Where we began: Class, disruption, and the heebie jeebies
Around ten years ago, while I (Talia) was completing my clinical training in a psychoanalytic counseling program and working at community mental health agencies in Chicago, I became preoccupied by a phenomenon that I keep seeing across various clinical settings: Everywhere that I went, therapists seemed to be doing a massive amount of mental gymnastics to rationalize professional practices that were financially motivated by persuading themselves (and, performatively, their trainees) that these actions were, in fact, wholly and exclusively determined by what was in the patient’s best therapeutic interest.
At the psychoanalytic institute, my classmates and I learned that a clinician’s fee needed to be set high enough in order for it to be “therapeutic”—charging too little, we were told, would be detrimental to the patient, who might unconsciously feel as though they were not entitled to inflict their suffering upon the therapist. Similarly, we were taught that the common policy among therapists in private practice of not accepting insurance was a matter of good patient care: cash-only transactions would ensure that the therapeutic relationship was intimate, confidential, and unmediated by third-party interests.
The same phenomenon occurred in community mental health settings, though it took a somewhat different form: In agencies, the types and amounts of services that clients could receive was heavily determined by Medicaid reimbursement regulations and yet, for the most part, therapists did not experience their clinical decisions as being constrained or compromised by these financial considerations. Instead, I observed, agency therapists found ways to apprehend those services that they were allowed to provide as conveniently coinciding with what was most therapeutically appropriate to the client’s needs and capabilities.
I came to theorize the apparent compulsion among therapists to produce elaborate discourses aligning their financially motivated practices with appropriate therapeutic care as a strategic yet inadvertent disavowal of political economy. Therapists do not engage in this sort of disavowal because they are ignorant, insensitive, or unkind. Rather, as I argue in an article that I eventually published on the topic, they unwittingly resort to political economic disavowal as a kind of coping mechanism that allows them to maintain a sense of themselves as moral actors with professional integrity in the face of impossible structural contradictions. Double-bound by a profession that prescribes upward mobility on the one hand and a selfless commitment to serving the underprivileged on the other, therapists at each stage of their career path—a path whose normative trajectory begins at an agency and culminates in private practice—attempt to manage the ambivalence that these divergent imperatives invoke by translating structural (specifically, money- and class-based) conditions that are outside of their control into morally principled agentic decisions—like charging a cash-only “therapeutic fee” or determining that a billable service is the most “therapeutically appropriate.”
The fact that therapists seem to have particular trouble talking about money and fees is hardly new information: Freud famously advised that psychoanalysts should model for patients a treatment of “money matters with the same matter-of-course frankness with which he wishes to educate them in things relating to sexual life,” adding that “it seems to me more respectable and ethically less objectionable to acknowledge one’s actual claims and needs rather than, as is still the practice among physicians, to act the part of the disinterested philanthropist.” Financial planners have even coined a local idiom to write about the phenomenon, diagnosing mental health professionals as “money avoidant” and publishing studies reporting on the profession’s “significantly lower levels of financial health” when compared to other occupations.
But it isn’t only therapists who are uncomfortable talking frankly about money, the systems and labor relations that structure its distribution, and its bearing on an individual’s social status. When it comes to thinking about ourselves and our life experiences through the category of class, Americans in general seem to have a tendency to—as my ten-year-old would put it—*die of cringe*. We could certainly point to a number of plausible historical, political, and ideological reasons for our aversion to class as an analytic in the United States. The notion of a class system connotes the existence of an aristocracy and fixed social status positions that are determined by birth rather than merit. It is, therefore, antithetical to America’s foundational ethos of rugged individualism and self-determination.
And yet, as much as Americans—and American psychotherapies—may attempt to disavow the reality of our complex class system and other structural constraints on personal autonomy, most of us have had moments or situations in our lives that gave rise to an acute and often unpleasant experience of class consciousness. In this special issue, we begin from the supposition that those moments, and the feelings of discomfort that they induce, are good to think (and write) with. Our project got started several years ago, when one of the chairs of APA Division 39 (Society for Psychoanalysis and Psychoanalytic Psychology) invited me (Talia) to organize a session on money, class, and psychoanalysis for the division’s 42nd Annual Spring Meeting, the theme of which was “Our Beautiful Struggle: Destruction, Creation, and Psychoanalysis.” Guided by the conference’s call to “reckon with our collective vulnerabilities and collective responsibilities” and to center the perspectives of the many who “[feel] unseen and unheard within professional psychoanalysis,” we aimed in our roundtable session to force attendees—particularly the more traditional and established analysts in the room—to not only theorize but also have to feel and confront the tensions around class and psychoanalysis that we were discussing. We opened the session with an odd sort of “icebreaker” activity: Inspired by an essay on conflictual emotions and class consciousness entitled “That place gives me the heebie jeebies,” one of our panelists led everyone through a series of multiple choice and open-ended questions, with attendees’ (anonymous) responses displayed in real time on a large screen at the front of the room. The questions included:
- What type of retail store gives you “the heebie jeebies” or class consciousness feelings? ____
- I am partnered with someone from the class I grew up in: (yes/no/not sure/never thought about it/The source of all our relational tensions/I’m afraid to bring consciousness to this)
- I am partnered with someone who shares the class I am settled in now: : (yes/no/not sure/never thought about it/The source of all our relational tensions/I’m afraid to bring consciousness to this)
- My personal income range is: (less than $40K/less than $70K/less than $90K/less than $100K/less than $200K/more than $200K)
- I am still paying off student loans: (until I die/never had them/My loans were paid off before student debt became what it is now/I didn’t need loans)
- My class status has fluctuated wildly in my life: (yes/no/up and down/chaotically/stable through my life/marriage gave me upward class mobility)
- My most shameful memory of class is ___?
- The most shameful decision I made based on class was ___?
The exercise, and many of the roundtable participants’ contributions that followed it, aimed to disrupt attendees’ expectations about the perspectives they would encounter, the feelings of discomfort, shame, or vulnerability that they might open themselves up to, and the collective mood that would permeate the room. At the scene of a professional psychoanalytic meeting–where conference-goers could reasonably expect to spend 105 minutes occupying an emotionally detached subject position while passively receiving “expert” knowledge communicated in the impartial registers of academic scholarship or clinical case study–we offered poems and and personal narratives that moved attendees out of a comfortably intellectual stance and confronted them with the raw pain, shame, ambivalence, awkwardness, disappointment, and hope of providers and patients. It is through the disruption of our habitual ways of orienting ourselves and doing things, we believe, that tacit politics and power dynamics embedded therein are denaturalized, made visible, and perhaps dismantled or transformed.
Art, feeling, and form in the psychological humanities
We situate this collection of writing within the psychological humanities. I (India) first became aware of the psychological humanities through Mark Freeman’s work, which considers what psychology might learn about the psychological from literature. Broadly speaking, the psychological humanities refers to a transdisciplinary movement committed to exploring the ways that the arts, arts-informed understandings, and literary principles can help us reimagine the discipline of psychology and offer unique insight into human subjectivity and human lives as they are actually lived. Work in the psychological humanities suggests that by drawing on art and literature, the discipline of psychology can become more felt, lived, and faithful to its subject matter (see also Freeman 2011).
While natural science psychology bisects and trisects psychological experience into ‘objects’ of study, the arts can acquaint us with the qualities of that experience through expressive works that are themselves experiential. These works reflect life back to us and we experience it again, a little bit differently each time. We learn and change with each iteration.
Teo (2017) writes that the need for the psychological humanities can be found in the psychological paradox that psychological phenomena have both physiological and first-person meanings. To understand the physiological, we must put aside our subjective impressions, but to understand the first-person, we must mine them.
While the writing collected in this special issue is diverse, each piece is an unapologetically personal and expressive account of psychoanalysis, money, and class that treats subjective, emotional, embodied experiences—like getting the heebie-jeebies—as significant, distilled expressions of larger sociopolitical dynamics. And these dynamics are expressed not only in the subject matter of the essays and poems collected here, but also in how they are written—in their form.
Whereas formal concerns go unaddressed in most academic writing in psychology, they in large part define literature and the arts. And the strength of a piece of expressive writing does not so much emerge from what a writer says as from how she says it—from the sonic interactions between her choice of words and their arrangement; in the personality of her written voice; in the ebb and flow of her narrative over time. Further, it is a piece of writing’s formal properties that engage us emotionally and that evoke a quality or sense that we can feel—because they speak to us in the same experiential register in which we live our lives.
Description versus evocation
If I don’t understand or know much about something, I may ask the person to whom I am speaking to “describe it to me.” And once he has put words to it (or on it) I will hopefully get closer to knowing what it is. “Description” is derived from the Latin word describere—meaning to write down, transcribe, copy, or sketch. It is explicit, tangible, specific, delimited, and defined.
A description characterizes an experience by accounting for it in greater or lesser detail. It can inform us about an experience—what to expect, what to prepare for—but it can’t necessarily make us know that experience in our bones. That is because a description happens mostly “in our heads”; it is a string of words that we hear, speak, write, and remember or forget. It is crisp black lines on white paper, a paragraph of text on a page. A description is successful if I learn something from it; if it tells me something about that thing that I didn’t understand or know. But a description is a one-way street—it does not require a comingling of consciousnesses. An evocation is different. It is social—it demands two.
Derived from the Latin word evocare—meaning quite literally “to call out from,” evocation has meant everything from the act of bringing something into consciousness, to eliciting a response, to invoking the spirit of a deity. An evocation passes through the air—as breath or call. It is invisible but palpable—like heat. An evocation is never “too on the nose” but brings us closer to something by reminding us of it, suggesting it, relying on our powers of association. Perhaps most importantly, evocation operates on the level of feeling. When we evoke, we enable someone else to feel something we have felt for themselves. We bring it into the room.
Evocation is spatial, embodied. Situations are evocative. We can place ourselves inside them. Metaphors are situations. So are personal narratives. They play the situation out so that you can feel it. Evocation gets close to an experience, holds true to it. When language is used to evoke, as it is in the essays and poetry that follow, the sounds matter, the arrangement of words matter, our senses and our feelings matter.
The case for expressive writing in academic and clinical psychology
Politics live not only in the realm of ideas but in the viscera of the body. People are made uncomfortable in moments when questions around justice find their felt counterparts. We do not only know “right” and “wrong” as empty ideas; we embody them as feelings. When we make others feel something, we are allowing them to know what we feel in an important way. When we feel things, we know where “we stand.” There is no lying when we get the “heebie jeebies”—we reveal ourselves and we are ourselves.
Mark Freeman has argued that an important distinction between what he calls informational scientific discourse (e.g., a scientific article) and literary discourse (e.g., a novel) is that while both can inform, only literary discourse can transform. This transformation is possible because literary discourse engages us not only as thinkers but as feelers and has not only the aim of increasing our knowledge, but also of increasing our sympathy and compassion.
While informational scientific discourse conforms to a standard of distance, objectivity, and emotional neutrality, the first-person expressive writing that characterizes this special issue was written in the trenches, in the moment of the experience itself, and from the felt responses of the writer—emotional, corporeal, behavioral—which that moment provoked. When reading the works herein, the reader can imagine herself in the writer’s shoes, in her experience—can feel touched, puzzled, awoken—and in so doing will have had an experience herself.
While informational scientific discourse focuses on the “what” of its subject, expressive writing offers us a sense of its “how.” How it felt to be that particular person on that particular day, how it was to be a patient or a therapist, to be apprehensive or abiding. What it was like. When expressive writing brings us closer to what an experience “was like,” it brings us closer to the truth of that experience in all its nuance and particularity—it is faithful to the experience. In this sense and as Freeman has argued—when a piece of writing becomes better art, it inevitably becomes better science.
A summary of contributions (by theme)
Emotional Economies
Among other things, yet irrefutably, psychotherapy is an economy in which the fee is both a literal and symbolic structure of power and in which money, value, and worth intertwine with love, care, and dependency. This special issue brings together essays and poetry that use personal lived experience to untangle and interrogate this power
Emotional and financial exchanges run throughout the work presented here—care and commerce circulating in the same psychic field. In my poem, I (India) conjure a therapist who runs on the “unharnessed energy” of her patient’s suffering. And each piece, in its own idiom, expresses a longing for a therapeutic and social practice that could escape, or at least have some distance from the economic determinism in which it is situated, even while acknowledging—as Eli Nova Rose does in her essay—that there is “no outside.”
Money and psychotherapy are strange bedfellows. When you think about their intimacy it is enough to make you squirm in your seat. Think of the expressive writing in this special issue as the textual expression of that squirm…
Workers and Consumers
Therapists, among other things, are workers—as Benjamin Fife, Carter J. Carter, and Lainie Goldwert have foregrounded in their essays. Through autobiographical vignettes, Goldwert gives the reader a feeling for the financial precarity of the analyst-in-training who struggles to make ends meet within an exploitative internship structure. Offered what seems like a desirable psychoanalytic postdoc position at a low-cost psychotherapy clinic, but unclear how the other postdocs support themselves on such low pay, Goldwert is told that, in fact, the other postdocs do not support themselves on such low pay, but with financial contributions from family members of means.
In his essay on labor organizing and psychoanalytic reform, Fife reframes analytic labor itself as political labor, requiring solidarity and structural awareness. And Carter, after characterizing a field of economic exploitation and corruption within social work training, and the dwindling viability for agency employment with benefits, describes their “Robin Hood Practice” as an independent clinical supervisor as “important for the overall health of the clinical ecosystem.”
Rose and I each share our experiences as therapy consumers in which psychotherapy is both another commodity, and always something beyond that. In my poem, I summarize my therapist’s ‘value economics’ and the emotional weighting of the sliding-scale: “We value what we pay for, you reason, but you will slide your scale for me.” Rose, meanwhile, argues that patient-consumers are inevitably more vulnerable in this economy than clinicians are because there is “rarely any guarantee of what you get from therapy, as a patient,” but “there’s almost always a guarantee of what they get, the clinicians—they get paid.”
Shame
Many of the writers here narrate the uneasy relationship of money and class to psychoanalysis from the very pit of their stomachs, from where their breath has caught at the back of their throats. In their work, the feeling of shame bridges the false divide between body and mind; emotion and thought. Rose writes about the moment in which economic stress put salt in her insecure therapist’s “ego wound” after feeling publicly humiliated by a negative review on Google, and also about her own palpable longing for the refuge that therapy both tantalizes and, in the context of its economic enmeshment, can never fully provide.
Goldwert argues that shame plays a powerful role in shaping the psychoanalytic clinician’s identity development and her relationship with the business of doing therapy. And she recalls the “fuzzy, sinking feeling” that she felt after her new training analyst told her that given her education and professional credentials, she should be able to pay the analyst a higher fee. What does the lower fee say about her, her own issues, her self-worth? Something, the training analyst says, that she can get to the bottom of and resolve in analysis. Goldwert writes that “part of me attached to this pathologizing idea: there was something deep within that was causing me to be broke.”
It has been said that shame thrives in the shadows and in silence—and Amber Trotter’s essay tells us about the significant silences she has experienced around class. Starting in childhood, Trotter traces her personal experience of class and money—from the “formative moment” in which her father chastises her for bringing the topic of money into “polite” conversation to her adult life as a psychoanalytic psychotherapist whose ability to “pass” as similarly wealthy in front of her wealthy patients simultaneously renders both her actual childhood and true adult class status invisible. While she has complex feelings about passing, ultimately, anger emerges—she wants to be visible.
In some sense, the need for psychoanalysis has shame at its core.
After all, psychoanalysis, psychodynamic therapy, and related forms of psychotherapy all provide a context for the expression, exploration, interpretation, and containment of feelings and thoughts which the patient (and perhaps the society) perceives and treats as shameful—thoughts that you do not speak of much with others. Rose describes her fondness for the confessional aspect of therapy: “I love how therapy can become a repository of dirty secrets about the self and the society, about unspeakable things, cravings, taboo wishes, hatreds, unavowable fantasies, traumas and everything else that’s difficult about living.”
Politics
Some of the writers in this special issue ask how, if, and when psychoanalysis can be politically radical and about avenues for meaningful change. Rose starts her essay by pointedly asking this question, and while she acknowledges the fact of therapy’s economic enmeshment, she makes the keen observation that “therapy’s very existence is…a critique of society.”
Fife argues that social change requires concerted effort, careful thought, and skillful action: “The idea that change will come spontaneously in either mental life or in an economic situation is a myth that often
inhibits groups of people from analyzing their circumstances and assessing the most effective ways to actualize needed changes.” Better theory will not spontaneously produce social change, he contends; instead, collective economic analysis and strategic organizing must be engaged in making psychoanalytic work both sustainable and accessible.
In their polemic on the for-profit takeover of social work training and the commodification of psychotherapy, Carter traces how private group practices and venture-capital-backed therapy companies have supplanted agency-based social work, exploiting both trainees and patients. And they unpack how capitalist logics distort the functioning of social work supervision, mentorship, and ethics. Carter advocates that social workers “go public” by returning to public service work at agencies and nonprofits, and by making their voices heard about this crisis in social work training and provision.
In an ethnographic essay drawn from her experience as a counseling intern at an agency while also a trainee in a psychoanalytic training program, Weiner observes that agency interventions fail to recognize their clients “as distributed, relational beings with concomitant entitlement to affective porosity and ongoing support” and instead uniformly direct clients towards self-sufficiency and independence. Rather than reflexively understanding client subjectivities as natural and essential, Weiner enjoins clinicians in both private and agency practice to see and understand their “clients’ selves as produced in and through a web of historical, political, material, and structural forces.”
Class Consciousness
When I (India) was in social work school preparing for my first field placement, we were advised to dress in such a way that we did not make our clients uncomfortable. At the time this meant that we were not to dress in a sexually provocative manner or let our tattoos show. Surely other things might make our clients ill at ease, I thought.
I never remember being instructed not to dress “too rich.” But as a therapy patient, the manicured nails, sizable diamond rings, elegant designer clothing, and Upper East Side addresses of many of my therapists have made me feel conspicuously poor in their presence. In my poem, I write about a comparison of clothing which brought about an acute episode of class (self)-consciousness in me: “You wear the silky blouses that tell us that you matter. Those of us that need you. I wear sneakers with undone laces. I bought them in the Bronx.”
Rose writes of a similar experience when going to see a psychoanalyst for couples counseling: “[H]er fancy office had its own wing at her $1.8-million-dollar home in Southern California. I felt a little bit intimidated by that office: a kind of class intimidation.”
In her essay, Goldwert characterizes herself as “precariously classed.” While in my essay, I write about my family culture in which the notion of class was unpaired from money and from worth. We were almost classless—a notion that only those of some means can indulge.
Trotter describes a lifelong class awareness that she brings to her clinical work with a wealthy demographic for whom class is an apparent non-issue: “My patients seem to implicitly assume that I occupy the same class position that they do. They reference financial privileges and challenges as if we inhabit the same world.” She writes that these assumptions of class-sameness go along with an overall imaginal disengagement in which fantasy, projection, mentalization and other analytically useful activities are less active.
Rather than describing her own class consciousness, Weiner narrates the experience of being split between two differently classed worlds—the elite world of private analytic psychotherapy training, and the proletarian world of agency mental health treatment: “[M]y life began to trace a circuit, week after week, traversing some of the nodes of greatest affluence followed by the of poverty and abandonment that comprised the city’s psychotherapeutic landscape… shape-shifting to inhabit and disinhabit the role, the practices, the very forms of selfhood and relationship that each of the spaces demanded or allowed.”
Elitism
Rose points to critiques leveled by Michel Foucault in the 1970s against the power and affluence of the old guard of psychoanalysis—“the clinical elites”—analysts with country homes like Jacques Lacan’s La Prévôté. And she states that while there are chinks in its armor, “this elitist therapy establishment is not altogether gone.”
Fife identifies elitism as part of psychoanalysis’ economic problem—a therapy for the well-to-do few: “Currently our livelihoods depend largely on supporting the mental health and social reproduction needs of the Professional Managerial Class and the very wealthy.”
Goldwert writes that just as a “too low” fee can summon the specter of low self-worth, a fee that is perceived as “too high” can suggest a clinician’s grandiosity. And “[a] desire to avoid these perceptions conflicts with a desire to situate ourselves as elites who have come far from scraggly training days.”
Lastly, Weiner narrates her life in clinical training as alternating between two worlds—one, everyday; the other, rarefied. And she expresses something powerful about the classing of therapeutic interventions by contrasting how agency clinicians are expected to make use of themselves—to accompany and assist their clients in accomplishing myriad day-to-day tasks—from the “use of self” that she was inculcated into through her psychoanalytic psychotherapy training, in which she and her fellow students were instructed to use “our selves in ways that allowed us to learn about, empathically attune to, and promote change in our patients through the flow of affect across the boundaries of our porous subjectivities.”
