Published: July 7, 2008
Not long ago, a young titan of New York real estate sat in his psychotherapist’s office. An art collector, he was thinking of bidding about $8 million for a painting, and something about the deal made him uneasy.
The therapist thought the patient was merely trying to impress him. This happened whenever the man felt unsure of himself, which was most of the time.
But instead of trying to explore the patient’s anxiety, the therapist encouraged him to buy the artwork: “This is what you want; you should go get it.”
T. Byram Karasu, a Manhattan psychiatrist whom the therapist consulted about the patient, was appalled. “That was precisely the wrong treatment,” he said. “The doctor forgot that addiction cannot be satisfied by its object. The therapist’s job is not to comfort and validate the patient’s excesses and consumption. Those are neuroses.”
Dr. Karasu, known as an expert in treating the wealthy and powerful, recognized a common pitfall among his peers: Rich people can be seductive. “The therapist wants to identify with the patients and comes to see it as his role to help them get more wealthy,” he said. In the process, the doctor risks becoming the patient’s “alter-id.”
Wealth reminiscent of the Gilded Age has encouraged a thriving business for a small and highly specialized group of therapists in New York and elsewhere. Their daily work gives them an intimate view of an elite who differ in some ways from their predecessors, and who can test the therapists who treat them.
More than a dozen therapists who are respected by their peers in the counseling of extremely wealthy patients said in interviews that, as with the real estate mogul, it can be hard to resist the temptation to sycophantically adopt their point of view.
In some cases, the patients treat their therapists as but another member of their entourage of servants. Some therapists also cited a heightened difficulty with frustration and setbacks for people used to getting what they wanted. And they are resistant to opening up, to showing vulnerability.
Dr. Karasu said the past few years had felt different to him.
“The problems are the same, but the scale is different now,” he said. “Hedge funds — there is no product, only wealth. It is flabbergasting to my patients, too. They can make so much money at once and then lose it.”
Dr. Michael H. Stone, a psychiatrist affiliated with Columbia, said that the preponderance of patients with self-made fortunes, many made at a relatively young age, marked a striking shift.
“It used to be that my patients were the children of the rich: inheritors, people who suffered from the neglect of jet-setting parents or from the fear that no matter what they did, they would never measure up to their father’s accomplishments,” he recalled. “Now I see so many young people — people in their 30s and 40s — who’ve made the money themselves.”
Dr. Stone said those two kinds of patients tended to have different problems: “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.”
Dr. Karasu is chairman of the department of psychiatry and behavioral sciences at Albert Einstein College of Medicine in the Bronx. He also has an office for private practice on 88th Street near Fifth Avenue. He charges $600 for a 45-minute session, seeing most of his patients at least twice a week.
It was during his first week in practice, in 1969, that he inherited a famous patient from a psychoanalyst who had recently passed away, and from that point on, he said: “My patients trained me in these issues. There’s a real school for it.”
Andrew Henderson/The New York Times
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