MONEY AND PSYCHOANALYTIC TREATMENT

The role of money in the analytic setting is an essential aspect of the arrangements that institute treatment and underpin it as it proceeds. Freud realized early on that subjective attitudes toward money are sure to create difficulties, for they inevitably are affected by outside reality, that is to say social and economic factors, and affect psychic reality, especially in its sexual dimension. Payment, as customarily required in the contract between analyst and patient, is a necessary if not always sufficient condition—the needed symbolic mediation—that frees the analysand from the danger of the analyst's repeating the kind of abuse to which the analysand has already been subjected in life. It is a mechanism, in other words, that saves the patient, in the transference, from acting out and paying in pounds of flesh and with the coin of suffering. It is also a means of protecting the analytic process from an excess of unanalyzable resistances. The analyst is thus helped in interpreting the transference. And, last but not least, the analyst's material needs are taken into account.

In two technical papers, "Recommendations to Physicians Practicing Psycho-Analysis" (1912e) and "On Beginning the Treatment" (1913c), Freud addressed the function of payment in the dynamics of therapy and its implications for the transference and counter-transference.

In "On Transformations of Instinct as Exemplified in Anal Erotism" (1916-1917e), Freud discussed the metapsychological ramifications of money in the analytic situation and the equivalence, for the unconscious, of the concept of excrement (and its derivative notions of money and gifts) with the concepts of the infant and the penis. Finally, in 1918, with the publication of From the History of an Infantile Neurosis (1918b [1914]), the "Wolf Man" provided the opportunity for considering a variation in the framework of analysis that took the form of money collected to support the patient. In the same year, at the International Psychoanalytic Congress in Budapest, Freud drew attention to the neurotic suffering of segments of the population who for economic reasons were unable to benefit from psychoanalysis, and for the first time he broached the idea of an institute where analysis would be free.

Under the direction of Karl Abraham, the Berlin Psychoanalytic Polyclinic began its activities in 1920. Ernst Simmel, in his report to the Berlin Psychoanalytic Institute in 1930, emphasized the role of the new social institution of "health insurance" in assuming financial responsibility for treatment. From the 1980s this question became the subject of intense debate, though one rarely discussed in the literature, to judge by the scarcity of work on it (Dupeu; Frécourt; Levy; Viderman). Meanwhile, a growing number of analytic practices make use of third-party payment systems (such as health insurance) within a private or institutional context. Thus, there is considerable risk that such systems will strengthen the medical approach to psychoanalysis already strongly developed in many countries.

Ghyslain Levy

See also: Anality; Anal-sadistic stage; Eroticism, anal; Feces; Gift; "Notes upon a Case of Obsessional Neurosis" (Rat Man); Pankejeff, Sergei; Symbolism; Viderman, Serge.

Bibliography

Deutschen Psychoanalytischen Gesellschaft (Ed.). (1930). Zehn Jahre Berliner psychoanalytisches Institut. Vienna: Internationaler Psychoanalytischer Verlag.

Dupeu, Jean-Marc. (1986, July). L'analyse conventionnée, un analyseur pour la question du paiement en psychanalyse? Psychanalystes, 20, 35-49.

Frécourt, Jean. (1988, July). Le psychanalyste est payé. Psychanalystes, 28, 3-16.

Freud, Sigmund. (1912e). Recommendations to physicians practicing psycho-analysis. SE, 12: 109-120.

——. (1913c). On beginning the treatment. SE, 12: 121-144.

——. (1916-1917e). On transformations of instinct as exemplified in anal erotism. SE, 17: 125-133.

——. (1918b [1914]). From the history of an infantile neurosis. SE, 17: 1-122.

Levy, Ghyslain. (1986, July). Un patient est remboursé, ou Variations sur le thème du paiement et de ses diverses alternatives dans la situation analytique. Psychanalystes, 20, 21-23.

Viderman, Serge. (1992). De l'argent en psychanalyse et audelà. Paris: Presses Universitaires de France.