While it's entirely possible that he uses a sliding scale, therapy is prohibitively expensive for most people and then usually not covered by health insurance. There is a white upper middle class American-centricity to Downs' approach, an outlook perhaps shaped by Downs' drawing most his interviews for this book from clients of his LA practice.
However, like many readers, it became clear to me very early on that I did not fall into this book's target demographic, which has led me to wonder if its scope is much more narrow than many (including the author) realize. Downs' broad premise - that gay culture is awash in deeply calcified narcissism - is a valid one, and bears the additional virture of being entirely true.
I wanted to like this book way more than I did.
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