Afford your own desire
In the ethics of desire, we are always dealing with the mechanism of either sustaining or retreating. Taking responsibility for your own desire is not only about the ethical choice of the path to follow in life but rather something even more complex—subjectivity.
For those seeking treatment for their suffering, usually, only one thing matters: that their problem is solved.
Whether it’s back pain, stomach discomfort, difficulty sleeping, or staying awake, people go to a doctor in search of a solution. Almost as a rule, leaving the doctor’s office without a prescription for something that can be bought to fix the problem is frustrating and often leads to seeking a “second opinion.” In other words, we pay the doctor to tell us what to buy to resolve the issue. When the doctor says there is no medication (or surgery) and that the problem lies elsewhere, then a real problem arises.
In this context, there might even be a suggestion for some form of psychological treatment. The issue, however, is when the same logic persists: people go to a psychologist expecting to be told what to do to solve their problem. The catch is that “solving the problem” from a psychological standpoint is not necessarily the same as eliminating the initial complaint.
Consider the common flu. Most of the time, medications are prescribed to treat the symptoms (something to reduce mucus, coughing, or fatigue). The flu itself, however, is not treated—the body takes care of it on its own. In many countries, nothing is prescribed other than plenty of fluids and rest. People don’t actually complain about having the flu; they complain about the symptoms of the flu. The same applies psychologically. People don’t complain about depression itself; they complain about sadness, apathy, and lack of motivation. Calling these things “depression” is a widely accepted convention that can sometimes help but can also hinder. Someone who tells their doctor they have depression might receive a different diagnosis altogether—burnout, vitamin D deficiency, or even a borderline disorder. Seeking a “second opinion” in such cases can be risky, as the focus shifts from the symptoms themselves to the artificial name of a condition created by convention. The same applies to any other psychiatric disorder.
Similarly, those seeking psychotherapy to “treat” a psychiatric condition may receive something quite terrifying: exactly what they asked for.
Psychological treatment must always consider the subject’s relationship with their symptom—no manual will ever fully encompass subjectivity, as manuals are, and always will be, objective.
That said, previously established diagnoses should not be dismissed outright, as they are part of the patient’s history. The issue arises when there is no room for deviation from these labels. A set of symptoms that constitutes a disorder can serve to teach something or explain a phenomenon. But when it is used to explain a person, the treatment is impoverished in a terrible way.
To sustain that there is no single, predetermined diagnosis and prognosis that will explain and resolve a person’s problems aligns with the idea that each individual’s desire is unique, and that search is profoundly personal.
The individualized cost of psychoanalytic treatment reflects its unique nature.
Psychoanalysis is not a standardized service with a fixed format. This is one of the main reasons why its dissemination as a viable treatment has been hindered in healthcare systems based on insurance or health plans. Insurance companies dislike unpredictable services—this presents a problem for patients with singular issues (which, in my view, includes all of them). Unlike other mental health treatments that may follow predefined structures, psychoanalysis unfolds in a unique way for each patient. This means that session frequency, treatment duration, and financial agreements must be adapted to the specific needs and possibilities of each individual.
Far from being arbitrary, this approach ensures that the analysis can develop sustainably for the patient, allowing treatment to progress without unnecessary financial pressures.
And perhaps more importantly, without diagnostic pressures.
A fixed-price model might seem simpler, but it would fail to consider that each patient enters analysis with different life circumstances, financial realities, and capacities for commitment. Some may need more frequent sessions, while others work at a different pace. Some can afford a higher fee without difficulty, while others would be unable to continue if required to pay a rigid, standardized rate. If the goal of analysis is to provide a space where the unconscious can unfold freely, that space should not be dictated solely by external constraints such as financial pressures. Instead, the treatment’s structure should be established in a way that enables long-term engagement.
Beyond financial considerations, the individualized nature of psychoanalytic fees also reflects the ethics of the analytical process. Psychoanalysis is not a commodity with a uniform price, as the desire for it does not follow a norm. Nor is it a simple service that patients acquire in a transactional manner.
To conceive of psychological treatment as something to be purchased is dangerous—health cannot be bought.
The framework, including the discussion of fees, is part of the analytical work itself. If a patient is charged an amount they can barely afford, treatment risks becoming a burden rather than a space for exploration. On the other hand, if the fee is too low, the patient may not fully commit to the process. Finding the right balance is essential, and this can only be determined through discussion between analyst and patient—just as analysis seeks to find a place for symptoms within a person’s subjectivity, rather than placing the person within a diagnostic label.
Ultimately, paying for one’s own analysis is an investment in one’s own desire.
The individualized cost of psychoanalysis is not just about money—it is about creating the right conditions for the analytical process to take place. By adapting fees to each patient’s reality, analysis remains accessible without losing its depth and effectiveness. This ensures that treatment is guided by the patient’s needs rather than artificial financial constraints, reinforcing the fundamental principle that psychoanalysis is a space for genuine engagement rather than a standardized service.
Gabriel is a qualified Licensed Clinical Psychologist, based in Centro, Caxias do Sul, Brazil.
With a commitment to mental health, Dr Fadanelli provides services in English and Portuguese, including Counselling, Psychoanalysis, Psychotherapy and Psychotherapy (Analytic).
Dr Fadanelli has expertise in Anxiety Disorders, Attention Deficit Disorders, Autism and Developmental Difficulty, Depression and Gay, Lesbian and Same Sex Counselling.
Click here to schedule a session with Dr Fadanelli.
Important:
TherapyRoute does not provide medical advice. All content is for informational purposes and cannot replace consulting a healthcare professional. If you face an emergency, please contact a local emergency service. For immediate emotional support, consider contacting a local helpline.
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