ABSTRACT
Money was both an aspect of the frame and the central part of the treatment. Bartering was acceptable, would have been an insult if refused and was a way of life. To feel that one was at least offering something in exchange for desperately needed psychiatric care helped maintained a sense of pride and avoided any further narcissistic injury. In the socioeconomic climate of the fishing village, bartering with seafood was congruent with cultural mores. The dual challenges of working with “phenomenally wealthy patients” relate to their entitlement and the therapist’s counter-transference. The Chinese American Psychoanalytic Alliance, has been making history in its efforts to bring psychoanalysis to China. The analysis of the payment arrangement is an essential aspect of the treatment situation. Whatever is negotiated—be it a reduced fee, standard fee, deferred fee, advance payment, credit card payment, Pay-Pal payment via the Internet, barter, daily payment, weekly payment, monthly payment, or annual payment—it all has meaning.
