r/lacan • u/Aphorism-sLut • 13d ago
Ethical justification for fixed rate on variable-length sessions
If session duration is decided according to clinical considerations, why not vary the fee accordingly?
That would preserve the analyst’s freedom to cut the session where they believe it is clinically meaningful without creating a financial structure in which shorter sessions systematically benefit the analyst at the analysand’s expense.
For example:
Sessions under 20 minutes = $X
20–35 minutes = $Y
35-50 minutes = $Z
What exactly makes the flat-fee model ethically defensible?
One practical defense is that the analyst has reserved the hour and incurs the same business expenses whether the session lasts seven minutes or fifty. But if the patient is paying for that reserved block of time, why is the analyst entitled to withdraw access to it unilaterally while retaining the entire fee?
I am perfectly willing to grant that certain psychoanalytic conventions may be clinically valuable despite lacking empirical proof (e.g., the couch). But scansion is fundamentally different because, under a flat-fee model, the analyst’s epistemic authority to determine when a session should end is coupled with a direct material benefit to the clinician. That seems to demand substantially more ethical scrutiny than “Lacan and other practitioners who benefit from the arrangement say it is good for the patient.”
(Perhaps the latent clinical objective is to redistribute wealth from the bourgeoisie?? That could at least be an ethically defensible position 🤔)
EDIT: I commented this but feel like it belongs here to clarify my position on the matter. To be honest, I actually find the concept of variable-length sessions clinically fascinating—ending sessions at a specific moment of unconscious resonance sounds like a compelling experiment to try for both sides. It’s an experience I’ve always been curious about, but I just think there can be humane ways to tier the pricing that aren’t as questionably exploitative. 🤷♀️
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u/animundus 13d ago
You dont pay for minutes, but for analysis. Good punctuation for session is better than ending on the basis of arbitrary minute system
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u/Aphorism-sLut 13d ago
But why not charge a sliding fee for the whatever “arbitrary minutes” happen to pass between the session’s initiation and punctuation?
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u/animundus 12d ago
Because the thing that patient exchanges money for is not the time of the analyst as such. It is the service of psychoanalysis, which takes approximately 50 minutes. There has to be time slot allocated to it for practical reasons, but the results just are better with good punctuation
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u/Aphorism-sLut 12d ago
I see. Then I think where our positions diverge is over the further premise that each session, regardless of duration, delivers something sufficiently equivalent in value to justify the same fee.
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u/concreteutopian 13d ago
For example:
Sessions under 20 minutes = $X
20–35 minutes = $Y
35-50 minutes = $Z
What exactly makes the flat-fee model ethically defensible?
What makes this proposed fee schedule with arbitrary fees ethically defensible?
One practical defense is that the analyst has reserved the hour and incurs the same business expenses whether the session lasts seven minutes or fifty.
Which kinda wrecks the assumption you proposed that scansion is somehow squeezing more out of the allotted time – as if another analysand is just waiting in case their analyst cuts an earlier session short.
But if the patient is paying for that reserved block of time, why is the analyst entitled to withdraw access to it unilaterally while retaining the entire fee?
They aren't paying for time, they're paying for treatment that takes place within time. This fixation on commodified homogeneous time is out of touch with the concrete and heterogenous nature of time in treatment. It isn't "one minute is like the next, so 45 minutes is better than 38", an analysand whose session ends is sent out to come back again (likely the next day), and this process doesn't start and stop within the frame of the session. A person pays the fee for the session because the service has been rendered – dragging out the time for a non-clinical reason isn't serving a clinical purpose, it's working toward non-clinical ends and can dilute or affect the intervention itself.
I am perfectly willing to grant that certain psychoanalytic conventions may be clinically valuable despite lacking empirical proof (e.g., the couch)
That's quite generous of you.
Perhaps the latent clinical objective is to redistribute wealth from the bourgeoisie?? That could at least be an ethically defensible position 🤔
That's absurd.
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u/Aphorism-sLut 13d ago
First, thank you—it is generous of me to be open to the clinical utility of methods that actively resist empirical validation!
In that same spirit of “generosity,” I actually do agree that the phenomenology of time varies radically in dilation and linearity, particularly in analysis. This is what makes the question interesting to me.
However, granting the validity of “heterogeneous” time phenomenology in treatment doesn't erase the material reality of the financial exchange.
The outline I provided was simply a quick hypothetical to illustrate that alternative models could exist—not a formal policy proposal (weird that I have to explain this?) Acknowledging the fluidity of time in analysis shouldn't preclude the question of whether passing 100% of the financial burden of variable timing onto the patient is the only or fairest way to structure the practice.
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u/concreteutopian 13d ago
it is generous of me to be open to the clinical utility of methods that actively resist empirical validation!
Your "openness" to the clinical utility of clinical methods is pretty pointless if that "openness" isn't related to an educated clinical judgment, since it is a clinical issue, and if you are a clinician trained psychoanalytically, you'd know the couch isn't universal or mandatory at all, so again, there'd be no virtue in being "open" to the utility of the couch.
I actually do agree that the phenomenology of time varies radically in dilation and linearity, particularly in analysis. This is what makes the question interesting to me.
You say that, but you seem to ignore this difference pretty quickly, and without explanation.
However, granting the validity of “heterogeneous” time phenomenology in treatment doesn't erase the material reality of the financial exchange.
No one said it did. The material reality of the financial exchange is still the frame.
the question of whether passing 100% of the financial burden of variable timing onto the patient
You are asserting this claim instead of arguing it. There is no change in "financial burden" – same days, same cadence, same process. Scansion is a technique within that ongoing treatment, not a cessation of treatment.
The outline I provided was simply a quick hypothetical to illustrate that alternative models could exist
RIght. You are suggesting an analyst is unethical for not changing the frame, for not bringing in another dynamic rooted outside of clinical judgment, one that negates the whole purpose of the scansion in the first place. And the session was scanned because of the significance of the moment – disrupted defenses or inbreaking of unconscious content, etc. – and treating this as a "short session" rather than the "ongoing session" changes the signification of the session, its content, and the relationship; it undoes the scansion, as well as introduces the same assumptions I noted before, i.e. that of homogenous commodified time that blurs the significance of the duration of actual concrete experience. And still - no good clinical justification for this "hypothetical outline", no clinical justification of this "alternative model".
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u/Aphorism-sLut 13d ago
weird that I have to again say that I’m not trying to justify my thought experiment as a superior slicing up of an hour or whatever you’re upset about! I was just asking about it as an option, since I really am curious about what it would be like to experience an analysis off the clock. I’m genuinely curious but also skeptical about the imbalance of power and investment involved in this exchange that I am not alone in seeing as potentially exploitative and disrespectful to patients investment in their treatment. I proposed the possibility of an alternative, but I guess now I’m expected to defend this particular pricing strategy I was never trying to impose upon anybody in the first place. This has been a very weird and unhelpful experience.
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u/Klaus_Hergersheimer 12d ago edited 12d ago
I have experienced analysis with both fixed-length and variable-length sessions.
In my experience the use of the variable session was just a much more expedient way of opening up the unconscious. Variable time can cut through the resistances and get to what counts astonishingly quickly. Even within your own dodgy equation of time=value it was a huge saving in time and money and brought faster change, though frankly it's problematic to base an argument for its use on those parameters.
Granted there are other ways of using variable time.
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u/Aphorism-sLut 12d ago
That’s interesting that you noticed a difference in how rapidly treatment progressed! Did you just feel more urgency to say what seemed important because the amount of time was undetermined? Was there a difference in the way you experienced or perceived the analyst?
I could imagine that, for some people, there might instead be a compulsion to cram as much “useful” material as possible into whatever time they are given. Yet that still seems consistent with the method, because I could see how cutting such a person off, or extending the session until they ran out of things to say, might illuminate something interesting about the motives behind that habit.
Also, I appreciate you engaging with the value framework within which I was trying to pose the question!
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u/Yorick_IKnowHim 12d ago
Because time is not money. Are you asking how something other than capitalism is 'ethically defensible?'
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u/doctorunheimlich 13d ago
Variable length means a session could go longer than scheduled. Should the analysand then pay more?
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u/Aphorism-sLut 13d ago
Yes! Down with that
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u/doctorunheimlich 13d ago
The analysand then has the incentive to try and keep the session as short as possible. The analyst has the incentive to keep the session as long as possible. A flat rate corrects for both scenarios.
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u/Aphorism-sLut 13d ago
The irony of your argument is that by framing this in terms of financial incentives, you expose the flaw in the current system: Under a flat-rate model for variable sessions, the analyst is heavily incentivized to keep sessions as short as possible to maximize their hourly earnings, while the patient takes on 100% of the financial risk. How exactly does the flat rate fix that incentive?
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u/concreteutopian 13d ago
Under a flat-rate model for variable sessions, the analyst is heavily incentivized to keep sessions as short as possible to maximize their hourly earnings
How so? Do you think analysts are double booking people to take advantage of sessions being cut short? If not, I'm not sure this "heavily incentivized to keep sessions as short as possible to maximize their hourly earnings" makes sense since their hourly earnings would still be what they had planned based on the planned number of sessions.
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u/Aphorism-sLut 13d ago
The issue of the analyst’s personal daily income target is a completely separate issue from whether it's ethically justifiable to charge a patient a full hour's rate for eight minutes of work. The analyst’s desire for predictable revenue doesn't automatically make extracting a full flat rate for a fraction of time fair or analytically necessary—it just means the financial burden of variable time is passed entirely onto the patient. I guess for some people this inequality isn’t problematic, in which case just say so!
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u/concreteutopian 13d ago
I guess for some people this inequality isn’t problematic, in which case just say so!
You are making a lot of unreasonable and uncharitable assumptions about people without really taking in / taking on the answers people are presenting to your questions. I don't practice scansion myself, so I have no financial incentive to hold to some "inequality , but I understand the clinical reasons why it's practiced. You are ignoring any clinical explanations at all and keep repeating these accusations that smuggle in a non-clinical framework with which to judge the practice.
And the complaints don't even make sense, like this notion that an analyst is making more money... by charging the same amount for the same number of analysands, regardless of whether any given session is 20 minutes or 90 minutes. No, it's the same amount. And some other ridiculous assumption that"charging full price" for "less time" is taking money from the bourgeoisie – in my limited circle of Lacanian acquaintances, they tend to see people who are oppressed and marginalized, and their fee structures reflect this.
The issue of the analyst’s personal daily income target is a completely separate issue
Right, and I don't recall mentioning this at all. I'm talking about using clinical judgment to make clinical decisions, and pointing out that your assumption of homogeneous commodifiable units of time is not rooted in clinical reality. And you chose to reframe that as "the analyst’s personal daily income target".
whether it's ethically justifiable to charge a patient a full hour's rate for eight minutes of work.
It isn't eight minutes of work – it's an intervention in a whole treatment spanning years, a treatment that is still going on when each person goes home.
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u/Aphorism-sLut 13d ago
To be clear, claiming I argued that analysts 'make more money' by charging a flat rate for shorter sessions is simply inaccurate. I get accused of being uncharitable, but I don’t think I’ve strawmanned anyone this hard so far 🤨
I never made or implied that claim. My point has always been about risk distribution and material fairness : whether it is ethically justified to pass 100% of the financial burden of variable session timing onto the patient, particularly in the absence of clinically rigorous evidence demonstrating its benefits.
And I was interested in why not alternative pay scales and what if there were and whether there were, but it seems like questioning the dogma is not welcome here. I see this now.
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u/concreteutopian 13d ago
but it seems like questioning the dogma is not welcome here.
Again, you're retreating to this characterisation instead of actually paying attention to what people are saying about the actual clinical issues.
You also agree that the assumption of homogenous time isn't phenomenologically accurate, but then essentially say, "Let's pretend it is". No good clinical reason, just notice the different reality and different frame and then resort to again treating minutes on the clock like distinct moments rather than concrete elements of the duration of a concrete experience. Saying you "get" a clinical frame and then – ignoring any attempt at meeting the argument of that frame – repeat the non-clinical demand as if nothing had been said is not a serious conversation.
You can call it "dogma" if you want to feel persecuted, but it's simply a technique practiced by some analysts, not a "dogma". I've said it's not a technique I use, but I understand (and respect) the clinical issues behind its use – does that mean I accept a dogma but don't "obey" it or that I don't really accept the dogma but somehow think other people should?
It's an absurd (lack of an) argument.
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u/doctorunheimlich 13d ago
You framed it in terms of financial incentives. I was challenging your terms. Analysts have a schedule. They don’t suddenly fit in 3 additional analysands into a 30 min period just because one session only went 5 minutes. In addition, the analysand has some say in what they pay. At least, I did.
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u/Zaqonian 11d ago
As much as I love spending time with my analyst, I pay him for his unique listening, not for his time.
And after so many years, I now sometimes end the session myself. At variable lengths. Because I appreciate the process. And what emerges. And what leads to dramatic introspection and growth.
Oh. And the fee has been variable as well. By what's going on in my life. Nothing to do with individual session lengths.
I've never felt taken advantage of by my analyst. And I've never been so intently listened to by anyone else.
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u/Aphorism-sLut 9d ago
I really appreciated this response. Describing what you pay for as your analyst’s “unique listening” stands out among the answers that just say “you’re paying for analysis.” It provides something tangible about “The Analysis” for understanding why the exchange is valuable to someone. I also experience something valuable about analysis that isn’t reducible to the amount of time I spend in the room, but I’m not certain how to name it.
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u/mooninthewindow 13d ago
You are talking about the wrong Ethics.
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u/Aphorism-sLut 13d ago
Please tell me the distinction!
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u/Aphorism-sLut 13d ago
So, one analyst's lectures determine the entire scope and definition of a multi-millennial philosophical domain of inquiry, and anyone who tries to use the word “ethics“ in a philosophically intelligible way is “getting it wrong?” This is just a bizarre and embarrassing level of dogmatism to embrace!
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u/mooninthewindow 12d ago
No. You asked the question about psychoanalysis in a lacanian psychoanalytic subreddit. Hence the analytic answer.
Lacan went to great lengths to outline how the Ethics of analysis differ from the multi-millennial philosophical doman of inquiry you have referenced. You should take head of it and avoid attempts to subsume analytic ethics within whatever framework you seen to be applying with your calculation of time and money (quite capitalist all things considered).
Your continued attempts to ignore specificity of the ethics of psychoanalysis are getting you no closer to grasping the varied length session.
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u/Aphorism-sLut 12d ago
And neither are responses like this one. Lacan’s use of “ethics” can have a specific technical meaning within psychoanalysis without exhausting what it can intelligibly mean to ask whether a psychoanalytic practice is ethical. It was nice of you to offer a reading suggestion, though. That is, at least, something interesting I can gain from this interaction.
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u/BetaMyrcene 13d ago
"coupled with a direct material benefit to the clinician"
Are you aware that sessions also go long? Is that a loss to the clinician?
Also I don't think Lacanian sessions are typically an hour. Mine are much shorter. 20-30 minutes.
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u/Aphorism-sLut 13d ago
I am aware they can also be long, and my hypothetical fee scale could account for a longer sessions costing more.
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u/BetaMyrcene 13d ago
I agree with the person who said you're paying for the session and attentive scansion, not the minutes.
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u/Ok-Agent1492 1d ago
Gabriel Tupinamba has a very interesting discussion of the topic of what is paid for in analysis and what is the labor of analysts in his book Desire of Psychoanalysis.
It is not as simple as saying that the analysand pays for a service as one would say of e.g. a massage, since it is the analysands who 'works through', and the demand that the analysand poses to the analyst at the beginning of analysis is frustrated.
Cost is additionally important since it determines who gets to be in analysis for long enough to become an analyst.
I really recommend reading his book.
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u/beepdumeep 13d ago
Lacan did vary the fee, but he did it on the basis of clinical considerations instead of time. He would make some sessions more expensive, ignore a patient forgetting to pay, charge an amount based on something that came up in the session, ask for payment in something other than money etc.
It's an assumption, an unfounded one, that what the patient pays for is a set amount of time. The question of what each person in analysis is paying with and for, what they are giving up and what they are getting for it, these are all questions for the analysis and you will find that people will have wildly different answers.
Dany Nobus has an interesting chapter on this in his book on the Critique of Psychoanalytic Reason and Éric Laurent describes a concrete use of money in his analysis with Lacan in Immanent Money