A Letter to Therapists: Beware of Financial Stress
Why do we avoid talking about money in therapy?
Posted May 30, 2016
To my fellow therapists, colleagues across the globe united in our common battle against mental disorders, negative self-talk, unconscious drives, limiting beliefs, unhappiness and/or _____ (state your theory’s foe here). I write today to draw your attention to yet another debilitating condition that afflicts millions but has flown under the radar of the psychological community: Acute Financial Stress or since every psychological concern needs an acronym, AFS.
Please resist the temptation to roll your eyes at yet another trumped up syndrome backed by Big Pharma or accompanied by a week-long certification course in Maui. That’s not AFS. This is a serious malady with devastating consequences. For the sake of your own wellbeing and the clients you serve, read on.
What is Acute Financial Stress?
I recently interviewed a woman reporting symptoms you’ve likely seen in your own work. “Mary” was a 32-year-old woman with a master’s degree in speech pathology who worked for a local school district. She came to therapy seeking tools to help her improve strained relationships, focus at work and learn to relax. She entered the room looking both vigilant and exhausted, trying to muster the energy to stay alert.
Mary said it had been difficult keeping up with bills since leaving grad school, as her loan payments and credit card bills took most of her paycheck. She slept very little. She’d lie awake trying to find a way to dig herself out of debt and avoid more calls from collections. She was too ashamed to talk about her struggle with her boyfriend, her parents or even her close friends because admitting to her plight would feel like admitting she was a failure.
Here’s the catch. Her stress and anxiety have produced common symptoms, but the root of that stress doesn’t have an officially recognized source. Despite all of our research and experience, the field of psychology hasn’t caught up with Mary’s issue — a condition hiding in plain sight.
AFS is Financial PTSD
Last year a random sample of 2,041 people were given a modified version of the PTSD Checklist (PCL) — the standard assessment for PTSD. Rather than assessing for general stressors, the questions asked specifically about financial stressors (“I have flashbacks thinking about financial situations,” etc.). The PCL has a cutoff score — those who score above have PTSD and those scoring below don’t. When using this same cutoff while assessing for financial stress, 23% of all participants scored positive for PTSD-equivalent scores for financial stress, and 36% of millennials. Due to diagnostic roadblocks (mentioned below), we aren’t calling this PTSD, so we’re calling it AFS.
But before we talk about diagnosis, we should look at why AFS is only now coming into focus. The most challenging part of AFS is the fact that it has been able to hide in plain sight. How?
It’s not in the DSM
In order to achieve a diagnosis of PTSD, a person has to exhibit behavioral, emotional and cognitive symptoms of trauma and the trauma needs to stem from sexual abuse, wartime activity, viewing death or having a near-death experience. So AFS qualifies due to the symptoms but is excluded based on the etiology. I’m not sure I agree with the brain trust of DSM psychiatrists on this one. After all, if I break my leg skiing or in a car crash it’s still a broken leg. Not so for PTSD, where the cause is a key component of the diagnosis.
It’s not taught in grad school
We never talked officially about financial stress in graduate school. Sure, we were unemployed 20-somethings racking up six-figure student loan debt, so we talked about it plenty amongst ourselves, but we never talked about it as a clinical condition. A discussion of socioeconomic status is a standard part of a case presentation as finances are one of many factors affecting a client. But it was always a side dish, never a main course. We also talked about the therapeutic implications money, typically around negotiating fees or viewing non-payment as a form of withholding or resistance. Without research to review or a condition to diagnose, why would we focus on money as a core problem? As a result, it was always a symptom of a greater condition, not an issue of its own.
People don’t like to talk about it
Since becoming aware of AFS and interviewing people who have it, it’s become clear to me how infrequently people talk about their finances and how our culture supports and even encourages the shame and secrecy. Most of the people I talk to have never spoken about it beyond vague statements (e.g. “money is tight” or “those damn bills”).
The thought of talking about their debt or their AFS symptoms with friends, family and even spouses seems nearly impossible. I asked them if they’d rather talk about sexual dysfunction or their financial concerns, and patients uniformly report they’d rather disclose their sexual issues. As therapists, you know the behavior that surrounds shame, the most prevalent being an inability to talk about it.
If you take a belief that says “I’m flawed because I’m in debt,” and hold it in isolation, away from loved ones who may be able to help, you’ve got a perpetual cycle of shame. Our culture says finances are private, not to be discussed in polite company, and oftentimes, that works best. But for people suffering from AFS, this means they continue to suffer in silence. They keep their pain to themselves, which further alienates them from the support system that may be able to help and only exacerbates their depression. It’s a nasty cycle.
Therapists don’t like to talk about money
Hell, I don’t even like to talk about it. I remember a year in graduate school when I would take an advance on my credit card and deposit the cash into my checking account so I could write a check for my minimum payment. Buying a can of soda would result in hours of guilt. I’d cram as many clothes as I could into the jumbo washer at the Laundromat so I could save my quarters. I hated the all-consuming helplessness I felt as I earmarked every dollar earned and grieved every dollar spent.
I doubt I’m alone. Nearly every graduate student I’ve known had a similar story. So, we likely bring our own financial baggage into the session.
Whether you’re Freudian or not, you know there is validity to the concept of countertransference (or enactment or reactivity or name-your-term). Your issues may produce a blind spot in your work with your clients. I think my painful history with finances may have pushed me to avoid asking the tough financial questions to my clients. I don’t want to make them uncomfortable. I don’t want to re-experience my own period of shame and pain. I don’t want therapy to become yet another reminder of the grip of the almighty dollar. So together, we collude to avoid it together. As long as I don’t ask and they don’t offer it as a topic, we don’t have to go there.
We entered this field to help our clients live full, vibrant, balanced lives. Let’s not neglect a paralyzing issue that may be staring us in the face.
This isn’t helping and now that we have data to illustrate how deeply people are suffering from Acute Financial Stress, we need to develop a language that enables us to talk about it. I’ll get into my thoughts on that next week.