The Intervention

I always make an arrangement with patients in group therapy about how to pay for services rendered. In this agreement I ask for payment to be made directly to me. 1 discourage payment being made to my secretary, by bank transfer or credit card, nor will I accept a check. The reasons I approach this form of payment are as follows:

1. We can clearly explore the therapeutic relationship without external, intervening variables such as, "I did not know my bank did not transfer the funds." We can explore the patient's attitude to the actual therapy, which ultimately will bring to light his or her relationship with both the therapist and the group.

2. By paying directly to me, both of us can see the money that comes between the patient/group and myself. This is a part of the relationship that must be present. It constitutes a key element of the work in private practice. It is important also in public practice, but in that environment there is more which is concealed. If, for example, the payment is made by a bank, or indirectly as in public practice, the fantasy of gratuitousness can grow in both therapist and patient with negative consequences in therapy.

3. We can manage easily all the events around the money because it happens between group/individual and the therapist, without other people in between.

It is necessary to establish a clear contract with the patients about the conditions of payment in order to know the limits and not confuse our need for money with the perception of money of the patient, which can be the manifestation of a symptom.

Case Example: The Context of an Experience

A new group was started in private practice. The group was comprised of four women of middle age, and me. All of them had previous experience with me in individual therapy. It was determined that we would work in group once a week for an hour and a half. The techniques used would be group analysis and psychodrama. The minimum therapy commitment to the group was a year. After this, people could end the commitment with a month's notice of termination. It was a "slow open" group: more people could also integrate the group at any time.

I previously informed the group members individually and during the first session about the amount of the payment. I decided to establish a payment based on a fixed amount for each person and session. I doubted whether I could establish a fixed amount per session no matter how many people would be in the group. I felt this kind of contract could increase the feeling of belonging to the group, but that it would put a lot of responsibility on the members if one of them stopped the experience. Also, the incorporation of a new member and the size of the group could be strongly conditioned by the money/fee. I choose for myself the economical consequences by the size of the group and place the payment responsibility on the individual patient thus liberating the patients of the burden of being responsible for the group as a whole.

The Actual Group Experience

During the first sessions I asked the group about how they would like to pay, when to pay, and if the group as a whole would assume the responsibility of paying the total amount or if each one would be individually responsible for her bill. Three of the four members answered clearly that they would like to pay at the last session in each month and that each one will take the responsibility of paying her amount. The fourth member did not assume a clear position. In the last session, of this month, one of the members did not bring her part of the money. One patient brought her money in an envelope with her name but added to her part the money previously owed for an individual session. Others put the money envelopes on the table, in front of the group, without their names.

Therapeutic Concerns

I was concerned with this contract: should I discuss the payment of the monthly group to each individual separately, or discuss the payment to the group as a whole? I needed a clear system in which I could confront clearly in the group the mistakes, delays, etc. I do not like to make particular communications, out of the group session, by confronting a mistake in payment. This would mean taking out of the group, information that is pertinent to the group as a whole. I too felt that individual dialogue with a group member could possibly give individual relevance and I did not want to reinforce that type of intervention.

My need, after the first month's payment of the group, was to confront a nonpayment situation in order to achieve the two aforementioned perceptual needs.

• First: my right but also my obligation to claim the money in the established contract.

• Second: the lack of implementation, of the contract, in the group and its meaning.

Implementing a Direct Intervention

In the next group session I put the money on the table that was given to me in the previous session. I disclosed that this was not the money that the group owed, because, in this type of intervention, my "patient" was actually the group as a whole and monies were still due to me. I too related that only monies for the actual group would be accepted and monies for individual psychotherapy would not be accepted at the same time.

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