This is a handcraft: valuation, morality, and the social meanings of payments for psychoanalysis

Abstract

This article examines valuation and payment practices of psychoanalysts in Buenos Aires, Argentina. Psychoanalysts do not use explicit sliding scales but rather reach an agreement about fees in conversation with the patient. This negotiation is conducted with some principles of gift-giving, where parties try to give more, rather than through competitive bargaining (an inverted bazaar). Drawing on the sociology of money, morals and markets, and valuation studies literatures, I distinguish four factors to explain this: 1) Some formally produced prices as well as market mechanisms shape benchmarks for fees, but the peculiar service psychologists offer (which makes quality judgments hard), the way patients and therapists are matched, and the lack of public information about prices allow for high flexibility in price-setting; these are structural factors that remain unsaid in the conversation on fees. 2) A professional narrative that highlights a responsibility towards patients that should not be contaminated by economic interest. 3) Psychoanalysts’ elaborations on the meanings of the payment, which should reflect the uniqueness of each patient and the bond analyst-patient and symbolize the patient’s commitment to treatment, involving a cost and a loss beyond the economic. 4) The prevalence of cash, face-to-face payment without intermediaries, which helps desacralize the analyst and disentangle the session from the rest of the economic life of the analyst, but impedes evading moralization of the transaction. Payments in psychoanalysis are delicate arrangements, and analysts often stress about valuation and payments. They have to be careful to ensure this flexibility results in morally acceptable transactions.