Indentured Servitude In The Wealthy Man's Army: A Therapist's Point Of View

In an industry of psychotherapeutic providers where countless studies have shown clear evidence that the cost substantiates the benefit of therapy, an interesting syndrome exists. Wealthy clients "expect" premium service.

Mental health issues are not uncommon and studies have proven time and time again that the benefits of psychotherapy outweigh the costs associated with the hourly rates. But somehow, those costs become inflated as the client becomes more wealthy and the challenges of the therapist? Well, only a few can handle it. In an article written for the New York Times, an interesting take on psychotherapy for the wealthy is presented. Patients having their executive assistants call to schedule an appointment, not unlike any other high level executive. Yet, these patients are so self-important that they demand the therapist see them aboard their personal helicopter for a session at their convenience. And of course, cost is no objective:

"[physician says] the only time he had available that week was at 7 one night. The executive’s assistant said: “He’s having dinner then. How about 10 p.m.? He’s flying out to the Hamptons, but we’ll send a car for you and you can ride with him and do therapy on the helicopter, and then we’ll send you home in the morning.”

The real syndrome here is called King Ludwig Syndrome and originates from the 19th century when the Bavarian Royal family's psychiatrist, Bernhard von Gudden, began treatment on King Ludwig, who suffered from psychosis. Dr von Gudden and the Mad King both drowned in a boat. A New York psychotherapist named Dr. Karasu, who successfully treats wealthy clients, and who has been the bobo doll for many an entitled patient, tells his staff that when it comes to treating the wealthy:

‘Don’t get in your patients’ boats.’

The main issue when dealing with the uber wealthy patient is not succumbing to the addiction or learned personality trait that money can buy whatever it is they want. Secondary, or underlying complications, like depression, manifest themselves beneath the fassad and when a therapist falls prey to the patient, no help has been provided. The article describes stories of weaker therapists giving in to a patient's need for wealth, demanding last minute schedule change or even bigger than life attitude. And why? At $300, $400, sometimes $600 US dollars an hour, it is easy to see how quickly a weaker mind focused on money might be drawn in. One psychiatrist was quoted as saying that, relative to depression and the rich, “In my experience, there was a high incidence of depression in the people who were born rich. And by contrast, the people today who are making a fortune are so often narcissistic in a way that excludes depression.” This says a lot about the entitlement of the extremely wealthy and their views of others. The view that money can buy an army of service people, including therapists. The successful therapists who deal with the wealthy go in armed with the notion that they will not get into King Ludwig's boat. They already know that this group has a higher "no show" rate, since cost isn't an objective and that they can be extremely charismatic and yet, highly distrustful. Yet even armed, they are still faced with challenges. For one man, it was his inability to stop controlling people, even going as far as telling the therapist how to do his job. For another, it was seeking therapy because he was beat by his own teenager at a sport and even tried to make his child give up the sport. This small group of mental health professionals are highly sought after, not because they are accommodating. Oh no. But quite the opposite. They overcome the challenges presented by the wealthy client and actually help them. At $600 dollars an hour, a five day work week, or over $1 Million US dollars a year, no longer puts this small group at the low end of the money making food chain either. I wonder who provides therapy to the therapists?