Notes on counselling
The therapeutic barter
Abstract
A full or partial therapeutic barter (non-monetary transaction) could not only fulfil economic obligations but could be creatively designed to be of therapeutic use and may not be limited to the economically disadvantaged only.
It all started when a pre-adolescent schoolgirl commented that it was wrong for me to take fees from suffering people who consulted me for counselling and therapy. In a way she was not wrong. Many existential problems that are dealt with today in counselling were presumably resolved in earlier times in spiritual and religious settings which had no commercial overtures.
However in the modern world of consumerism, it is Freud’s view, which even non-Freudians love to quote, that one should not only take fees but refuse to take negligible fees so that therapy is not under-valued and the risk of counter-transference can be averted.
Such Western standards cannot always be practicable in mixed economies like India where a section of the clientele have genuine difficulties in managing their finances. But the tradition of the guru-disciple relationship in India where the guru was always paid an offering through monetary or non-monetary means has been carried over in the therapist-patient milieu. It is very common in Indian settings for villagers to offer vegetables, fruits and even fishes to the therapist when they lack adequate monetary means of paying fees. People from the weavers’ community often present tokens like table-mats. A weaver couple I chanced to meet again two decades after I had treated them presented me a tablecloth with my name and my wife’s name stitched beautifully (my wife as a clinical psychologist had spent considerable time in counselling them along with me). They had prepared it twenty years back but had not come back after the lady who was the original patient had recovered. Yet they had kept the stitched tablecloth with love hoping that one day they would present it to me if ever our paths crossed again.
Afterwards I found a novel way to deal with such non-monetary transactions. Patients who were otherwise living lives full of boredom or who had become lethargic could be stimulated into doing something that required energy and at times creativity. A farmer who had frequent episodes of depression was encouraged to make special preparations of lentil (a Bengali delicacy) that had to be dried in the sun before being cooked. A youngster with artistic and musical talent but suffering from borderline personality disorder and substance abuse had to be kept under regular surveillance which could not be financially supported by his family. In lieu he was told to be present regularly in the clinic where he played music to the clients in the waiting room and participated in psychodrama sessions that were held twice a week. This arrangement could be maintained for a decade though there were ups and downs when his moods used to fluctuate and impulsivity surfaced.
There were also cases where due to social obligations, I could not take fees but I was presented with gifts that had some special appeal to me. I still relish the moment when a judge from whom I did not take fees presented me with plaster of Paris statues of Sri Aurobindo and the Mother.
These experiences led me to think if such non-monetary transactions could be used for therapeutic gains. It was then that I came across the remarkable hypothesis of The Economic and Therapeutic Barter (ETB) by Paul S. Rappoport. Though originally designed for clients who could not pay the full fees but only partial fees, a barter or partial barter could be worked out by the therapist-client duo that could simultaneously fulfil economic obligation to the service rendered while itself being designed in a therapeutic form. The phenomenon of barter would rest on its adaptive potential that would simultaneously reflect individualism and reification of an abstract therapy. It would be a novel way to reintegrate humanism and commercialism (1).
Selecting an item for barter is creating a commodity for the patient in a mutual decision-making process. “The commodity may be in the form of goods and services, have aesthetic or utilitarian value, or have great or little monetary worth(2).” It may include mechanical services like typing or helping in construction work, knitting, art-work, pottery, sculpturing, growing fruits and vegetables, helping in editing manuscripts, choreographing dance and organising dramas, poetry and music sessions, aiding in computer-based work like data-keeping, medical transcription or accounts keeping, helping in library work, assisting in clinic reception services and helping to organise rehabilitation programmes.
An optimal maturity in self-functioning is needed for patients who would be suitable for therapeutic barter. Psychotic subjects with disruptive self-functioning or delusional behaviour and mentally challenged subjects with immature self-functioning would not be suitable for therapeutic barter. Subjects with psychopathic traits and personality disorders could also back-stab the process and need to be carefully selected.
Rappoport gives a classic case study in ETB through his transactions with Steven, a middle-aged male with compulsivity disorder, seen in the aftermath of a painful divorce. He was the third and youngest son in a poor family and his father died in an industrial accident when he was three-years-old. He had no memories of his father and his home had no pictures and memorabilia of his father. His mother never remarried but was quite punishing and severe with him and he felt rejected by her. He began drinking from his early adolescence and continued to do so for the next twenty years during which he married and divorced. He somehow stabilised with the help of Alcoholics Anonymous and at the age of 45 sought to re-discover himself through counselling. He considered himself lonely and a failure in life and tried to deal with himself through compulsive and ritualistic behaviour.
As Steven’s meagre funds would have made it difficult to pay for therapy sessions, he was proposed an ETB alternative which he misinterpreted at first thinking that he would have to sacrifice what he valued most. After clarification he agreed but considered that he was too worthless to offer anything in barter.
After a few sessions he commented that the only thing he valued was his collection of musical records which he had been compulsively buying and preserving meticulously with indexing and cross-referencing but seldom listening. He had hundreds of albums which gave him pride and he could bring out any record in a minute as he had planfully preserved them well. He was an audiophile and enjoyed tinkering with his stereo.
It became clear that Steven could not enjoy anything he valued and in fact got more and more detached from all his valued possessions. The therapist talked about music and a possible barter. He was encouraged to explore getting closer to things he valued and re-integrate them into his life instead of being detached from them.
After a few sessions, Steven agreed to barter his music with the therapist. He agreed to provide the therapist with a list of recordings from which the therapist would select and Steven would provide two full cassettes per session. This arrangement continued till the termination of therapy.
The barter provided a way for Steven to apply his compulsivity constructively. Rappoport writes:
“It was paying for his therapy. It was now working for him rather than against him. He turned defense into coping, avoidance into acceptance. The music tapes provided him with an opportunity to prove himself…The album collection later came to represent an attempt to regain the lost father: that is to retain the father and albums alike in an idealised state.
“After some period of time, Steven became frustrated with the tapes. His own compulsivity became a burden…He became angry and hated the whole idea. Eventually he recognised obsessive-compulsive mechanisms elsewhere in his behavior, and he disliked them. He recognised how much time he spent putting everything but his life in order. As he progressed in therapy, he had less time (and less need) for his compulsivity. ..He found himself enjoying his music and was gratified by sharing it.. Steven once commented that, ‘The barter is more than payment — it’s the giving of pleasure. For me it means that putting effort into yourself can bring pleasure to someone else.’
“The barter became an integral aspect of therapy. It provided ego support and served as a perpetual source of interpretive material. During periods of doubt and uncertainty, it acted as an outstretched hand — as an anchor in rough seas (3).”
Thus, the concept of ETB carries some remarkable characteristics:
a. It overrides the tyranny of economics,
b. It reflects convergence with humanistic ideals,
c. It is existentialistic as the person and not one’s money assumes responsibility, and
d. It carries a creative therapeutic potential.
“The ETB programme, as an open-ended, indeterminate and self-styling arrangement between two people, carries the relationship to a new level of responsibility: utilitarian components parallel the creative; the conceptual and abstract balance the concrete; privately shared experience manifests itself publicly; the interpersonal struggle generates the intrapersonal confrontation; and with both a finite product and infinite existential meaning, the phenomenology of the barter becomes the therapy of the barter (4).”
The barter of course has resistances that have to be worked out and in certain cases the enormity of resistance may lead to termination of the therapy. It is also interesting that the phenomenon of transference may occur during the barter in a new denouement.
Can the therapeutic barter survive in an age where the economic factor is paramount? However human society moves in cycles and there was a time when non-economic factors were predominant. In ancient India, the economic man was “third in the scale”, preceded by the man of learning and the man of power and action (5). Today, the economic factor has come in front but that does not mean that in a progressive movement, non-economic factors might not dominate again. The aim of economics itself might shift from fostering a consumerist mindset to the encouragement of ‘the joy of work’ in consonance with a subject’s psyche and the facilitation of “free leisure to grow inwardly(6).” The therapeutic barter is not non-economic; it only gives a concomitant place to humanism while providing an existential perspective and a creative space in therapy. In fact, contrary to conventional practice, a therapeutic barter may not necessarily be related to the economically disadvantaged only; a partial barter could be creatively used in therapy with a client, irrespective of his or her economic background, to bring out hidden talents and facilitate re-integrative experiences.
References
1. Rappoport PS. Value For Value Psychotherapy – The Economic and Therapeutic Barter. New York: Praeger; 1982, p. 8.
2. Ibid., p. 62.
3. Ibid., p. 105-106.
4. Ibid, pp. 147-8.
5. Sri Aurobindo. Complete Works of Sri Aurobindo, Volume 20. Pondicherry: Sri Aurobindo Ashram Trust; 1997, p. 170.
6. Sri Aurobindo. CWSA, Volume 25; 1997, p. 257.
Dr. Soumitra Basu, a practising psychiatrist and member of SAIIIHR, is the Director of a school of psychology, Integral Yoga Psychology. He is also one of the editors of NAMAH.
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