A monetary exchange?

Being a therapist is as tricky as walking a tightrope in the circus. The client expects a bag of ‘solutions’ for every relational difficulty they are experiencing in their life and an implicit expectation of the therapist having an instant answer to all the ‘why’ in their psyche. ‘Why do I feel sad? Why can’t I say no?’ And then perhaps comes one of the most conflicting moments within the therapeutic relationship when after a session where the client finds herself sitting before the helper/healer she imagines the therapist to be, it’s time to pay for the help and healing.
Suddenly an inner conflict emerges within the client. Does my therapist whom I share all my inner pain and secrets and more with, whom I trust more than anyone else, and who seems to deeply care for my wounds offer this unconditional regard and empathy for money?
Suddenly the end of the session which encompassed an emotionally intimate human-to-human contact seems to have boiled down to a transaction only. Am I just a client who pays for this care? And then one wonders what it means to be a ‘client’ and ‘paying for care.’
I have been explicitly asked this question in therapy and the client and I have explored what is the meaning for that client when she asks these questions.
In most cases, clients feel mistrust towards the therapist’s empathy and understanding. A part of the client wants to believe in the emerging therapeutic bond and feeling of being accepted and seen and another part of the psyche believes that being a client means she is a number on the client’s diary and forgotten the minute the session ends and her pain and wounds only matter once a week and because it’s paid for.
The client carries the therapist beyond the session. So many times, my clients have expressed to me that they have an ‘internal Zara’ and that when there is a conflict, they imagine what I might suggest and that thought grounds them in the face of a conflict.
So, they have the same fantasy and want the therapist to carry them around and remember them beyond a session. A client needs to know that she matters to her therapist as much as the therapist matters to her.
I understand how so many personal relationships are conditional like a parent telling a child that he will be rewarded if he performs well in school or an adult telling his partner that if she loves him, she needs to stop working. Therefore, the therapeutic relationship that offers something different, the exchange of fees at the end perhaps seems like a harsh reality bite.
It is a unique relationship where the client bares her soul before a stranger and learns to sit in the safety of not being judged for her vulnerability and is accepted at so many levels. And the transaction is perhaps a reminder of the conditional world they live in.
As a therapist, I get paid for my time and knowledge and my professional support for my client. Do I not think about my clients beyond a session? Of course, I do. I am as emotionally invested in my client’s journey as they are and mostly more than them. I grieve with them when they express pain and loss. I cry and laugh with them. I wonder many times during a week about the client who expressed an inclination to harm herself. I feel pride as a parent when I see one aspire to change or their success and the happiness they find.
I experience compassion, fatigue and vicarious trauma. My clients have more impact on my life than they realise. How can raw human pain not change me? Do I not suddenly feel low and understand that I am feeling the pain I am exposed to? I do.
So, while the client wonders if they are paying to feel cared for, that might be not true. You are paying to receive care that is genuine and authentic by your therapist who is not charging you for the care but for the time and money she has invested over years to learn the best way to offer that care. So that you can learn how to recognise and understand yourself more, and start a journey within yourself towards growth and change.

The writer is a BACP (British Association For Counselling and Psychotherapy) accredited individual and couple psychotherapist based in Islamabad. She can be reached at zaramaqbool@yahoo.com or her official website.

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