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Billable Services and the "Therapeutic Fee": On the Work of Disavowal of Political Economy and its Re-emergence in Clinical Practice

ABSTRACT:This article analyzes the structural contradictions in the professional lives of social workers and counselors ("psychotherapists") that give rise to a set of rationalizing discourses that align billing practices with notions of therapeutic appropriateness. I propose that, bound by a normative professional trajectory that prescribes upward mobility on one hand and the performance of a commitment to helping the underprivileged on the other, psychotherapists attempt to manage the ambivalence that these divergent imperatives invoke by working discursively to disavow the role of political economy in shaping their clinical activities. As therapists move along a career path that begins in an agency setting and culminates in private practice, they deploy situated strategies for effacing economic considerations by shifting to a moral register. In so doing, I argue, psychotherapists inadvertently articulate and legitimate a class-differentiated "moral economy of mental healthcare" that reasserts precisely the market-based logics that it seeks to transcend.