Thoughts on Psychic Work

On Death and Late Fee Policy

It would not be unusual for a therapist and patient to collude in ignoring the reality of death. In a society that exists in active denial, pushing death out of sight into hospitals and hospices, both parties face considerable psychic pressure to conduct the treatment in a similar vacuum. The result is a prolonged fantasy that there is infinite time for one to start being who they wish to be tomorrow*.

There are, however, meaningful ways that a therapist can bring the finality of life into the treatment room. I suspect one of the most effective ways is by implementing a strict late cancellation policy*.

Case Example

A therapist shared that during her own analysis, she traveled a long distance four days a week to attend her sessions. On one occasion, she was caught in a severe snowstorm. After more than two hours of traveling, she arrived at her session just a few minutes before the end of her hour. Knowing the analyst had the subsequent hour open, the analysand asked if she could take up that next slot. The analyst agreed but noted that she would be charged for that session as well, meaning the analysand was charged for both the "missed" session and the "makeup" session. The therapist, reflecting on her time as an analysand, shared how infuriating, and ultimately useful, this experience had been for her.

While the analysand found this experience useful for reasons unique to her own treatment, the policy also forces a symbolic communication: like life, psychic work is finite.

By enforcing the late fee policy, the analyst meaningfully brought home the reality that while psychic work occurs in a timeless state, our lives and resources are limited. There is an urgency to living the life one wants now. Let us assume instead that the analyst had given in to feelings of guilt, or an unconscious undervaluing of the work, because the patient commuted too far or faced harsh weather, and decided to waive the fee. One communication inherent in such a decision would be to join the patient in the fantasy that resources, including time, are unlimited.

Past and future only have meaning in the ways they impact us in the present moment. Therefore, effective treatment requires a therapist to engage in the timeless state of psychic work while simultaneously keeping the reality of death alive in the room. Otherwise, the treatment becomes just another vehicle for the unconscious denial of death, and another way for the patient to postpone living.

*Note: This consideration does not take away from the reality that the psyche functions in a timeless state and deep psychic processing often requires a sense of timelessness.

*Note: Much is written about the importance of the fee as a means for holding therapeutic boundaries, where the patient can safely experiment with taking psychic risks, and as a real and symbolic offering that forces the patient to actually "buy into" the often difficult process of therapy.