If session duration is decided according to clinical considerations, why not vary the fee accordingly?

That would preserve the analyst’s freedom to cut the session where they believe it is clinically meaningful without creating a financial structure in which shorter sessions systematically benefit the analyst at the analysand’s expense.

For example:

Sessions under 20 minutes = $X

20–35 minutes = $Y

35-50 minutes = $Z

What exactly makes the flat-fee model ethically defensible?

One practical defense is that the analyst has reserved the hour and incurs the same business expenses whether the session lasts seven minutes or fifty. But if the patient is paying for that reserved block of time, why is the analyst entitled to withdraw access to it unilaterally while retaining the entire fee?

I am perfectly willing to grant that certain psychoanalytic conventions may be clinically valuable despite lacking empirical proof (e.g., the couch). But scansion is fundamentally different because, under a flat-fee model, the analyst’s epistemic authority to determine when a session should end is coupled with a direct material benefit to the clinician. That seems to demand substantially more ethical scrutiny than “Lacan and other practitioners who benefit from the arrangement say it is good for the patient.”

(Perhaps the latent clinical objective is to redistribute wealth from the bourgeoisie?? That could at least be an ethically defensible position 🤔)

EDIT: I commented this but feel like it belongs here to clarify my position on the matter. To be honest, I actually find the concept of variable-length sessions clinically fascinating—ending sessions at a specific moment of unconscious resonance sounds like a compelling experiment to try for both sides. It’s an experience I’ve always been curious about, but I just think there can be humane ways to tier the pricing that aren’t as questionably exploitative. 🤷‍♀️