Paying for the Listening Ear

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If you’re paying someone in a therapeutic relationship, how can you know whether they really care? Is it all about the money? And how do questions like these touch on concerns that might come up in other relationships?

Sometimes within the context of the therapeutic relationship many of my clients realize they are paying money for therapy. As a matter of fact, now that I think about it, they all do, as they greet my office staff on their way out and payment is required. As a client, you are engaged in a very personal relationship that you are asked to pay for — paying for that listening ear. For the therapist, it’s important to be cognizant of when the client begins to truly understand this and why. This realization brings about issues that are often confusing and difficult to navigate for the client. Frequently, the issue is expressed by reconsideration of the therapist’s motivation. “You’re only saying that because you’re paid to.” “You’re only saying that because you’re a therapist and it’s your job to do it.” The underlying question here is more difficult to vocalize for a client: does my therapist really care or is it about the money?

First of all, good question. It’s helpful to understand what’s possibly going on there. Sometimes these things are said because we are feeling too close or vulnerable to our therapist and believing that they don’t care or are just paid to do this can put some safe distance where it’s needed. Sometimes these things are said because we need to know that what we are saying and feeling is important to our therapist. This means you are important. Both of these reasons are a challenge to the therapeutic relationship. How I respond is important. It will either confirm or deny some important connection between us.

My answer is usually “Tell me some more about that?”

This response to my patients lacks the absolute answer they are looking for and can be frustrating. What it does do is help us examine what the real issue is here. Do I really care? What’s it like to have me care? Is that scary? What would it be like if I didn’t care? Now we are talking about the insecurities you have about the therapeutic relationship. Maybe these are the same insecurities from other relationships. Deep stuff really. Remember though, within the therapeutic relationship are elements and issues that you bring with you from other relationships. You can bring those issues you have in other relationships to our therapy relationship. You can’t help this. Don’t try not to either, because this helps us understand you. If your relationship issues play out in our therapy together, that’s a great safe place to have that happen and to begin to understand and work through it all, free from the consequence of being yelled at or cast aside. The therapy relationship can help you correct and change those things when they come about in therapy.

If that answer still leaves you feeling unsatisfied about how your therapist feels about you, remember this: I wouldn’t have dragged my sorry butt through years of school and chosen this field if I didn’t care about the people I work with.

Does that make you feel better? Good. Now, tell me some more about that.

All clinical material on this site is peer reviewed by one or more clinical psychologists or other qualified mental health professionals. This specific article was originally published by on and was last reviewed or updated by Dr Greg Mulhauser, Managing Editor on .

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