jerome S. Gans (1992) Money and Psychodynamic Group Psychotherapy, International Journal of Group Psychotherapy, 42:1, 133-152, DOI: 10.1080/00207284.1992.1173258

How Much is Your Business Costing You?

In her book entitled Sacred Success: A Course in Financial Miracles, Barbara Stanny states “To think strategically, you must constantly link big picture to the costs of doing business, or to put it another way, connect your purpose statement to your profit/loss statement.”  I try to examine my overall business spending every month to make sure I am on the right track.

Business expenses can add up quickly and it’s important to review them regularly to avoid overspending. Early on I noticed I was buying too many psychology books on Amazon. Now I add books to my wish list before buying them and I ask myself if I really need to own this book and whether I have time to read it. I try to borrow books from the library whenever possible, the Los Angeles Public Library has a huge collection of psychology books.

When I started out, I struggled with the cost of investing in Brainspotting and EMDR training/certifications; my practice was still growing, and I was trying to keep my expenses low. I made the choice to invest in these trainings because they supported my specialization as a trauma therapist and over time this proved to be a wise choice.

I’m not recommending you restrict your spending, instead I am suggesting that you remain conscious and aware of what you spend. Be sure to leave room in your budget for consultation. I’m a member of a monthly peer consultation group and I’m in weekly individual consultation with a seasoned group therapist.

It’s just as important to be strategic with your time. For example-if you have a limited amount of time for administrative and marketing tasks, you might want to hire an assistant or a bookkeeper. That way you’ll have more time to attend networking events or develop promotional materials. This year I realized I was underspending on support for my business, and I decided to hire a bookkeeper.

This kind of strategic decision allows me to spend more time on business development and creative projects. If you are seeing clients five days a week that does not leave much time for developing your business. This year I invested in a meal service several nights a week so that I have more time to relax in the evenings. I also hired a dogwalker twice a week to make sure I have a long enough lunch break on my busiest days.

Some therapists gave up their office space during the pandemic, rent is a big expense, so you’ll want to weigh the pros and cons of subleasing vs. taking on a full-time office.

Now that we are approaching July and the halfway point of 2021, I like to review my income and expenses for the last six months (Profit and Loss report) and see where I might need to adjust. I met with my accountant to make sure I was on track for my quarterly tax payments. I will also examine the number of hours I have worked so far and make sure I am scheduling enough vacation time.

Sometimes solopreneurs like us can get lost in the “busyness” of our businesses and it’s important to regularly schedule time to take stock of how we are doing and what we want for ourselves in the future.

Are You Addicted to the Internet?

I was watching a basketball game one night and found myself reaching for my phone to check Instagram. I wasn’t feeling bored, and my team was playing well at that moment. I checked in with myself to see what feelings I might be trying to avoid, and I discovered that I was feeling worried about my beloved aunt whose health is declining. This insight didn’t prevent me from checking my phone but it did motivate me to move the phone to the other room so I could enjoy the game and explore my feelings toward my aunt.

As a child I used books and bike riding to numb my feelings; there were no cell phones. As an adult I have used overworking, overexercising, and other habits. I’m fascinated by our constant need to be occupied/distracted or busy; an “addiction to busy” with technology and the internet leading the way.

In my prior career, I felt compelled to check my email and phone before, during and after work. After work, my home computer would chime, letting me know I had new messages. I would glance at the screen, intending to answer one or two messages and before I knew it thirty minutes had passed. I was exhibiting at least one of the symptoms of internet addiction- spending more time online than I had originally intended. Today I check email during business hours and no longer use auditory alerts on my computer.

The late Dr. Kimberly Young was a pioneer in the field of Internet/Technology Addiction. Dr. Young studied the pleasure people receive when clicking and finding content on the internet, viewing a text on the phone, reaching a high score in a challenging game, searching for content on Facebook, etc. The variety and intermittent timing of these “hits” is what makes the internet so addictive. She conducted the first study on Internet addiction in 1996 and found that the subjects in her study met the same criteria as individuals who were classified as pathological gamblers; gambling occurs in an environment where there is intermittent reinforcement. When people gamble, there is a pleasurable charge which occurs intermittently; it is called a “variable reinforcement schedule”; that same schedule exists when we use the internet.

Dr. Young developed the first screening measure for diagnosing Internet Addiction, the Internet Addiction Diagnostic Questionnaire (IADQ). The IADQ consists of the eight questions listed below. Sometimes I use this questionnaire to help my clients explore the desire to use their devises to numb out. The next step is usually some Brainspotting our EMDR.

1. Do you feel preoccupied with the Internet, (think about previous online activity or anticipate the next online session)?

2. Do you feel the need to use the Internet with increasing amounts of time in order to achieve satisfaction?

3. Have you repeatedly made unsuccessful efforts to control, cut back, or stop Internet use?

4. Do you feel restless, moody, depressed, or irritable when attempting to cut down or stop internet use?

5. Do you stay online longer than originally intended?

6. Have you jeopardized or risked the loss of a significant relationship, job, or educational or career opportunity because of the Internet?

7. Have you lied to family members, therapists, or others to conceal the extent of involvement with the Internet?

8. Do you use the Internet as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)?

If you answered yes to 4 or 5 of the questions, you may want to examine your own internet/technology usage. I continue to explore these issues in my own life. I use an out of office message on my business email on weekends but sometimes I slip and take a quick peek; but normally I wait to return email on Monday mornings. I’m working on leaving my phone in another room when I am relaxing in the evenings.

Do you find yourself using the internet, or your devices more often than you’d like?

How to Identify and Prevent Burnout

Zion National Park

Are you feeling overworked, maybe a little burned out?

In graduate school, our Law and Ethics professor asked us to write a self-care plan describing the ways we would enjoy our free time and take care of ourselves. He believed it was unethical for therapists to overwork and neglect themselves. To make his point he showed us photos from his rock-climbing trips and other outdoor adventures. He patiently explained that if we didn’t take care of ourselves, we wouldn’t be present for our clients and we’d eventually experience burnout. I came from the business world where I was rewarded for working hard and staying late. I wasn’t sure how I felt about this self-care stuff, but I was willing to consider it.  When my schedule filled up, my professor’s words made sense.

I have several clients who are therapists in my practice. One day I was talking about burnout and how to know if you are approaching burnout. I reached for one of my favorite books The Resilient Clinician by Robert J Wicks where the author (2006) describes some of the symptoms of burnout.  Here are a few examples:

• Feeling mentally fatigued at the end of the day.

• Feeling unappreciated, bored, tense or irritable as a result of contact with clients or staff if you work in a treatment setting.

• The pace of the day’s activities/requirements seems greater than you can handle.  Feeling like “you don’t have enough gas in the tank” on a regular basis.

• Experiencing boredom during client sessions.

Wicks (2006) states that psychotherapists often make statements that imply that that their chronic symptoms of secondary stress are “part of the job” as opposed to symptoms of burnout that require a response. One important example is engaging in workaholism which he defines as the idea that we have to be constantly checking and responding to clients’ texts and emails during non-work hours. Or making excuses like “I have to work longer hours right now because we are saving for a down payment for a house.” Once this goal is achieved it is often followed by another large goal that requires more hours.

I love my work as a psychotherapist, it is meaningful and rewarding, however, it is only one aspect of my life. I tell my clients to imagine their time like a large pie with each section representing a slice. One of my clients preferred to think of her time as a flower with petals for each section, we explored all the petals and she realized that she wanted to spend more time doing her art and less time at work.

The answer to preventing burnout is simple, you need to create a fulfilling life outside of work. The photo above is from one of my annual hiking trips to Utah, I chose not to fly this year but am planning a local hiking trip next month. I schedule vacations every year and usually travel. On the weekends I enjoy outdoor activities like hiking and riding my bike, dinners and walks with friends and family, and daily time with my beloved dog; the list goes on. I realize we have had to make many adjustments during the pandemic, but now more than ever it’s important to take time for ourselves and do the things that help us replenish our brains and bodies.

Are You Paying Too Much For Credit Card Fees?

If you accept credit cards and are working virtually, you may have noticed an increase in your credit card fees. Prior to the pandemic, I swiped my clients’ cards in person using a card reader (also known as a dongle). When the cardholder is present, the card can immediately be verified by the credit card company and the rate is lower. When my clients were present in my office the rate was 2.4% +25 cents. Now I email my clients an invoice and the rate is 2.9% +25 cents. If I chose to hand key the credit card into Quickbooks, I would be charged 3.4% + 25 cents.

I review my credit card processing options every few years to see if I can reduce my costs. When I was charging my clients in person (pre-pandemic) I used Quickbooks GoPay card reader, I switched to GoPay when I realized the rate was much lower than Stripe’s. I chose GoPay because I was already using Quickbooks for my accounting, the card reader works well, and their rate was the lowest. That rate is only available to customers who use Quickbooks’ accounting software. The software requires some effort to learn and I still use a bookkeeper to review my books each quarter to check for errors.

Here are a few of the many credit card processing options that are available.

I use a few apps in addition to my Quickbooks invoicing, but many of my clients prefer to receive an email invoice. I use the CashApp which currently does not charge for transactions, this product was created by PayPal, and several of my clients use it and like it. The downside is their customer support is not great. Zelle is a Wells Fargo app that doesn’t require your customers to have a Wells Fargo account, it’s easy to use and there are no transaction fees. I use Venmo for my Brainspotting consulting work and currently there are no fees, but Venmo is now launching a business version with will include fees.

If an existing client asks me for a fee reduction due to a current financial hardship, I will ask them to pay me via Zelle so I can save money on the transaction cost and pass that savings on to my client as part of the reduced rate.

There are so many options for accepting payments and this post could be ten pages long. The bottom line is that I want to offer my clients a convenient, modern way to pay for therapy and I consider these fees to be part of the overall cost of running a service business. If you are feeling frustrated about the high cost of credit card processing, it may be time to raise your fees. I’m interested in hearing about your credit card processing choices., feel free to connect with my on FB, Instagram or via email.