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Value for money?: Issues of fees in

counselling and psychotherapy
a
Keith Tudor
a
Temenos 13A Penrhyn Road, Sheffield, Sll 8UL, UK
Published online: 16 Oct 2007.

To cite this article: Keith Tudor (1998) Value for money?: Issues of fees in counselling
and psychotherapy, British Journal of Guidance & Counselling, 26:4, 477-493, DOI:
10.1080/03069889808253858

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 Counselling, Vol. 26, No. 4, 1998
British Journal of Guidance 6’ 477

0 n n 0

Value for money?: issues ot tees in

counselling and psychotherapy
KEITH TUDOR
Temenos, 13A Penrhyn Road, Shefield Sii 8UL, UK
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ABSTRACT Drawing on literaurefmn di#erent psychotherapeuric maditions, the meaning of money

is reviewed, and the psychological and practical issues which arise from the sem’ng, changing and
payment of fees in counselling and psychotherapy are discussed A pmon-centred approach is offmed
0s a framework for the counsellor’s understanding of fees in the therapeuric relationship.

Introduction
In her book on money, Rowe (1997) makes the point that ‘we recognize money but
we don’t know what it means. We, alone of all the animal species, use money, but
we don’t understand it. How could we, when money has ’for us so many different
meanings’ (p. 12). Given that money is the principal means of exchange in our
society, and given that meaning-understanding meaning and making meaning-is
such a central part of the therapeutic process, it seems important that the meaning
of money is the subject of discussion and processing between counsellor and client.
In the title of one of only two books on the subject, Krueger ( 1 9 8 6 ~ )describes
money in psychotherapy and psychoanalysis as The Last Taboo. Judging by its
absence from the syllabi of most counselling and psychotherapy training courses,
from discussions of good practice and from consideration in many therapeutic
relationships, money and issues of fees are socially and psychologically still taboo, as
if talking about money is talking dirty.

‘Attitudes to money are also shaped by experiences of the wider world and
it is the interaction between social experience and personal history that
explains individual responses to such developments as increasing insecurity
in employment or the crumbling of the welfare state’ (Samuels, 1997, p.
190).

This paper draws on and reflects a tradition within psychology which is concerned
with the interaction between the personal (psyche) and the sociaYpolitical world
(society). Not only are economic issues the subject of therapy (see Samuels, 1993),
but the economics of therapy itself are an integral part of the therapeutic process.
0306-9885/98/040477-17 0 1998 Careers Research and Advisory Centre
 47 8 Keirh Tudor

T h e meaning of money
Various traditions and disciplines contribute to our understanding of money: from
the wisdom represented in mythology, through philosophy, politics and economics,
to psychoanalysis and psychology. Figures such as Lakshmi, the Hindu Goddess of
Prosperity and the Greek King Midas offer ancient wisdom about our relation to
money, wealth, abundance and prosperity, as well as warnings about greed. A
second tradition is represented by the great economists, e.g. Smith, Ricardo and
Keynes, and the philosophicaVpolitica1 analysts, notably Marx, from whom wc
derive the notion that, within capitalist economies, money is the means of measuring
the value of exchange and the expression of capital(ist) power over labour. A third
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tradition is influenced by Freud (1908/1959) and others such as Ferenczi (1914/

1976), Jones (1919) and Abraham (1923), and more recently by psychological
perspectives which vary from the mainstream and accessible Rowe (1997), through
the radical and innovative work of Bloom (1996), to ‘new age’, ‘pop’ psychology
(e.g. Wilde, 1989). One writer who integrates both the economic (HegeliadMarxist)
and the psychoanalytic perspectives, in a reflective psychoanalysis of economics as a
subject, is Schilder (1940). More recently, Samuels (1997), writing about the
economic psyche, argues that the psychology of economics is part of the resacraha-
rion of politics: that is, ‘the aim to get back into political [economic] culture a sense
of purpose, decency, aspiration, and even holiness’ (p. 166).
Citing myths, fairy tales and word associations, Freud (1 897/1966, 1908/1959)
connects money with dirt and faeces and provides the basis for subsequent analysis
of the anal character: ‘capital accumulation and indebtedness are as closely related
as feces accumulation and feelings of guilt’ (Borneman, 1976, p. 19). Expanding on
Freud’s views from a developmental perspective (which represents a second strand
of psychoanalytic thinking about money), Ferenczi (19 14/1976) views retained
faeces as the child’s first ‘savings’. Jones (1 9 19) associates faeces as an unconscious
symbol with money and children; Abraham (1923) views faeces as a child’s gifts to
their mother and the money spent on subsequent gifts to represent anal or genital
interests. Borneman (1976) also draws on Freud’s phases of the maturational
process-polymorphously perverse, oral, anal and genital-and, using them as an
organising framework for reviewing the psychoanalytic literature, describes seven
developmental phases in the developing child’s and adult’s relationship to money.
Influenced by Reichian character analysis (Borneman studied under Reich), Bome-
man elaborates the analogy of the human body as a biological household, identifying
four metabolic stages of a ‘somatic economy’:

(1) Ingesting or incorporating (acquiring, buying).

(2) Digesting (investing).
( 3 ) Withholding of excreta (saving, parsimony).
(4) Expelling of excreta (spending, selling) (ibid., p. 32).

In the last 10 years. a small number of psychologists and authors have developed
other perspectives on the meaning of money. Krueger (1986a) presents a view of
money from self-psychology, arguing that money (and work) may represent a pursuit
 Fees in counselling and psychotherapy 479

of self-esteem; he also (Krueger, 1986b) discusses a fear of wealth. Wilde (1989)

writes about money as a thoughtform and, as others in the self-help, human
potential movement, views money as a symbol of abundance, and abundance as a
factor in how we feel about money and what we have rather than what we lack.
Manillier (1996) criticises classical psychoanalytic interpretations of money as too
literal and argues for an appreciation of our ambivalence about it. Although Rowe
(1997) provides a wide-ranging and highly readable guide to The Real Meaning of
Money, she is short and cynical about therapy and strangely does not connect this
with the issue of money.
Bloom (1996) argues that money is ‘both materially and psychologically en-
twined with our most primal senses of survival [and that] we need to develop
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strategies for dealing with this ongoing threat. In particular, we need to begin a
healing process of wise understanding’ (p. 15). In an excellent and challenging book
full of innovative ideas and creative practical suggestions, Bloom elaborates his wise
understanding through an analysis of the true social and ecological context of
money, arguing that it is possible to support wealth, personal happiness and social
justice. This is more akin to ancient wisdom which defines abundance in terms of
sustainable growth and a relationship with our environment that balances extraction
and replacement: ‘Only when the last tree has died and the last river has been
poisoned and the last fish has been caught will we realise that we cannot eat money’
(19th-century Cree Indian saying).

Issues
Money has always been the principal means of exchange for therapeutic services,
most clearly so in the private sector. Freud (19 13/1958) regards arrangements about
money and time as points of importance at the beginning of analysis, recommending
that the fee ‘must be decided at the beginning of treatment’ (p. 131). In its Code of
Ethics and &actice for CoutlseUoTs, the British Association for Counselling states that
‘counsellors are responsible for reaching agreement with their clients about the
terms on which counselling is being offered, including ... arrangements for the
payment of any fees [and that] the communication of essential terms and any
negotiations should be concluded by having reached a client agreement before the
client incurs any commitment or liability of any kind’, (BAC, 1997, Section B.4.3.1: my
emphasis). This is a clear statement of the counsellor’s obligation to offer a free
initial assessment meeting or at least a free element of the initial meeting or a
thorough negotiation of terms during a telephone conversation or correspondence
prior to the initial meeting.
I think of this as a service to the community akin to window-shopping. Shops
do not charge me to examine their goods. Similarly, I believe that the public should
be able to shop around in choosing a counsellor or psychotherapist, before they incur
any financial liability; charging for initial meetings restricts client choice. Clearly
counsellors have ethical and professional responsibilities to provide the public with
the necessary information-about training, qualifications, experience, the nature of
the service, etc. (BAC, 1997)-by which potential clients may decide how to choose
 480 Keith Tudor

a counsellor. Openness and clarity about money is good practice: ‘clear contracting
enhances and shows respect for client autonomy’ (BAC, 1992, S.2.2.10). It is also
good modelling of dealing maturely with such exchange and casting off ‘false shame’
(Freud, 191311958) about this issue. This process reflects Beme’s (1966) three
levels of contract: the administrative contract (e.g. about fees), the professional
contract (about the nature, aims and valid considerations of the therapy), after
which, having clarified these, the counsellor ‘is free to devote himself [sic] to the
psychological aspects of the contract which become part of the therapeutic struggle’
(Berne, 1966, p. 20).
In this discussion about money, valuds and fees in counselling, I draw on
Syme’s (1994) considerations about the setting of fees, changing the fees, the
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payment of fees, and rules about fees, and the negotiation of these. This discussion
is concerned to challenge some of the received wisdom and perceived assumptions
about the role of money in counselling, and especially to offer creative solutions to
the issues raised by workmg with clients who need but cannot afford counselling.

Setting the fee

This is influenced by the counsellor’s values in two respects: our moral values about
money, service, and access to counselling; and, literally, how we set a value on the
service we are offering and on ourselves. Putting a price on what we are worth often
raises personal issues for counsellors. In valuing myself and in working as a
counsellor, supervisor and trainer, I find Rogers’ (1 959) concept of ‘conditions of
wonh’ a useful one in understanding under what conditions the client, counsellor,
supervisee or trainee values or gives themselves worth, psychologically and
financially (see Gutheil, 1986).
For counsellors working in thc public and voluntaryhdependent sectors,
setting the fee is not usually an issue, although how much they are paid for their
work may well be and this latter may well affect their work. When I worked for a
voluntary agency youth counselling project, I know that there were times when I
found it hard K O value clients when I felt devalued by the project’s management
committee. Other counsellors, who do contract work for general practitioners,
employment assistance programmes, etc., are either paid a set fee or salary, or may
be involved in setting their own fee with third or fourth parties to the counselling (for
a discussion of which, see below).
Counsellors working in the private sector generally set their fees, constrained
only by the forces of the market. This is itself interesting as, politically, many of
these same counsellors would question the economics and values of market forces as
well as their economic and psychological impact on many clicnts. Many counsellors
adopt various strategies in response to this, offering low-cost counselling, conces-
sionary rates, reduced fees, sliding scales, and payment in lund. Whilst these and
other ideas are honest attempts to redress an iniquitous macro-economic system,
there are also dangers in seelung individual solutions. Karpman’s (1 968) drama
triangle-to which Clarkson (1 987) has added the role of the Bystandcr-is a useful
 Persecutorls
- Fees in counselling and psychotherapy

Rescueris
48 1

\/ Victim/s

w Audience or
B ystanderls
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FIG.1. The drama triangle, incorporatingh e Bystander role (based on Karpman, 1968; Clarkson, 1987).
framework for thinking about the various roles we may unwittingly play in relation
to setting and collecting fees (see Fig. 1).
Fig. 2 shows the drama triangle enacted with the counsellor, cliends, 'the system'
and professional organisations in the various roles, explained with reference to the
legend of Robin Hood, as characterised by the counsellor who says, implicitly or
explicitly, 'I'll charge the clients who can afford it (the rich) higher fees and thereby
subsidise those less well-off (the poor) clients'. The usefulness of the drama triangle
is in understanding personal proclivities (history, countertransference issues); the

-
interpcrsonal invitations to assume certain roles; and the social context (i.e. there are
genuine victims and there are people who take a 'Victim' role); and that these roles
change (represented by the directional arrows in Figs 1 and 2). Thus a counsellor may

ZS),\ /
find a band of poor clients and, having taken a Rescuing Robin Hood position in

Persecutods Rescuer/s
I'hc wnnoiiiic c'oiiiisL'Ilor/
I<obiii Hood
Govcnmcntl
Notliiigliain

Victimls
cllcllt/s/
I'oor ~xi~iiiVs

B ystanderls
I'rol'cssioiial instituted

FIG.2. The drama triangle applied.

 482 Keith Tudor

relation to them, over time find themselves feeling or being ‘persecutory’. A client who
negotiates a concessionary rate may end up resenting their counsellor’s concession
(Victim to Persecutor). A training institute may decide to impose a fee structure on its
trainees (which may be ‘persecuting’ the trainees whilst ‘rescuing’ the trainees’ clients)
(Richard I, whilst being largely a Bystander in relation to his rule in England, was also
a Persecutor or, depending on your perspective, a Rescuer as regards the Crusades).
In terms of the understanding which the drama triangle provides, the aim is not to
change roles but to come off the mangle altogether. It is thus crucial for counsellors
to be aware of and to understand their own relationship to money and fees through
training, discussion, supervision, and personal therapeutic and development work.
In terms of fees for groupwork, most group counsellors appear to charge
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individual members of a group about half of what they charge for an individual
session. Thus a counsellor charging E30 per hour (or 50 minutes) may charge El5
per client per group; a two-hour group comprising eight people accordingly gives the
counsellor an income of El 20, i.e. E60 per hour. This is by no means rare and
indeed, particularly in London and south-east England, may be a conservative
example at 1996197 prices. In any case, in the context of a group, it is important that
the payment or non-payment of fees are discussed in the group (see Tudor, in
press). If questioned about their fees, group counsellors may well argue that the
money they earn from groupwork subsidises their other work with, for example,
individuals on low incomes, children and trainees, or their voluntary work. These
common and honest arguments are nevertheless driven by market forces.
Another way of setting fees is to take account of one’s training, qualifications
and experience as a counsellor, plus costs etc., and to set (after the free initial
meeting) an hourly rate (which may be E60) and charge that no matter how many
people one works with, whether an individual, a couple, a family or a group. The
advantage of this is in setting a value on one’s work and worth independently of
market forces within the profession, although inevitably still within the dominant
economic system. It is honest and open, and it clarifies the cost of subsequent
decisions to work with individuals at, in effect, a reduced fee or in offering a number
of low-cost or free places in one’s practice.
From this, some practitioners make the following kind of calculation:

(1) Take an overall view of Say, E20,000.

what you need in order
to live your chosen lifestyle.
(2) Consider, in terms of your
workstyle, professional and
ethical principles, how many
client contact hours you will
work.
( 3 ) Divide 1 by 2 and calculate
how much to charge.
Say, 600 hours over a 40-week
working year, i.e. 15 contact hours
per week (a number of hours which,
according to the BAC Professional
Sub-committee ( 1 9 9 9 , entails all but
the most experienced counsellors in at
least one hour’s supervision per week).
0 E33.33 per hour, on the basis of this
example.
 Fees in CounseUing and psychotherapy 483

This is a useful exercise both in itself and as a way of calculating the cost of working
for less than a (mathematically) ‘mean’ fee. Thus if the counsellor works for E5 or
El0 per hour, this calculation highlights the fact that he or she needs to generate
E56-62 income from another hour’s work in order to support low-cost work.
Overheads such as advertising, membership of professional bodies, training, supervi-
sion, books, rent, telephone calls, accountancy fees, etc. need to be taken into
consideration when calculating overall income. An appreciation of these economics
and this financial and psychological detail is essential for any counsellor who wishes
to translate their principles into practice and to sustain their philanthropy as
anything more than a transient role (after all, in the legend, Robin Hood was rescued
by the return of Richard I).
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If fees are set and kept high, relative to the uneven distribution of income
amongst different groups in society, then counselling, certainly in the private
sector, becomes inaccessible to these groups. Money is clearly an issue which
affects and is affected by class, race, gender and disability-as regards both client
and counsellor. That money is a feminist issue is reflected in this field in the
finding of one American survey that female psychologists were paid significantly
less than their male counterparts (see Burnside, 1986). In an analysis conducted
by the author based on the BAC’s Counselling and Psychotherapy Resources Directory
2998 (Palmer, 1997) this was not found to be the case amongst counsellors in
Britain (see Table 1). Where there is a significant difference, it is women who are
charging more than their male counterparts: 25% more in the North where,
surprisingly, the highest average fee is to be found-10% more than in London
and the South East.
As far as working for no fee is concerned, frequent reference is made in the
literature to the demmental effect of free therapy. Freud (1 9 13/1958), for example,
advises against it on the grounds that it increases neurotic resistances such as
gratitude. Others, notably Menninger (1958), argue that the fee should constitute a
sacrifice on the part of the client in order to secure their motivation, presumably on
rhe basis of ‘no pay, no gain’. Aside from a theoretical objection to this view on the
basis of a humanistic attitude to human motivation (see Maslow, 1970), I know of
no sustainable research evidence which supports this claim. The widespread and

I . Comparison of average fees amongst counsellon in England,

TABLE
Scotland and Wales by geographical area and gender

Average Fees Women Men % difference

London & South East L24.57 L24.71 Men + 0.5%

South West €23.50 L20.48 Women + 14.7%
East Midlands €22.57 k22.67 Men + 0.5%
West Midlands L24.16 L24.49 Men+ 1.4%
Nod L27.18 L22.79 Women + 25%
Wales L22.36 L23.33* Men + 4.3%
Scotland L21.90 L20.55 Women + 6.6%

‘This figure is based on only three men listed in Wales.

 484 Keith Tudor

increasing take-up of public-sector counselling and psychotherapy reflects a critique

of the argument and of the notion that not offerkg free sessions may represent a
neurosis (such as ingratitude or greed) on the part of the counsellor! Uniquely within
the profession at that time, Schofield (1964) argued for greater free access to
psychotherapy for those in need, commenting that friendship should not be bought
or sold. Similarly a perspective which understands psychotherapy as, literally, soul
(psyche) healing (therapy), may also view the journey of healing as a spiritual one
involving both seeker and guide or pilgrim and guru (Kopp, 1974): generally, one
does not pay a spiritual guide or director. Kopp emphasises the mutuality of the
relationship between pilgrim and guru, and Rowe (1997) suggests that ‘paying
someone for a service allows us to distance ourselves from that person’ (p. 44).
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Perhaps the clearest and most honest argument for charging a fee is simply that, in
most instances, the counsellor needs to earn a living, and that without the exchange
of money for services ‘the whole relationship is removed fiom the real world’ (Freud,
1913/1958, p. 132).
Earlier, I emphasised experience as a counsellar. Some trainee counsellors
set their fee according to their experience in another field or profession. Some
years ago I knew of one trainee who was charging E60 per hour to counselling
clients by virtue of his experience as an organisational consultant. Challenging
such thinking, and discussing the ethical and professional issues involved in setting
fees, should be an explicit part of counsellor training and of the roles of the
trainer and supervisor. Of course, most of the points and discussions in this
article are equally applicable to trainee-trainer/institte and supervisee-supervisor
roles and relationships.
Finally, in setting or negotiating our fee and being clear about our services, we
need to remember that clients are also czaromen buying these services:

‘Customers are the most important visitors on our premises.

They are not dependent on us. We are dependent on them.
They are not an interruption to our work. They are the purpose of it.
They are not an outsider on our business. They are part of it.
We are not doing them a favour by serving them. They are doing us a
favour by giving us an opportunity to do so’ (Mahatma Gandhi).

Changing the fees

Once the counsellor has set the fees (andlor negotiated them), the next issue is that
of increasing-or decreasing-them. There is a strong argument, in terms of clear
contracting (see BAC, 1992), that a counsellor’s policy as regards changing fees
should be discussed as part of the initial discussion, negotiating and contracting (see
BAC, 1997). Counsellors in private practice need to be sensitive to the fact that, like
Members of Parliament (MPs), they are setting their own salaries-indeed, even
more so since, unlike MPs, thcy cannot be voted out by their constituentslclients
except when these vote with their feet by lcaving. Thus, an annual increase in line
with inflation is clearly fair and justifiable in terms of Stadler’s three tests for a
 Fees in counselling and psychotherapy 485

chosen course of action: universality, publicity and justice (Stadler 1986a, 1986b,
cited in Bond, 1993). Further increases are common, and may be justified, as a
result of qualification or further qualification or increased status, although some
counsellors do not raise their fees once they have contracted with a client. Moreover,
an increase motivated by counsellors voluntarily expanding their financial commit-
ments (e.g. a second mortgage, house, car, etc.) may not be directly justifiable in
terms of Stadler’s tests and may well be resented by clients. Counsellors need to be
aware of the impact of and the issues raised both by any increase itself and by their
unilateral power to increase their fees.
These changes are initiated by the counsellor. There are other changes, e.g. to
a client’s economic circumstances, which may be decided by the client and within
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their control (having a child, separation, early retirement, etc.), and yet others
which may be outside their control or responsibility (forced separation, redun-
dancy, etc.). Some counsellors take the view that the fee is the fee is the fee, and
that the client has to bear the financial responsibility for any change in their
circumstances. Others take more account of the client’s macro-economic and
social context and may express t h i s in practice by being willing to accept a reduced
fee, either for a specific period or for as long as the client’s circumstances are
changed, or by being willing to negotiate some payment in kind (discussed
below)-and, of course, a variation in fee may be suggested by the client in view
of their changed circumstances. There is some research evidence to suggest that
female therapists are more likely than their male colleagues to be willing to reduce
their fees (Burnside, 1986). The issue of flexibility of fees is hotly debated in the
literature: Menninger (1958) argues strongly against any flexibility; whereas
Schonbar (1986), also writing fiom a psychoanalytic perspective, believes that ‘a
flexible approach to fee issues is more conducive to productive therapeutic explo-
ration than is the more rigorous approach’ (p. 43). In being more flexible and
conscious, the counsellor is offering a shared social context (see Caste1 et al., 1982;
Holland, 1985).

Payment of rhe fee

Counsellors have different preferences about the payment of the fee: in cash, b y
cheque, by standing order, on account with a monthly bill, at the beginning or the
end of each meeting. Freud (1913/1958) cautions against allowing ‘large sums of
money to accumulate’ and suggests asking for payment ‘at fairly short intervals-
monthly, perhaps’ (p. 131). One argument for payment in cash is that this heightens
the client’s awareness of the exchange and the value of the counselling. Drawing on
transactional analysis, S. Fish (personal communication, September 1986) suggests
that when a person pays cash they are in their Child ego state, whereas when they
write a cheque they are in their Adult ego state. Furthermore, writing a cheque may
not be experienced by the client-or the counsellor-as paying real money, whereas
paying in cash or writing a cheque for a large sum (in the case of an accumulated
number of sessions or a monthly bill) may cathect more energy (‘If I am holding and
 486 Keith Tudor

spending that much on myself) and create a greater expectation of exchange and
reciprocity (‘I’m paying for a service here’)-what Steiner (1971) refers to as the
‘valid consideration’ of the exchange. Whilst cash payment may be therapeutic for
some clients, for others it is not necessarily so (e.g. clients in the public sector who
value their counselling and keep appointments); furthermore, any insistence on this
point on the part of the counsellor in private practice may create fantasies about
them not declaring all their income for tax purposes.
There is also the issue of clients who forget to pay or who pay late. Counsellors
need to think about their response to this: a gentle but polite reminder at the end of
the session, a confrontation, an interpretation, a letter, or leaving it until the client
remembers and discussing what this might mean. There is a difference between
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clients who cannot pay and those who will not pay (see Reider, 1986). Recently I
have noted and become interested in clients who write incomplete cheques, and the
significance of which part is incomplete: missing out my name may be a way of
discounting me (I can complete this myself or wait and ask them to do so); not
signing the date may indicate a level of withdrawal from the immediate present; not
writing the amount may reflect their resentment about what I charge; not signing the
cheque (which I cannot rectify) may be a passive-aggressive response to the session
or to me. I write ‘may’ as I suggest these as hypotheses, rather than interpretations,
to be considered and discussed.
Whilst money is one form of exchange for counselling, other forms of exchange
may be both practical and therapeutic. Two examples are barter arrangements and
Local Economic Trading Schemes (LETS) which organise exchanges of labour
between people contributing to the scheme that are valued in token units of stones,
bobbins, spokes, queenies, etc., depending on the area of the country-in these
cases, Sheffield, Manchester, Oxford and the Stewartry respectively. Thus someone
may offer counselling, charge 15 ‘stones’ per session and then accumulate that credit
within the LETS, which they may ‘spend’ when, for example, someone does some
decorating for them. Barter is a direct exchange, whilst offering counselling within
a LETS is an example of an indirect exchange; both have tax implications for
self-employed practitioners. As regards bartering, although BAC has no particular
vicw about it, the American Counseling Association (ACA) discourages it, arguing
that such arrangements ‘create inherent potential for conflicts, exploitation and
distortion of the professional relationship’ (ACA, 1995, §A. 10.c)’ and links this
point to one about the avoidance of dual relationships. T h e ACA sets out four
conditions under which bartering may be considered: ‘counsellors may participate
only if the relationship is not exploitative, if the client requests it, if a clear written
contract is established, and if such arrangements are an accepted practice among
professionals in the community’ (op. cit.).
There are further therapeutic and practical considerations. For some clients, the
actual work which they are bartering is often best negotiated and reviewed by
someone other than the counsellor. This depends on the nature of the therapeutic
relationship (Clarkson, 1990, 1995; Gelso & Carter, 1985) and in particular
whether such arrangements and negotiation are mutual (I-You relationship) or
reparative (developmentally-neededreparative relationship) in which cases there
 Fees in counselling and psychotherapy 487

may be a therapeutic value in the negotiation being between the counsellor and the
client: the counsellor may indeed support and encourage the client in doing the
work. One practical consideration is how much the counsellor values the barter
work. Given that manual labour is valued at less than most professional services, the
barter is likely to involve the client in working a number of hours for every
counselling hour. This needs to be made explicit when the barter is agreed: Freud’s
caution against the accumulation of debt also applies to a client owing hours of
bartered labour. The indirect nature of a barter arrangement through a LETS
separates the payment in kind from the counselling and may be simpler; equally, it
may m i s s an important therapeutic point-the psychological aspects of the struggle
of exchange and value (valuing).
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Payment by money, barter or LETS is a direct or indirect form of exchange;

it is nevertheless an exchange on the part of the client for services. Two issues arise
from this: first, that of third-party payment for counselling; and second, a wider
issue about payment in terms of the affordability and therefore availability of
counselling.
Third-party payments reflect situations in which a third party to the counselling
relationship pays the counsellor. Perhaps the most common example of this is when
a parent or carer pays for their child’s counselling (for a discussion of the conmctual
and therapeutic implications of this, see Tudor, 1998). Other examples include an
employer as is the case with most Employee Assistance Programmes, a health
authority in the case of the increasing internal and external market in health care,
and an insurance company in the context of private medical care (see Halpert,
1986). Chodoff (1986) suggests that, although particular fantasies (and phantasies)
may be played out in such situations, such as those of narcissistic gratification and
of omnipotence, it is better that these are mobilised and analysed than repressed.
Whilst any situation regarding fees is arguably ‘all grist for the mill’, generally
third-party payments are viewed as introducing unnecessary complexities into the
‘treatment’. Notwithstanding this, Freud himself saw the ‘Wolf Man’ for no fee,
raised money to work with the ‘Rat Man’, and accepted third-party payments (see
Pulver, 1974).
On the wider issue of affordability and availability, as discussed, many counsel-
lors work out their own form of subsidy for individual clients. Whilst these are
worthy attempts to offer counselling to particular individuals, they are nevertheless
individual solutions. There are many people who want but cannot afford coun-
selling. The policy of (so-called) community care has resulted in even more people,
often ex-psychiatric patients with little or no after-care, seeking forms of psycholog-
ical support and help (Robertson & Tudor, 1993). There are still others-classified
by one client, including himself, as ‘the womed sicky-who fall in between the
statutory health and social care services (they are not ‘mad’, ‘sad’ or ‘bad’ enough)
and the traditional private counselling sector (their problems or pathology being too
severe). This in-between population includes people diagnosed as having personality
disorders whom psychiatrists can claim are not covered by the provisions of the
Mental Health Act 1983. Some, such as the recently formed coalition Counsellors
and Psychotherapists for Social Responsibility (CPSR), campaign for increased
 480 Keith Tudor

provision of free or low-cost counselling and psychotherapy in a variety of settings,

including the National Health Service (NHS) (see Dunhill er d.,1996). T h e
problem with counselling within the NHS is three-fold: the limitations of the
medical model in understanding and even recognising certain forms of disease; the
fact that only certain ‘schools’ of counselling and psychotherapy are recognised
within the NHS-the humanistidexistential ‘third force’ being generally excluded;
and the fact that the NHS itself is being dismantled. Whether we like these politics
and policies or not, counsellors in the voluntary/independent and private sectors are
increasingly picking up their psychological fall-out and, in doing so, need to have a
coherent and realistic response.
A more collective, social solution to this problem is to create a fund of
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money for counsellors to work with people who, because of their psychological
problems, cannot afford to pay for counselling-a fund which could be created
and maintained through tithes and ornrusts. Collecting a tithe (a tenth) has its
roots in ancient times as a means of raising taxes or conmbutions. Similarly,
counsellors could collect money by raising and setting aside a tithe or a propomon
of their fees to subsidise their work with other clients. Tithing is fair (in that it is
proportional), universal (in that it is applied to all clients) and stands up to public
scrutiny (counsellors may tell their clients about the scheme). Establishing a
charitable Trust find to collect and distribute monies on an agreed basis to
counsellors for specific work with particular clients takes this idea further: the
precise practicalities of such a scheme are currently being investigated by John Parr,
a UKCP registered psychotherapist, who welcomes comments and suggestions
from interested practitioners. [ I ]
These various arrangements-offering free sessions, engaging in barter arrange-
ments and LETS, and tithing-all reflect attempts on a micro level to apply some
alternative economic ideas to the issue of paying for counselling and psychotherapy.

Rules and conmacts about fees

In counselling, I distinguish between rules (unilateral, non-negotiable) and contracts
(bilateral, negotiable) (see Tudor, in press). This division equally is applicable to
issues about fees in counselling, and counsellors need to be clear about the
difference. For some, payment for missing sessions is a rule which the counsellor
establishes at the beginning of counselling; for others, it is based on a negotiated
contract which includes the basis for paying and not paying (commonly, if the client
gives 24 hours’ notice or is unwell). Counsellors, therefore, need to be clear about
the circumstances under which payment is due, as regards: cancellation, including
the reasons and responsibility for cancelled or missed sessions (unavoidable or
avoidable delay, illness or bad weather); not& required by both parties of cancel-
lation, holidays and termination of counselling; and missed payments; and to be clear
about which (if any) are rules and which are subject to contract. Some counsellors
prefer to draw up and written contracts which are dated and signed b y both
counsellors and clients (see Sills, 1997).
 Fees in counselling and psychotherapy 489

A person-centred approach
Each tradition or ‘school’ of psychotherapy and counselling has its own understand-
ing of concepts, theories and issues regarding therapy or healing. All have some
notion about how change takes place or is effected; although not all have a distinct
theory of human development. Some apply their ideas to the wider world outside
counselling: psychoanalytic theorists, practitioners and commentators especially
have, particularly since the 1930s, been applying their analysis to social issues and
phenomena. As discussed earlier, Borneman (1 976) and Krueger (1986c) represent
this application in their psychoanalysis of money, in terms both of its meanings and
symbolisations in the world and of its impact in the consulting room. There is no
doubt that policies, rules and contracts about fees affect the nature of the coun-
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selling relationship and that such policies etc. are, or should be, an integral part of
the counsellor’s orientation and style (see Tulipan, 1986).
This section frames the issues of fees in counselling and psychotherapy within
a person-centred approach (PCA). In an integrative statement, Rogers (1957A 990)
drew together six conditions which are necessary and sufficient for constructive
personality change to take place (it is a common misunderstanding and misrepresen-
tation of the PCA that what have come to be known as the ‘core conditions’ of the
counsellor’s congruence or genuineness, unconditional positive regard for and
empathic understanding of the client are all that is necessary and sufficient-they are
not and Rogers never claimed them to be). The six conditions offer a necessary and
sufficient framework for consideration of issues of money and fees.

Psychological contact
This covers establishing contact and an agreed definition of ‘the helping situation’.
It includes discussion and negotiation about money and fees. Jacobs (1986) believes
that:
‘the fee should not be fixed by the therapist at some arbitrary amount, but,
whenever possible, during the initial sessions be the subject of full dis-
cussion in an attempt to understand the significance of the fee to the
patient and its impact on his [sic] view of the therapist as treatment is being
considered’ (p. 124).
Although Jacobs reflects a different (psychoanalytic) theoretical orientation,
this establishes from the initial contact important and fundamental principles of
negotiation and of mutuality.

Client incongruence
This refers to ‘a discrepancy between the actual experience of the organism and the
self picture of the individual insofar as it represents that experience’ (Rogers,
1959/1990, p. 222). Thus a client may be financially comfortable (experience) but
feel impoverished (self picture)-and, of course, vice-versa. The client’s vulnerability
 490 Keith Tudor

anxiety and incongruence may all reflect and be reflected in issues about money and
in negotiations about fees.

Counsellor congruence
Being a congruent, genuine, integrated person requires the counsellor not only to be
aware, through using all their senses, but to live that awareness and to be able to
communicate their awareness, if appropriate (the author W.Somerset Maugham in
Of Human Bondage considers money as ‘a sixth sense without which you cannot
make a complete use of the other five’). Congruence involves the counsellor in a
commitment to personal development and continued therapeutic work on their own
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personal issues as well as on issues which arise in their work. Money may well be a
practical and psychological issue for the counsellor and, given the cost of training,
especially for the trainee and beginning counsellor.

CounseUor’s unconditional posirive regard

One common client fantasy/phantasy about counselling is that they are paying for
love, regard, respect, care, attention or to be valued. Indeed, I have heard counsel-
lors likened to prostitutes. Rather like Freud, who considered that the patient was
leasing a definite hour, I consider that the client is paying for my time and for my
expertise as a counsellor, not for my love (which in any case cannot be manufac-
tured) nor for who or how I am (which is, at any moment, congruent or not). I have
found this distinction between time and love or being valued helpful in clarifying
and at times confronting clients’ perceptions about counselling. For instance, what
I do in my work as a counsellor is subject to agreemendcontract (and ethical and
professional consideration) and not to financial constraints: I do not work ‘better’
with clients who pay more; I do not feel any less regard for clients who pay less. I
do regard the process of counselling as involving the free giving of value to clients
and to rheir internal valuing process.

Counsellor’s empathic understanding

This condition requires the counsellor to develop an accurate, empathic understand-
ing of the client’s awareness, of the client’s own experience, and of how the client
understands and frames this experience. This is especially important in any disputes
as regards money and fees and particularly, any impatience the counsellor may feel
with poor or impoverished clients or any envy of wealthy clients. As with the
previous condition, this also rests upon the counsellor’s self-awareness.

The communication of regard and empathy

Finally, the counsellor’s regard or acceptance and empathy needs to be perceived by
the client, at least to a minimal degree. As regards money and fees, it may be enough
for the client that the counsellor accepts and understands her or his financial
 Fees in counselling and psychotherapy 49 1

situation, even if this does not affect the final negotiation and decision about fees or
working together.

Conclusion
Whatever the counsellor’s orientation, personal and professional style, issues regard-
ing fees and their negotiation in counselling form an important element of the
therapeutic relationship, which requires knowledge, understanding and sensitivity.
Talking straightforwardly about money in therapy, training, supervision and work-
shops, dispells the taboo of filthy lucre. Bringing the subject of money into the
consulting room makes it personal rather than impersonal, and political rather than
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neutral. This paper has addressed the macro issues of the setting, changing and
payment of fees and their negotiation in two respects: as part of wider concerns with
the psychology of economics and with the economics of psychology, and in order
that counselling may be seen as value for money rather than money for value.

Acknowledgement
I am grateful to Sue Fish, Richard House, Ian Stewart and Mike Worrall for their
comments on and contributions to earlier drafts of this article and to Isobel Palmer
for providing the data on fees for analysis.

Note
[I] For those interested in the Trust scheme, please contact John Pam, Norcot House, 131 Norcot
Road, Tilehurst, Reading RG30 6BS, UK.

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(Accepted 9 Febmay 1998)