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J Psychother Pract Res 9:142-148, July 2000
© 2000 American Psychiatric Association

Regular Article

Inadequacy and Indebtedness

No-Fee Psychotherapy in County Training Programs

Robert Geistwhite, M.D.

Received October 27, 1999; revised March 8, 2000; accepted March 9, 2000. From the Harbor/UCLA Medical Center, Department of Psychiatry, Box 498, 1000 West Carson Street, Torrance, CA 90509. Send correspondence to Dr. Geistwhite at the above address. e-mail: RGEISTWHITE{at}medscape.com

The nature of the fee arrangement has significant influence on the psychotherapeutic process even when there is no fee. Given the large number of psychiatrists who receive at least some part of their training in the public system, understanding the no-fee arrangement is vital to the psychodynamic training of future psychiatrists. Following a brief overview of the meaning of money and the fee arrangement, various scenarios are considered under the headings of "inadequacy" and "indebtedness." Although similar dynamics may be present in other public and private settings, attention is given to the county training program, with the intent to assist psychiatry residents and supervisors in their awareness and understanding of the psychodynamics of psychotherapy without fee.

Key Words: Fee • Psychotherapy Cost • Residency and Training




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