The Demon of Comparison

"Saint Anthony" Tempted by Master of the Osservanza

Have you ever noticed how comparison and resentment go hand in hand?  I was reminded of this again when a new bout of it erupted on a listserv I follow.

One therapist began speaking about how s/he was on the phone with an insurance company for a claim, and began to ask them about their salary, and whether they, like the therapist had not seen an increase in it since the 1990s.  This prompted a bevy of emails back and forth to the tune of, “Yeah, we should find out how much they make, what they’re salary structure is” and of course the inevitable, “it is terrible that their executives make X amount of dollars.”

Really?  Do you really want to be like the executives of a managed care company?

I know that I often blog here about how it is important to cultivate a business sense, so this may sound like a contradiction, but there is a vast difference between learning from businesspeople and emulating the ones we consider are doing unconscionable acts.  Therapists often seem to want to have it both ways, we want to have the money and ease we imagine the “fat cats” at HMOs have, but we want to decry them as monsters.  You can’t have it both ways, or either, if you want a profitable yet socially just practice.

What I think we often see here is good old fashioned projection, namely, projecting whatever part of ourselves we either find unacceptable or yearned for.  Many of our colleagues have strong ambivalence about getting paid for helping, listening, and emotional labor.  Sometimes we disown the parts of ourselves that see what we do as valuable, worth every penny, amazing.  The way we disown this is to judge it as greed, and project our greediness onto someone else we can despise.  The CEOs of insurance companies make great targets, when we look at the financial reports they deliver to their Board of Directors.

But when we project these things on the customer service rep, or care advocate, we miss the mark in many ways.  Probably the most important way is that we act out our aggression with a worker who is not making anywhere near the money a CEO makes.  And those customer service people aren’t uncaring, their doing a job for a company and often protecting themselves from the assaults they receive via irate therapists all day.  Did it ever occur to you that the call the person on the other end of the phone just before you was someone haranguing them about how much they make and how greedy and unfeeling they are?

Look, I’m not trying to make excuses for the bureaucratic nature of managed care.  The point I am making is that splitting is a primitive defense, even when the target has a big ol’ bulls-eye on it.  More importantly, it doesn’t help your practice.

We have to befriend the part of us that wants to make money by listening to it, and using it to motivate our creativity.  If the only way we can access that is by “pinging” off a projection of the “greedy” other, we are staying stagnant.  If you are looking to an insurance company, customer service rep, or CEO to recognize you’re value you are wasting your time.  Go look in the mirror, that’s who you’ve got to get to recognize you.  Can you look that person in the eye and say, “I want to make a good living, and I am valuable?”

Remember, each of you IS a CEO, of your own business.  If you aren’t happy with your salary, what are you doing to grow the business that has been entrusted to you by yourself?


  1. Hi Mike…. so what’s the psychological explanation for a Mental Health Professional who commits insurance fraud (billing for sessions not provided) Maybe a future blog topic?

    • wisdom, I think it boils down to fear. Insurance fraud, when deliberate, is a lie, and people lie when they don’t feel safe to tell the truth.

      • I agree with you regarding the “truth about lies” . A person that commits insurance fraud is probably living in more toward the fear end of life’s continuum, than the joyous side. (as a means of comparison!)

        btw…proving what one knows to be the truth of a certain situation is “deliberate” or “intentional” can be a real b****, as I found out!

  2. Hi Mike,
    So, what’s the symbolism of St Anthony and what was his temptation? Certainly not coveting the CEO’s job…

  3. I have a comment on managed care for what it’s worth. I was licensed 3 yrs ago in CA. Of the MC co.’s I’ve checked with not one is accepting new providers-not even ONE!
    I dislike MC for a variety of reasons. But, here’s the deal: the other therapists in my building are getting checks in the mail every day. So before you whine about how awful it is-remember you’re still cashing checks every week. The issue about the whole insurance routine is philosophical at this point. Those folks have carved out the mountain for themselves, and they don’t believe they can ever be challenged. And, truthfully, in this country, they never lose a challenge-or Rarely!! Whether it’s MH or a physically devastating disease-the system is what it is. If you feel ambivalent, then get out; or ponder your ambivalence for clues as to what your psyche is trying to tell you. It’s all grist for the mill…

    • You make a good point. On the other hand, when you successfully build your insurance-free practice, you’ll probably be making money. Because those paychecks are usually half of what your colleague’s full fee is. Full fee is not an illusion, there are people out there who actually make theirs.

      That said, this blog salutes your “no whining” policy!

  4. Hi Sophia

    What makes youe comment even more interesting is the number of “ghost panels” provided by insurance companies. Back a couple years ago when I was interviewing to hire a new therapist ( for me) there were at least 4 that I called who were listed on the insurance company’s panel, but no longer accepted that insurance plan. In fact, my former therapist, who was “caught” triple dipping”for sessions and had to pay the insurance company back and was forced to drop himself from the panel, is still listed in my provider directory, despite a couple phone calls from me in which they confirmed he was no longer a provider.

    BTW…. my former therapist also felt he could ever be challenged…then he met me. Therapists also rarely lose a challenge…I’ve read that 80% of complaints to licensing boards are completely dismissed without “futher” review, 20% receive further review, and out of all, only 2% end up in disciplinary action.


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