In New York City and many parts of the United States there is a discrepancy in cost for therapy in a private practice based on the discipline of the provider. From what I've seen Social Workers tend to charge less than Psychologists, who usually get somewhere between $125 and $225 per session. A Psychiatrist friend of mine charges about $275 and stated that's mainly because she can prescribe and manage any necessary medications. There's probably some elitism involved in that as well but that's not important right now. I've heard of some Psychiatrists charging upwards of $400 per session and recently as much as $500 but this new benchmark of $600 blows me away, especially given that there's no mention of medication management involved.

What is this shrink saying for 45 minutes that could possibly be worth $600? "Your mother is the sole cause of your neurosis. You have both my ethical and legal permission to kill her." I suppose that might be worth a lot. Is he reciting words of wisdom off of some diamond-studded scroll from the mountain tops with bolts of lightning crashing down to punctuate how profound his statements are? Does he hold the secrets to world peace and immortality? Does he offer a Happy Ending to the clients who are into that stuff?

I suspect that he's charging this rate simply because he can. His wealthy clients will believe that he's worth it because he's so expensive. They'll tell their other rich friends that's he's "the best." And if they can afford it good for them. But the reality is that Altoids don't taste any better if you pay $59 per tin.

If anyone has $600 laying around, let me know and I'll contact this guy about doing a 45-minute interview for the site. I've been cranky for the past few days so maybe he can fix that as well while he's here.

For me working with colleagues is generally a positive experience. We share a common bond because we've been through the same years of training and share a similar mindset about people and their problems. Clients who are shrinks themselves know the lingo; they know the format. It usually flows well. Many theorists believe that psychotherapy has an inherent power differential that isn't always comfortable: I am the expert, you are not. I am healthy, you are sick. My life is exactly the way I want it to be, yours is not. If you've read more than two words of this site you know that thought process is skewed, but many people enter a therapeutic relationship with this dynamic intact. I make every attempt to minimize this power differential by making therapy a collaborative relationship where we each share thoughts and ideas. Doing this with colleagues is often quite easy.

Conversely, the potential problem for me with a "pro to pro" relationship is a certain, self-induced pressure. Does she know more about therapy than I do? What if I make a mistake? Will she call me out on it? Is his practice more successful than mine? His Armani suit is much nicer than my Banana Republic khakis and Gap button-down polo shirt. I'll bet he makes more money. He's wearing a ring too...why is he married and I'm old and alone??

Dr. Rob: So you can see, then, how this type of thinking is leading to your negative mood?

Dr. Non-Rob: Hmm...interesting. That's not how I would have handled it though.

Dr. Rob: How would you have handled it?

Dr. Non-Rob: I'd probably have asked about the origins of this type of thinking. Did it come from my mother?

Dr. Rob: Did it?

Dr. Non-Rob: Did it what?

Dr. Rob: Come from your mother?

Dr. Non-Rob: I don't know. I think if you had asked me earlier my answer might have been more spontaneous and emotional.

Dr. Rob: Would you like me to ask you that now?

Dr. Non-Rob: I'm not sure. Do you think that's the best course of action?

Dr. Rob: No, otherwise I would have asked you that to begin with.

And so on.

The Psychologist with Bipolar Disorder and I used the first appointment to design a possible treatment plan. When the time was up I asked him if he would like to return for another appointment. "Oh yes, absolutely," he said. "I just need to check my schedule so can I call you?"

"Of course. Here is your receipt. Will you be paying by check for this session?"

"Oh...could I just pay you next time?"

This isn't unheard of as some clients assume that I will bill them at a later date. However, most Psychologists know that the most common approach is to "pay as you go." I looked at him a bit suspiciously.

"I suppose so. As a general rule I prefer if clients pay for their sessions as they occur because I'm a solo practitioner and don't have an elaborate billing system. But I probably didn't explain that over the phone, so it's fine."

"Great. I'll be in touch to set up something."

A week went by and I didn't hear from the Psychologist. After about ten days I called him to find out if he was still interested in working together. If he wasn't then I'd close his chart. I left a message on his voicemail.

After another week I called again. Voicemail. A few days later I mailed him a bill. No response. Another phone call followed, but this one had more edge. "Dr. ___________, please return my call as soon as possible to resolve your bill for the therapeutic services that were delivered." Those are pretty intimidating words so I assumed that I would hear from him immediately.

No return call. The proper clinical term for this is "being screwed over."

More harassing phone calls, collection agencies, small claims court. All of these are options that practitioners take to obtain payment for services rendered. I haven't decided if I will pursue any of these or simply let it go. Regardless of the outcome, however, I feel betrayed. Other shrinks are supposed to know what it's like. They are supposed to know how hard it can be to build a practice, to have to deal with clients who are demanding or unappreciative or complain about fees or refuse to pay you if they don't like something you say. They're supposed to know that you're not rich simply because your name starts with "Dr." And they're definitely not supposed to take advantage of you. Apparently, though, some do. And that's just wrong.

The mentally ill are often talked-down to and generally are treated as second-class citizens. During my graduate training I had some experience in psychiatric wards and the patients were often ignored or infantilized by the medical staff. This phenomenon was empirically demonstrated in 1973 by D. L. Rosenhan, whose study had people pretending to be patients in a psychiatric hospital. They approached staff members with questions like "Could you tell me when I will be eligible for grounds privileges?" or "When will my case be presented at Grand Rounds?" 71% of the time the psychiatrists (these are doctors, mind you) simply looked away and walked past. Only 4% of the time did they stop to talk to the people.

35-year-old studies are often not valid to highlight current psychological principles. After watching this video, however, the results seem more relevant than ever. If people want to make the argument that patients can be very demanding and need boundaries and limits, that's all well and good. However, the fact remains that this woman died at the very hospital where she was being treated, and multiple members of the staff watched it and did nothing.

To say that this disgusts me is an understatement. I bash shrinks all the time for being neurotic and weird and elitist and all sorts of other negative shit. I didn't know I should consider some of them to be soulless as well.

It's no secret that many staff workers at psychiatric hospitals are both overworked and underpaid, which often is an underlying cause of poor interpersonal contact and the delivery of therapeutic services. But what occurred in this video is simply inexcusable. And so the staff is fired according to news report. That's it? Does this "doctor" get to keep his license? If so I hope he ends up treating the very people who decided that he can continue to practice medicine.

I don't see a silver lining in this, save for the fact that perhaps people will give some more thought to the idea that the mentally ill are just as significant as the rest of us. But if this is what it takes to make people think, then I'm embarrassed to be part of the mental health community.

"Being able to have a laugh at yourself," she said. "Without being able to poke fun at yourself you'll never have a great sense of humor. You're also a tremendous disappointment to your father and I so please leave me alone."

She was right about that. The sense of humor part that is. And as a pseudo-young, Caucasian male it's important to have a lighthearted view of myself and my fellow white people.

To that end we have with us today Christian Lander, author of the popular website StuffWhitePeopleLike.com and soon-to-be best-selling book. Mr. Lander joins us to discuss the subtle yet complex intricacies of the psychology of being a white person.

It's hard to provide a glimpse using only words. I think the best way to do it is to watch an Obama rally and really observe the people. Failing that, a trip to a Farmer's Market or San Francisco will do more to delve into the psychology of white people than my words ever could.

I'm often told that I'm "pretty fly for a white guy." I believe this is a compliment and thus it pleases me but what exactly does it mean?

Though some would say it means that white people can only achieve a basic level of 'fly,' it actually is a person telling you that they enjoy Offspring. It could be your key into future friendships or relationships with that white person.

I know white people who are constantly liking things. Just the other day my good friend Dr. Allison said to me, "I'd like you to please go away. You're annoying." Do white people ever stop or is this just an endless cycle of pathological liking? In fact is there anything white people don't like?

White people do not like non-organic food, low property values, sending their children to public schools, and many more things. White people also like to use the word 'like' because love is too strong a word, and "like" reminds them of middle school relationships.

It's no secret that white people love etiquette. Let's suppose that a white person, after a long day of shopping at IKEA, visits a local Starbucks. But rather than simply order a Vente Latte the white person also wants Altoids. Because those are strategically placed next to the Celine Dion CD's the white person naturally buys one to hear her mellifluous, Canadian voice. The total is $20.14. Having just come from the Chase ATM, however, the white person only has $20 bills. Is it acceptable to pay the sum with two of these bills or does the white person have an obligation to buy a copy of Tuesdays with Morrie to bring the total to a more reasonable $35.60?

Ha! Trick question! As I point out in the book, white people do not carry cash! This would be easily put on their Amazon Visa and they would collect essential reward points. Also, advanced level white people would never buy anything by Mitch Albom.

One of the things I, a white person, truly like is wine. However I prefer red wine as opposed to white. Is there some strange psychological irony at play here or am I reading too much into it?

Many white people associate white wine with white trash, while they associate red wine with France and Italy (two very desirable things!).

So true, France and Italy are pretty great. Now we all know that white people love music and are probably the most knowledgeable about the subject. The question I pose to you is who is the rockingest of all the hard-core rockers out there: Dave Matthews or John Mayer?

This is tough because both artists are so beloved by "the wrong kind" of white people. The truthful answer is that the best, hardest rocking band is the one that I have heard of but you haven't.

Most of us are aware of the acute oppression that the white person has suffered over the centuries. When will the day come that a white individual can simply enjoy his ascot, brunch or Gap Gift Card without fear of reprisal?

The problem is that the reprisal and hatred come from within. So white people will only escape their oppression when there are no more white people.

As a white person I enjoy a good roasting of my peeps. Why do you suppose people are able to make fun of their own race, color or creed without being labeled "racist?" And is there a message that white supremacists should take from your lampooning of white people?

I suppose you can go after your own race since you've earned credibility by being born into it. As for white supremacists, I suppose they could learn how to infiltrate the white society that they hate so much and then I guess destroy it from the inside. Although, in my experience with white supremacists (limited), they have not been particularly crafty.

Christian, thanks for joining me today to embrace our whiteness. This is great stuff. I'd like to take you out for a ride now in my brand new Volkswagon Jetta as a show of gratitude.

My time in this group was preset from the day I walked through the agency's door. September to May. And when May came, I didn't like the idea of leaving. After such an unusual and intense training experience the thought of going back to doing research on projective tests wasn't overly appealing. With the group it felt like I was doing real work but more importantly, I knew that I would miss a lot of the women there.

Shrinks who say they love or even like all their clients are either delusional or lying. Not everyone who comes into therapy is likable and often their psychological problems can make them very difficult to deal with. Other times people are just disagreeable and make no mistake that the reverse is true as well: no shrink is going to be a perfect fit for every client and certain clients will actively dislike their therapists. That being said I was fortunate in this particular situation because I did like many of the women there and the feeling appeared to be mutual.

Even though our support group wasn't a formal therapy setting, many of the women improved to the point that they didn't need the group anymore (assuming their significant others were no longer in treatment). Others reported that they would stay in the group for as long as it existed, that they always took something new from what the members had to say. I believe that some of the women saw themselves as role models for new members and relished the opportunity to serve as a sponsor of sorts for new participants.

For the last group I had a small speech planned: review what we learned together, tell them how proud I am of them, never stop growing, rah rah rah! I've never successfully delivered a pre-determined speech and I knew this would be no exception so I scrapped it before group and decided to let the final session flow organically.

My supervisor had some charts and notes for me to sign before I left the agency for the last time so I took care of all that before group began. I arrived a few minutes late to find the women already there talking up a storm.

"He did what? That's horrible."

"He should be lynched for that."

"String him up by his balls!"

"Hi ladies," I said. "I think I'm missing an interesting conversation here."

"Jill's husband was late for their anniversary dinner. Being late...is something we don't tolerate around here," Anne winked.

"Ah, my supervisor warned me about negative reactions toward me. This is because I'm a man?"

"Yep. You're all the same," Jill said.

"Fortunately not everyone is like our men," Anne said with a small frown.

"No, not everyone is like that," I said. "You all have a very unique situation."

We talked about this notion of 'being different.' Some women challenged the idea, stating that plenty of people have family members who are murderers, thieves, rapists, or even a combination of those things. "No one has a perfect family," one woman asserted. "People are messed up, they do messed up things. Sometimes really messed up things. Do you know how many thousands upon thousands of people are in prison? Well those people have families. That's us."

Others held fast to the idea that the lives of the women in this group weren't like anyone else's. "I don't know anyone who is married to a Pedophile," said Ann. "I know these people exist but when I picture them they're just hypothetical figures, blank faces on generic bodies. So it's only here that I feel I'm with my own kind."

"That's why I'm here and I'll probably never leave. Because we're different." Jill said. "However, this one," she said pointing at me, "is leaving us," and smiled.

I couldn't help but think there wasn't at least some resentment behind that.

"Yes, as we had discussed, today is the day." I said. "I'd like to ask each of you how you feel about this."

"And are you going to share as well?" one woman asked.

"Absolutely."

Jill spoke. "I have mixed feelings about this. Our last two group leaders were women so this is a new experience for me." She paused and looked down into her lap. "I'm happy for you in some ways. You've taken another step toward getting your Ph.D. You probably learned a lot between working with us and our partners. And you were helpful and I'm grateful for that."

"Thank you," I said.

We had spent a small number of sessions talking about how the women might feel about me leaving. This is always good clinical practice but not always easy to implement, especially in groups. The members have crises and problems to attend to and not everyone is comfortable sharing thoughts about their group leader. So this was our first foray into deep feelings about...termination.

"Do other people feel this way?" I asked.

One woman nodded and then Ann spoke. "I feel abandoned but I don't resent you or feel jealous. I'll just miss you."

"I wouldn't blame anyone for feeling resentful or abandoned," I said. "This is how the system works and unfortunately people come and go through this revolving door that is our lives." Revolving door that is our lives? Christ, you are walking cliché.

"I want you to know," I continued, "that I will miss this group terribly. You've all been through a lot and those of you sitting here decided to fight back against your problems. Even if that meant leaving your spouse you didn't bail and hide under a rock. You sat here, week after week, and worked through the feelings. I'd like to think I was a part of that process. I didn't always agree with your decisions but to say I respect you for your work is an understatement."

"Well we respect you too, soon-to-be Dr. Rob" said Ann. "And I'll bet you'll make a lady very happy someday with all of the knowledge about sex you learned from our discussions."

At the end of the session the ladies gave me a card. It had just a tree on the front. Inside it had all of their signatures scattered about and, in the middle, it said:

Stay Warm
Stay Safe
And for God's Sake Stay Legal!

They all laughed and smiled as I read the card aloud and I gave a perfunctory smile. Even though the women knew I was not flawless, Freud might have said that, in addition to using humor to protect against psychological pain, the last line was a warning to not shatter the positive image they had of me. This isn't unheard of in therapy where clients will give admonishments and pieces of advice that underneath the surface are really saying "Please don't change, don't become something bad. I need you to stay exactly who you are!"

And just like that it was over. Some women gave me a hug good-bye, others simply waved as they walked out. The next week a new intern would be in my spot, doing my job and forming a relationship with the women. My women. I was jealous that someone else was going to be helping them going forward.

That was my first experience with the "loss" involved in a therapeutic relationship, at least of one that had some significant time behind it. Even today this part of the job doesn't get much easier. The best therapy relationships are the ones that are hard to let go of, even when you're ecstatic for the person who has made the gains they sought out.

I left the agency that night and met up with my fellow students, many of whom had finished their internships as well. We were that much closer to graduation. One year to go. We drank beer and wine and partied to start the summer off right. I even got the phone number of a woman I had my eye on at the bar. But for a few weeks after the group ended I had a nagging feeling that I can only describe as grief. All of us grew as people because of our experiences together but I still lost them and they lost me. I eventually got past that feeling and moved on to other groups and other therapy relationships - the woman who gave me her number never returned my call, but let's not get into that right now - but the women were never forgotten.