Social and Market Exchange
At the heart of the matter regarding reasonable human service expectations is the nature of norms and expectations established by the provider in their relationship with a client/patient. In recent years, those who identify themselves as behavioral economists have drawn an important distinction between what they call “market exchange” and something called “social exchange.” The second of these two exchanges (“social”) occurs when we meet with a dear friend to share some personal problems or offer a party to celebrate our friend’s graduation or job promotion. These “services” are offered at no fee and are reciprocated. We can be helped sometimes, and at other times, provide the help and support. This is what friendships are all about. Our friend or a member of our family doesn’t reimburse us for the cost of the celebration, but they are expected to “return the favor” at some point in the near future.
Psychological and other human services are not based on social exchange. They are based on market exchange. Payment is received for services rendered, and the helping role is rarely reversed. This means that the concerns of one’s client/patient are primary. Focus is NOT placed on the therapist, but instead on the client/patient. The therapist is expected to ask questions, take notes, or in some way demonstrate sustained attention to what their client/patient is saying or doing. Most of the time during a session is taken up by client/patient talk, not by therapist talk—unless the therapist is providing some relevant information. Periods of silence are acceptable. The client/patient is not expected to keep the conversation going (as is often the case with a social exchange).
While the psychologist is quite active when doing an assessment, the focus is still on the client’s performance. Similarly, an organizational consultant might be doing some teaching or demonstrating some mode of constructive interaction—yet the focus must always be on the interests and needs of the client rather than the ego needs of the consultant. Most organizational consultants conduct interviews, observe operations in an organization, and/or review documents before generating a report that summarizes the consultant’s conclusions and recommendations. In this consultative mode, there is a much greater proportion of taking in rather than giving out—this proportion defines what it means to engage in the provision of human services via market exchange.
The other distinguishing characteristic of a market exchange, of course, concerns payment for services rendered. This payment might be made specifically by the person receiving the services or a third party. It should be noted that financial matters are often very difficult to address even when market exchange has been established. How much should be charged? What if the client/patient can’t afford this fee? Can I and should I do pro bono work for worthy causes? What if a client/patient fails to show up or fails to pay? All of this suggests that a ghost of social exchange resides at the heart of many (if not all) market exchanges in the domain of human services. It is not hard to manage a market exchange when it involves the selling of hats or zucchini. It is much more difficult to manage when it involves the treatment of human pain.
