“‘cus she’s got that power,

to love you by the hour…”

– The Velvet Underground, Cool it Down


She pretends not to glance at the clock.

But we both know our time is up.

Here comes the awkward part.

When the intimate interaction is reduced to a monetary transaction.

Did she really care?

Or was this all just a money grab?


The above thought bubbles pop up in the hush-hush recesses of whore houses and therapy offices throughout the day, throughout the world. The illusion of unconditional acceptance comes at a cost. And the more skilled the illusionist, the higher the price per forty minute hour.

As a lifelong client (and wayward clinician) in the field of mental health, I’ve always struggled with this inner tension. In fact, I took a long hiatus from my private practice and fired my own therapist (not an easy feat, if you’ve never had the misfortune of trying it), because, at a particularly cynical juncture of my life, I came to the crude conclusion that the entire gig was an absolute sham.

I currently write this from the waiting room of my new therapist (for those keeping score at home, we’re on shrink number sixty three) and I’ve recently reopened my private practice (I’m calling it a “soft open” to assuage my insecurities) — so I guess you can say that I’ve come around on the matter. But I still, at least partially, hold on to my admittedly unflattering comparison. We are emotional prostitutes — providing a very intimate and deeply personal service to fill a void that should’ve been nurtured more naturally, but for one reason, or another, must now be outsourced.

The metaphor will, unquestionably, meet resistance among mental health professionals. And I can already hear the counterattack, sung to the tune of: “Psychotherapists deserve to get paid just like any other service providers, do they not? If you’re calling talk therapy “prostitution,” you may as well tag acupuncture, dry cleaning, and Uber driving with the same derogatory label!”

So let me assemble a preemptive defense.

Acupuncturists, dry cleaners, and Uber drivers don’t sell unconditional positive regard as part and parcel of their services. There is no intimacy or prosthetic compassion involved. But you don’t need to be Carl Rogers to appreciate the personal tenderness of the therapeutic relationship. It’s an inescapable reality: if clients don’t feel embraced and accepted, we are not doing our jobs. And if they don’t pay us for making them feel this way, we will wish them well and block their numbers. If that doesn’t strike you as emotional prostitution, I don’t know what will.

As of this writing, I have never employed the services of a prostitute, but I can imagine the goodbyes are at least as awkward as those of a therapy session. Everyone pretends this was more empathic than economic, but we can’t take the price tag out of the equation.

So instead of rebelling against this tension, I’ve grown to reframe it.

It’s strange to distinguish between “good fat” and “bad fat” but those in the know have enlightened us to this counterintuitive distinction. And I think we can say the same for prostitutes. The emotional prostitutes are the “good fat” of the bunch.

After all, we don’t destroy marriages, we help repair them. We don’t leave an aftertaste of shame and self-disgust, we alleviate shame and guide self-discovery. We are not an impulsive, short term investment, but a deeper, long term investment.

So, yes, therapy may be a form of emotional prostitution.

But as prostitution goes, it’s by far the best bang for your buck.