Money Is Already in the Room: Why We Need to Talk About Money in Therapy

Earlier this year, I was selected as one of the American Psychological Association’s “100 Psychologists Rising” because of my work at the intersection of psychology and money. At the APA Conference, I had the opportunity to share more about this work and, more personally, about my own money story and how it was shaped by my family’s migration story, our experience receiving food stamps, and the scarcity mentality that can develop when survival is not theoretical but part of everyday life.

When I was about two years old, I would ask my mother whether my “milk check” had arrived. That was what I called our food stamps. I obviously did not understand public benefits or household finances at that age, but I understood that something needed to come in the mail before we could buy what we needed. Long before I understood money intellectually, I was already learning what it represented: safety, uncertainty, responsibility, and whether there would be enough.

That is part of why I have become increasingly interested in bringing money more directly into my clinical work. I still primarily work with trauma, anxiety, depression, identity, relationships, grief, and major life transitions, but I am also recognizing how often money sits underneath or alongside those concerns. Sometimes that connection is obvious, such as when someone is worried about debt, job security, caring for aging parents, or whether they can afford to leave a relationship or make a major life change. Other times it shows up more quietly through beliefs about productivity, self-worth, responsibility, independence, success, or what it means to feel secure.

One of the things that stayed with me after my APA talk was how many people came up afterward and essentially said, “Why don’t we talk about money?” It is something all of us interact with, often every day, yet there is still so much hesitation and shame around discussing it openly.

Interestingly, I presented right after a psychologist who spoke about sex, which may have primed the audience a little. Still, I found myself thinking about how much progress we have made in talking more openly about topics that were once considered deeply private while money continues to carry its own particular secrecy. People may be willing to talk about relationships, loneliness, sex, mental health, or family conflict while still feeling uncomfortable saying, “I am struggling to pay my bills,” “I cannot afford the lifestyle people assume I have,” or “Every decision I make right now feels like a financial calculation.”

That matters because financial strain does not only affect a bank account. When someone is continually weighing whether they can afford groceries, eating out, a vacation, medical care, or their child’s extracurricular activities, those repeated decisions take up mental and emotional space. There is increasing discussion about the cognitive burden of scarcity and the ways financial stress can narrow our attention toward immediate needs and tradeoffs. In therapy, we may call this anxiety, stress, irritability, difficulty concentrating, or feeling overwhelmed without always asking how much of that experience may also be connected to money.

At the same time, I am becoming equally interested in what happens psychologically when someone has significant financial resources. Psychology has appropriately developed guidance for working with people experiencing poverty and economic marginalization, including attention to structural barriers, stigma, and clinicians’ assumptions about social class. We have far less formal guidance about working with people navigating sudden wealth, inherited wealth, family wealth, or the psychological complexity of having more than enough.

I have started hearing more people talk about guilt related to wealth, discomfort with being perceived as privileged, and fear of being seen as one of “them.” Sometimes the person inherited money or is connected to a family business they did not create. Sometimes their financial situation changed dramatically over one generation. Sometimes they have done considerable work examining their own relationship with money and are only beginning to recognize how their current financial reality affects their identity and their relationships with other people.

There is also a cultural tendency to separate “self-made” wealth from inherited wealth as though those are morally different categories. Even Forbes explicitly distinguishes between fortunes that are considered inherited and those that are considered self-made. I think that distinction can create additional pressure for the next generation of families with wealth, particularly when someone did not ask to inherit money, access, responsibility, or a family legacy but still has to figure out what all of it means.

For some people, that pressure sounds like, “What do I have to complain about?” or “I should be grateful because I have so much.” Those statements can become a way of not allowing oneself to experience grief, anxiety, depression, anger, loneliness, or uncertainty because those feelings seem incompatible with financial privilege. Yet gratitude and struggle are not mutually exclusive. Someone can recognize the opportunities they have been given and still have a complicated relationship with their family. They can feel fortunate and still be depressed. They can have financial security and still struggle with belonging, identity, relationships, meaning, and what they want their life to be about.

My own career has allowed me to work with people across a wide range of economic circumstances. I served as a Peace Corps Volunteer in rural Peru and later worked in federally qualified and community health centers with people who were navigating very real barriers to housing, healthcare, transportation, food, and other basic necessities. I have also worked with people who have substantial financial resources and access.

Those circumstances are not equivalent, and money absolutely changes the range of choices and protections available to someone. At the same time, the more people I work with and the more I examine my own assumptions about both scarcity and wealth, the more I see familiar human questions appearing across that spectrum. Questions about safety, belonging, responsibility, significance, family, identity, and meaning do not disappear because someone has more money. The context changes, the consequences change, and the available options change, but the underlying emotional questions can still be very recognizable.

For people with significant resources, there can actually be an added pressure to minimize their own distress because they believe they have no right to struggle. I often find myself reminding clients that both things can be true. They can be grateful for what they have and still be struggling with the experience of being human. They can recognize their privilege and still have emotional needs. They can care deeply about inequality and still need a place to explore their own relationship with money.

Therapists are not outside of these dynamics either. We all have our own money stories, whether we have explicitly examined them or not. We grew up observing how our families spent, saved, borrowed, gave, argued about, hid, or avoided money. We learned what money supposedly said about a person. We may have developed assumptions about wealth, poverty, success, generosity, greed, independence, responsibility, or security, and those assumptions can enter the therapy room with us.

I know that my own background shaped the way I initially understood money. Growing up in a refugee family and receiving public assistance gave me a particular lens around scarcity, survival, and responsibility. As my own circumstances have changed and as I have worked with people whose experiences with money are very different from mine, I have had to continue examining those assumptions. That process has made me increasingly curious rather than certain about what money means to any individual person.

Bringing money into therapy does not mean asking clients to open their banking apps or disclose their net worth. It can begin much more simply by asking what they learned about money growing up, who talked about it in their family, who controlled it, what happened when there was not enough, what happened when there was more than enough, and what emotions they associate with spending, saving, receiving, giving, earning, or asking for money.

Those conversations often lead somewhere much deeper than finances. They lead to family, culture, migration, race, gender, power, responsibility, love, fear, belonging, and identity. They can help us understand why someone feels guilty when they spend, panicked when they save less than usual, uncomfortable receiving help, responsible for everyone around them, or unable to feel secure no matter how much they have accumulated.

I came back from APA with even more conviction that money belongs in our conversations about mental health. It is not the only story in the room, but it is often part of the story. The more willing we are to ask about it with curiosity rather than assumption, the more complete our understanding of people becomes.

Money is already in the room. We might as well talk about it.