When Therapists Discuss Money

One therapist worries that his field isn’t prepared to address the biggest concerns in his patients’ lives.

Photo credit: Brian Teutsch, CC BY 2.0.

I love reading the Captain Awkward advice column, and I wanted to share a NYT article the Captain linked to in her recent advice:

Why Therapists Should Talk Politics

The article’s about a month old, and I can’t believe I missed it when it first ran, but here’s the thesis:

[Employment and financial] worries among my patients are becoming so common, so persistent, that I find myself focusing less and less on problems and neuroses that are specific to individual patients, and more and more on what is happening to the fabric of daily life.


Typically, therapists avoid discussing social and political issues in sessions. If the patient raises them, the therapist will direct the conversation toward a discussion of symptoms, coping skills, the relevant issues in a patient’s childhood and family life. But I am growing more and more convinced that this is inadequate. Psychotherapy, as a field, is not prepared to respond to the major social issues affecting our patients’ lives.

I’m a little surprised that employment, money, and social changes haven’t always been part of the conversation between therapists and patients; family relationships aren’t the only stressful relationships in a person’s life, after all. Our very livelihood often depends on our relationship with a series of employers (and these relationships can very often be dysfunctional), and even our relationship to money is worth discussing.

Our Relationship to Money Affects Everything

The NYT article suggests that our workplaces have literally become traumatic, which feels a bit like discovering something that a lot of people have known for centuries, but it may be appropriate to say that more people who seek therapy are also experiencing workplace-related trauma, and not all therapists are prepared to address this in their sessions.

It makes complete sense that the stress of our economy and our employment might affect our mental health (while also understanding that not all mental health issues derive from external stressors), and that we might need to talk to someone about developing specific coping skills to manage, say, starting your day by learning that your entire department has been laid off, effective immediately.

We live in a world where we don’t know if we’ll be employed three months from now and many of us don’t even know what hours we’ll be scheduled to work one week from now. We don’t know, as Ester Bloom wrote, whether we’ll go to the hospital and come home with an $800 bill for a blood transfusion that never happened—or if we’ll open the mail and find a bill incorrectly stating we owe an extra $1,400, like Nicole Chung did.

Why shouldn’t this be a part of any conversations we have with our therapists? Why shouldn’t this be a fundamental part of these conversations?

For Billfolders in the psychotherapy field: do you agree that psychotherapy “is not prepared to respond to the major social issues affecting our patients’ lives”?

For the rest of us, if you feel comfortable sharing: do you wish you had better coping skills to deal with issues like money and employment? Do you wish you had someone you could talk to about your relationship with money, your career identity, or your (potentially dysfunctional) workplace? Or do you feel, like I do, that you’ve built your own self-care toolbox out of friends, exercise, entertainment, and reading the Billfold and Captain Awkward archives to remind yourself that you aren’t alone?

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