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Paid Friendship: An Unorthodox Guide to Achieving Mental Health (March 2021) by Dr. Michael A. D’Anton came up as a recommendation on my Amazon feed. I was curious about it because I had heard of the expression “paid friendship” used to describe psychology in general. The book specifically applies this term not to all psychology, but to “weekly psychotherapy sessions devoid of any therapeutic interventions and dedicated to making the therapist rich by years of non-goal directed sessions that do little to challenge the psychopathology of the patient.”
While the focus of the book is on unlicensed practitioners, I have found the concept of the paid friend to be pervasive in psychology among licensed professionals as well. I think this is one thing that tends to shock new psychologists who are just coming out of their training programs. When it comes time to observe supposed seasoned professionals, it can be shocking how often all that they are doing is having chit chats with their clients.
What’s so bad about having a paid friend?
There is nothing wrong with paying for friendship if that is what you want to do. The hazard is having a paid friend when you think you are getting therapy. While it might be fun for both the professional and the client, the client is not actually challenged to get any better. In the long run it could be very frustrating. You (the client) could spend a lot of money and come away with the impression that therapy is not very helpful or useful. Additionally, you might become dependent on your therapist. You might come to depend on your therapist for social support. In reality, a good therapist should empower you to go out and find your own social support.
A good therapist aims to make themselves obsolete to the client. I have heard some psychologists worry that they might lose their client base this way. I don’t think there is basis in such fear. Sadly, I think there are enough mentally unhealthy individuals to go around. However, if mental health professionals suddenly become so competent that they end up curing all their clients and have to go into a different line of work, would that really be so bad?
I think one of the problems is that, in most systems throughout the world, there is simply not enough money allocated to mental health care. For example, I live in Canada, and I can go to the doctor and not pay a fee. However, if I want to go to a psychologist, the standard fee is $200 an hour. I’m not saying that psychologists don’t deserve that money. I’m saying that it seems a bit strange to me that people who are in mental distress are not considered a priority by the healthcare system. (To be totally fair, there are psychologists who are covered by free health care in Canada, but they are very hard to come by, and one usually has to be extremely mentally ill before one can get such care.)
So, how do you know if your therapist is a therapist or a paid friend? There has to be a certain amount of rapport building built into therapy or how can you possibly make progress?
I think the answer is that if you are feeling very comfortable and contented in therapy, it is probably not therapy. On the other hand, you shouldn’t feel uncomfortable with your therapist. There’s a subtle distinction there.
The process of therapy is not comfortable because change is not comfortable. If you want to feel better, chances are you’re going to have to do things differently. That means changing in some way. When we change we have to examine things about ourselves that are not necessarily things we want to examine. It can be fascinating, and it can be a wonderful learning experience. However, it is seldom fun.
Also, therapy need not go on and on and on and on for years. Some people might need a lot of therapy. Some people might have been through extensive trauma, and they might need to work on many issues, and these might actually take years to go through. However, for most people, a series of sessions is necessary. It might be five to 10 sessions. Or it might be more. However, it is unlikely that most people need to continue going to therapy for years.
Your therapist should have some sort of a plan. He or she should have an idea of how you might get better. And, depending on their style, they will let you in on this plan and, in most schools of therapeutic thought, you should be part of the process in devising this plan. There should be goals. A lot of people don’t like therapy homework, but often it is homework that makes therapy the most effective.
For example, with cognitive behavioral therapy, determining what your negative “automatic” thoughts are is the first step in combating them. So, if you neglect that homework, you don’t have much to work with in therapy. If you absolutely hate homework, a good therapist can usually work around it. However, you’ll get more out of therapy if you do the homework. The point, however, is that if your therapist is not even trying to give you homework because they think you might like them less, you have a problem.
In my opinion any therapist who is primarily concerned about retaining clients is not really doing their job. That is why this book was like a breath of fresh air. It’s the first book that I have seen that blows the whistle on this whole process. There are many therapists out there who are making a sincere effort to help their clients to get better.
Unfortunately, there are also therapists out there who are just chatting with their clients and making it so that their clients feel okay about not being okay. Is that helpful to some people? Maybe. And if that’s all that a client wants — validation for staying the exact same way — and if the client wants to pay money for that — who are we to say that they shouldn’t?
However, I think that a lot of people don’t realize that that’s not what therapy is supposed to be. There are so many therapists out there doing this that a lot of clients don’t know that they could be getting better therapy. A lot of clients don’t know that they could be getting better.
I have heard people who are severely depressed who don’t believe that they could ever not be depressed. And many of these people have tried a variety of medications and have tried a variety of therapists. And I suspect that many of the therapists that they tried, unfortunately, did not truly understand depression. Because, although it is not easy to treat, it is definitely a treatable illness. And most people who suffer from depression can find relief. And most good therapists can help them to find some relief at least.
However, one difficult thing is that when a person has some sort of mental illness such as depression, borderline personality disorder, bipolar disorder, or any other disorder, or a mix of disorders, it is often difficult to hear what a therapist has to say if it is not 100% positive. This is partly because we are very vulnerable when we go to therapy. And maybe this is also because part of us feels silly for suffering for so long when there actually was a way out.
But we would not feel silly. Going to therapy is a very brave act. And standing up for oneself when one is not well mentally is extremely difficult. Also, knowing whether other people are right about our mental condition or whether we are correct can be difficult. Sometimes, a therapist will say something that challenges us. And we don’t know whether the therapist is correct or whether they are way off base.
My suggestions for that type of situation is that, when a therapist suggests something that seems really off, give it some consideration, but also consider that they might be wrong. Consider both options. If you blindly follow what the therapist says, you might go down the wrong path. You know yourself best. And therapists can easily be wrong.
It is important, however, to remember that change is uncomfortable. And when a therapist suggests something that feels off, it might be because they’re wrong, or it might be because it is an uncomfortable truth that you’re not quite ready to face. A good therapist will back off if you insist that something is not true for you. Even if they’re still pretty sure that it is. They will recognize that you’re not quite ready to hear it yet.
A less competent therapist will try to push their own agenda. Or will push no agenda at all.
The point is if therapy is too comfortable, it’s probably not therapy. On the other hand, if it’s extremely uncomfortable, it might not be the right therapy for you. And it’s really hard for anyone who’s not there to say what’s right for you.
Ultimately, you have to come to your own decisions about things. You might wonder why a paid friend might be a bad thing, assuming one can afford a paid friend. And the reason is because it robs the client of the opportunity to have real therapy and real growth.
Most psychological problems can be overcome. I don’t mean that you can necessarily get 100% better, but you can learn to reframe the way that you think about things. You can learn to feel a little better in some ways. And if you can feel 10% better one year, maybe the next year you can feel another 10% better, and so on and so on.
The point is to use therapy as a tool, not as a crutch. And I suppose if the only therapist you can find is a crutch for you, that’s better than nothing. Sometimes, we need a crutch for a while. However, it is much better if we can use our time in therapy wisely and learn new tools to solve our own problems. Ideally, therapy should be empowering. It should help teach us how we can lead better lives.
And one thing that I take issue with in this book is the distinction between licensed and unlicensed professionals. I take issue with it because I think that some people are inherently healing and able to provide tools to help others. And I think that some people who are “life coaches” can provide more value and therapy than some who are licensed professionals.
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