Wednesday, July 9, 2008

Psychobabble for $600 a Session

According to Eric Konigsberg's fine New York Times article, "Challenges of $600-a-Session Patients," $600 is the rate that hedge fund billionaires, entertainment moguls, and real estate developers pay for psychotherapy. For that money you could hire a good lawyer, so what do you get for $600 a session?

You would expect some superior level of insight. For those prices you would not settle for a warmed-over Dr. Phil, announcing: You've got issues! Or would you?

Let us stipulate that the psychiatrists quoted in the article may not be divulging their greatest thoughts. They may be saving the good stuff for their paying customers.

In any event, one thing you get for $600 a session is credentials. You get to see someone who has lots of degrees and titles, preferably the Department Chair.

Why does this matter? People who are insecure about their social standing can affirm their high status by announcing at charity balls and cocktail receptions that their doctor is Chairman of the Department. That is certainly worth something.

Or it may be that the very wealthy only respect their near-peers. They would not respect someone who charges much less. They may be getting a lot of psychobabble, but at those prices they are more likely to accept it. To you and I the insights might sound like the musings of an adolescent philosophy student. At $600 an hour they are scientific facts.

In the last line of the article a Department Chairman offered a pearl of high-priced wisdom: "All of the philanthropy you see... is the result of one man after another trying to conquer his mortality."

There it is: an insight that is worthy of a Freshman philosophy course. But what does it really mean? Simply put, the Chairman is one-upping his wealthy patients. I daresay he is also insulting them. See, he is saying, for all their worldly wealth they are afraid of dying. I, possessor of superior understanding and inferior means, am in better touch with my feelings.

Is that the be-all and end-all, the alpha and omega of human motivation? We are afraid to die. Does that explain all philanthropy?

What if people endow hospital wings because they want to provide high quality medical care for their fellow citizens? What if they fund research because they want to reduce human suffering? What if they endow libraries because they feel that making books available to more people for less money is socially beneficial? What if they feel that they need to give something back to a community or nation that has treated them well? And what if they like to have people slaver over them, kowtow to them, bestow honorary degrees on them, and treat them like modern-day Medicis.

Aren't these credible motives for philanthropy? I would hope so.

Perhaps I am not being entirely fair. Maybe I'm taking a sentence out of context and refusing to plumb its deeper existential meaning. If so, look at another example of really expensive insight.

A man is saying that he feels uneasy about whether or not he should spend $8,000,000 on a painting. (Funnily enough, I wrote a post called "But Is It Art?" about someone spending exactly $8,000,000 for a work of art. Check it out.)

Now his therapist is thinking that the man is just trying to impress him, so he replies: if you really want it, buy it. I daresay, this response is contemptuous. It is like saying: Do what you want... and don't bother me about it.

This therapist now goes to see his supervisor, who upbraids him for failing to explore his patient's anxiety. Given his superior insight-- that is what supervisor means-- he continues his thought.
He calls this spending a form of addiction and declares that addictions cannot be satisfied by gaining their objects. Then he says that the therapist is trying to comfort the patient's consumptive excesses. This is not a good thing because this compulsion is the patient's neurosis.

Do you feel that you are watching the blind leading the blind?

We should probably not be too harsh about the fact that this eminent psychiatrist has confused addiction with neurosis. If this patient is addicted, then he needs a twelve step program. He does not need to explore his anxiety.

The real confusion lies in the fact that when you are buying a painting or a scultpture, you are not spending, you are investing. You might be addicted to bespoke suits or orgies or heroin. You may spend your money or yourself indulging them. They are not investments. An expensive painting is.

But why not try a little common sense. The patient's uneasiness might be warning him that he is making a bad investment. Shouldn't this therapist and his supervisor know that their task is to help this man to explore all of the information he has about the painting, the art market, and his larger order to make the best decision? Would this not be better, and more respectful, than dismissing his unease with contempt and writing it off as pathology.

Take another example from the article. A highly credentialed Dr. Phil is working on his patient's moral dilemma. The tycoon is wondering whether he should work on a business deal or play catch with his 7 year old son.

The therapeutically-correct decision is to play catch. Thus, the therapist interprets: the man is afraid of playing catch because: "it's not an activity he can control or succeed at the high level of accomplishment to which he is accustomed." The patient has a control issue. The therapist has a problem formulating coherent thoughts.

I find this to be especially vapid. What if he wants to play catch but is facing a deal that requires his undivided attention because it involves the livelihood of thousands of people? What if his therapist has been guilt-tripping him for being a bad Dad? You can understand that this man would now be facing nothing other than a therapy-created conflict.

If this sounds a bit unreal, examine a somewhat analogous situation that was recently in the news. In July, 2007 two major hedge funds at Bear Stearns were in serious trouble. The firm was in turmoil. The situation required the undivided attention of top management. Yet, Chairman and CEO James Cayne was in Nashville playing in a bridge tournament. For seven hours every day he was giving his undivided attention to bridge. He could not be reached.

Fast forward to March, 2008. Bear Stearns is now on the verge of collapse. Is James Cayne, now reduced merely to Chairman, manning his desk? Not at all. He is at a bridge tournament, this time in Detroit.

You know the unhappy ending, especially unhappy for those who lost their jobs and their life savings when the company collapsed.

When balancing a business deal against a game of catch with a 7 year old, one should examine the level responsibility these wealthy people maintain. That, after all, is the rationale for their high incomes.

Take another example, this time of a politician with a control issue. The man in question has hired an expert to avise him on foreign policy. He does not like the advice he is hearing and wants to fire the expert.

Here the therapist intervenes. He declares that the politician has a control issue. How can he overrule someone who is more of an expert on foreign policy than he is? To this the politician replies: But I'm his boss. The therapist declares that this proves that the man has trouble giving up control.

The problem is: the world is full of experts, many of whom offer contradictory analysis and advice. Political leaders are charged with the responsibility of choosing among the different experts they consult. Their name will be on the policy; theirs will be the ultimate responsibility. How would a psychiatrist be able to take it for granted that a politician is wrong when he wants to dismiss an expert?

After all, Abraham Lincoln became a great war president by firing his generals. Would his therapist have told him that he had control issues?

The Times article declares that masters of the unvierse are ill-equipped to profit from talk therapy. Perhaps this is a good thing. Therapists seem to be bothered that these new patients are not like others who are equally rich but who inherited their wealth.

Heirs and heiresses tend to be depressed. They have trouble finding themselves, they are often disengaged from the world. They are great candidates for introspection.

The new tycoon are different. They are competitive and aggressive-- what a surprise!-- and they like to win. This makes them alpha males.

One wonders how many years of advanced training it took to understood that alpha males are aggressive, or even that they do not "open themselves to intimacy." Anyone who tells them that they need to get in touch with their feelings will be seen as an obstacle to their continued success. Such people are likely to be tuned out. No one gets to the top of a male status hierarchy by being sensitive and empathic, by opening himself to true love.

And we should be shocked that these experts in psychiatry do not know that becoming an alpha male causes an increase in serotonin levels in the brain. You would not expect this patient population to exhibit signs of depression.

Meantime, the therapists in question seemed to want to use their newspaper exposure to show that they are in touch with their own feelings. To set an example they confess that they feel chronically inferior to their patients, that they are jealous,contemptuous, resentful, and envious of their success.

Does this mean that these credentialed therapists possess superior self-awareness? Not at all. It means that they are whiners.

Can you imagine an attorney billing himself out at $600 an hour and feeling sorry for himself or feeling contempt for his client. He will likely feel happy to share in his client's success; he will want to share it. After all, he is part of the team. Therapists seem to have missed this point.

Of course, the article says nothing about how effective this expensive therapy is.

Fortunately, there have been some very wealthy public figures who have been up front about their experience of therapy. These people have clearly used therapy to overcome their intimacy issues and open themselves to love.

Take Woody Allen. While no one ever considered him to be an alpha male, this uber-consumer of psychotherapy capped off three decades of couchwork by falling in love-- with his son's adoptive half-sister.

But that is already old news. More recently, we have the case of New York Yankee third baseman, Alex Rodriguez, a man who is surely an alpha ballplayer. A few years ago A-Rod announced that he had profited immensely from a decade of psychotherapy. He liked it so much that he had two therapists. The result: he is so in touch with his feelings that he is now hanging out with Madonna in a Kabbalah den.

If that is what success looks like, I'd hate to see failure.


dave said...

Although I can basically appreciate your overall criticism of the stultifying practice of "psychobabble" by those $600 a session psychotherapists referenced in the article, the overall tone in your blog seemed to suggest an underlying bitterness and hostility. What gives? Has 30 plus years as a psychoanalyst in NYC in some way soured and disillusioned you to the profession of psychotherapy as a whole? I would be interested to know what happened to you. What were YOUR motives for leaving the profession of psychoanalysis and joining the ranks of the life coach? To maybe one day become a master (rather than slave) of the universe yourself? I'm simply curious.

Cheers, dave

Stuart Schneiderman said...

On my website I link to an article I wrote called, "That Night at Elaine's." Perhaps that will offer something of an an answer to your question.

dave said...

I read your article, "That Night at Elaines." It saddened me to read about someone who had lost his ideal, a person who had the formal sense of himself ruptured beyond repair. Your loss was crippling, yet maybe you rose too quickly out of the ashes in order to reinvent yourself. Is it not possible that by taking on the identity of life coach, you were seeking a too quick fix to your emerging nihilism and despair? Why not embrace the tension that confronted you? In light of your dissastifaction with and de-idealization of the profession of analysis, what I find most interesting is your tacit rejection of the "fuzzy thinking" of a man like Kohut, an empathic analyst who could be understood as fully acknowledging "the emotional matrix of all good relationships: humility about one’s self and tactful consideration for the feelings of others." Rather than renounce analysis all together, why not give it one more try. This time work harder to truly mourn the death of an intellectual hero, both yourself as well as he who you have idolized.