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这是一门手艺:精神分析付费的评估、道德及社会意义。

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

作者信息

Fridman Daniel

机构信息

Department of Sociology and Lozano Long Institute of Latin American Studies, University of Texas at Austin, 305 E 23rd St, A1700, Austin, TX 78712-1086 USA.

出版信息

Theory Soc. 2022;51(1):1-29. doi: 10.1007/s11186-021-09450-4. Epub 2021 Jun 23.

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.

摘要

本文探讨了阿根廷布宜诺斯艾利斯精神分析学家的收费与支付方式。精神分析学家并不使用明确的滑动收费标准,而是在与患者的交谈中就费用达成协议。这种协商遵循一些送礼的原则,各方试图给予更多,而不是通过竞争性讨价还价(一种反向集市)。借鉴货币、道德与市场社会学以及估值研究文献,我区分了四个因素来解释这一现象:1)一些正式制定的价格以及市场机制构成了收费的基准,但心理学家提供的特殊服务(这使得质量判断困难)、患者与治疗师的匹配方式以及缺乏关于价格的公开信息,使得定价具有高度灵活性;这些是在关于费用的交谈中未明确提及的结构因素。2)一种专业叙事强调对患者的责任不应受到经济利益的影响。3)精神分析学家对支付意义的阐述,这应反映每个患者的独特性以及分析师与患者之间的关系,并象征患者对治疗的承诺,涉及超出经济范畴的成本和损失。4)现金支付普遍,面对面且无中介,这有助于使分析师非神圣化,并将诊疗过程与分析师的其他经济生活区分开来,但阻碍了交易逃避道德审视。精神分析中的支付是微妙的安排,分析师常常对估值和支付感到压力。他们必须谨慎确保这种灵活性能带来道德上可接受的交易。

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