Some of our most intense emotions are prompted by money. We are quick to anger when we feel swindled or ‘done’, instantly offended when we are overcharged or taken advantage of. 

I found myself pondering this after a recent supervision session! At the end of our hour together, I reach into my wallet and pay for her good offices. Something about this upsets me quite profoundly. This is part of my learning, something I am required to arrange; why do I have to pay ‘extra’ for it?

Of course we all pay for our education – now more than ever – but the crude monetary exchange is taken care of under the umbrella of ‘fees’. The undergraduate does not tip her tutor, the junior doctor does not dip into his white coat pocket to pay the registrar after the ward round so why am I forced to pay for, then report back on, this part of my learning?

My supervisor was chosen from an approved list supplied by the university – so surely the university could collect the supervision fee as part of the four figure course fee and distribute it themselves. Paying live makes me feel inveigled into a closed shop. Because hard cash, counted out live is an altogether different animal from the huge course fee. Consider the mortgage. How many of us know exactly the amount of the capital sum borrowed? It is so high, we tend not to give it much thought; it does not affect us. But the monthly rate we are charged on the interest, we are aware of, because that is money we can weigh against alternative purchases. My supervision fee looked, as it left my hand, like a takeaway curry, a trip to the pictures or a crate of beer! The conclusion I am forced to come to, which is an indictment considering the course we are on, is that this payment methodology is just poor psychology!

But something else happens in this exchange which might encourage us to look at the set up of counselling and therapy generally, that is to do with what happens to the relationship when one of you is paying the other. From the outset let me declare that I have gained a lot from my individual supervisor. To measure my interventions against the opinions and experience of a long-standing professional has been really valuable and a key component of my learning.… but, because I am paying for her advice, I know that my standards and expectations alter – I am looking not just for a valuable experience, but for ‘value for money’, so I am reacting less as a colleague and more as a consumer.

Scratch the surface of counselling’s seeming altruism and we find the market mechanism hard at work. Lord Layard’s rationale in devising and launching IAPT suggested that it ‘would positively impact on the number of people who are fit to work’, and effect ‘savings for the DWP’. Subsequently, CBT has been the therapeutic approach of choice because it is short term and auditable (something economists tend to insist on). The economic imperative is everywhere. It is also true, as perhaps in my own case, cast as consumer to my supervisor, that the presence of a monetary factor undermines the declared aims and conditions of the therapeutic relationship. As counsellors we set out to enable clients to realise their own strengths, but by paying us, perhaps the client is encouraged to think of us as provider and therapy as commodity. Conversely, the London Association for Counselling and Psychotherapy are looking at the high incidence amongst NHS patients of DNAs and clients who do not complete courses of therapy provided free of charge – can this be related to a counselling marketplace? A judgement that if the therapy is free, it cannot be any good? 

Approaching our second year, it feels as if this band of budding counsellors has outgrown altruism. Our minds turn to making a living; there is more declared interest in CBT, and for myself, I recognised another thought in my reaction to parting with my £20 notes….how do I qualify to be a supervisor?

The question of how the market influences the practice of counselling is intriguing, but seems to fall into the territory explored in the recent Reith lectures delivered by Professor Michael Sandel on ‘The Common Good – Towards a New Citizenship’. He provides food for thought with the epithet – ‘There are some things money can’t buy; and there are other things that money can buy, but shouldn’t.’

Some details have been changed to protect identities.