Clinical Formulation & Philosophy

Tell me about you — name + title, how long you’ve been practicing, what you specialize in, where you’re based.

Dr. Paul L. Hokemeyer.  I am a former attorney and licensed Marriage and Family Therapist. I’m also the author of Fragile Power: Why Having Everything is Never Enough, (2019) and the soon to be released Fragile Power 2.0: Wealth, Narcissism and Mental Health, (2024). I practice as a clinical consultant to ultra-high net worth individuals, couples and families around the world. I hold a Bachelor of Arts in economics, a Master of Arts in clinical psychology, a Doctorate in law, a Ph.D. in psychology and I am a graduate of the Global Leaders in Healthcare program at Harvard Medical School. I live in Telluride, Colorado where I spend a great deal of time on Zoom and travel internationally for work. When I’m not engaged in work, I spend as much time as I can exploring the beauty of the American West in a late model Toyota 4 Runner with my spouse and family.

I’ve been practicing as a clinician and consultant in the realm of ultra-high net worth identity and mental health for the past decade. My academic and clinical work explores how people of wealth manifest their identities in the intrapersonal, interpersonal and cultural realms of their existence. I view my work through the lens of cultural competency. My clinical and academic work has been peer reviewed and published by a host of academic publications including The International Family Office Journal, the Journal of Wealth Management, Lambert Academic Press, Hazelden Publishing.

What’s the definition of an ultra-high net worth individual?

The descriptor, ultra-high net worth, is one that comes out of the realm of wealth management. According to this standard, ultra-high net worth individuals are people who have an investable net worth of at least $30 million. This group consists of the wealthiest people in the world who have enormous influence over the lives of others and the well-being of the planet upon which we are privileged to live. Although this is the industry standard, most of my clients have net worths of many multiples of this minimum standard.

How did you get into therapizing UHNW individuals? 

While I’ve worked diligently to ground my work in empirical data, my work has a personal thread running through it. As a white male born and raised in America, early in life I internalized the dominant cultural messages that financial wealth and the power inherent in it, would provide solutions to whatever problems came one’s way and that the attainment of great wealth would guarantee a problem free life. After acquiring a level of financial and professional success as an attorney, I soon learned that while providing material comfort, wealth elevated people into an isolated and frequently destructive sphere of existence.

I also experienced during the first internet bubble how sudden wealth caused people who were unprepared for the intensity inherent in it to devolve into acute states of mental illness and substance abuse. These people, who before had been part of the shared struggle of humanity, suddenly became objectified, deified and vilified simply by virtue of their wealth. This phenomenon, of being separated from humanity and being viewed as an object to be manipulated, was a factor that was not being properly addressed from a clinical perspective in the field of mental health and addiction treatment. I found this firsthand when I needed to find clinical care for a loved one who was a person of great wealth. While there were plenty of profit and not for profit facilities who were very keen to treat him, what I found was they were really interested in his ability to provide elevated fees and bring what’s known as narcissistic supply to their practices and programs.

Finding this unacceptable, I set out on a personal and professional journey to provide culturally relevant and clinically effective care to this minority group of people by obtaining academic credentials, clinical experience and engaging in empirically based research to set out a new clinical construct to treat human beings of wealth as a cultural competency.

What are your clients like? What types of jobs do they hold? Do they tend to be old money/ come from money, work in tech, have married rich?

The people with whom I am privileged to work are highly sensitive and motivated to be better versions of themselves. They want to use their wealth and privilege to make the world a safer, more compassionate place for everyone, but because of their mental health issues get stuck in unhealthy patterns of being and can’t quite figure out how. They worry about the health of our planet, the well-being of their children and live in fear of the chaos, division and social unrest that has come to define our modern ethos. They put enormous pressure on themselves to use their wealth in productive rather than destructive ways.

My typical client is a middle aged second or third generation wealth holder. They come to me to help them address an acute mental health or relational challenge in the context of their wealth. In this regard, I help them find the best-in-class care for their mental health issues and to process their recovery through an existential lens by exploring how their identity as a person of wealth impacts their individual and relational wellbeing.

I also work with ultra-high net worth families around the world to improve their relational functioning and to find clinical care for what is known as an ‘identified patient’- the person in the family who carries the most obvious symptoms of a mental health disorder.

Over the years I’ve become an expert in narcissism, and I work to help couples and families address its destructive impact on family functioning.

Because of their wealth, my clients live itinerant lives and are constantly traveling from one place to the next. My work helps ground them in a frame of self-understanding, relational integrity, a healthy self-concept and consistent self-care. In short, I help them find peace of mind and a sense of place in the context of their wealth and in a world that is constantly clawing at and demonizing them for their wealth, power and privilege.

What are the most common things UHNW people talk about in therapy? — Do they tend to want to talk about issues specific to them as UHNW individuals, or is it more general things that everyone experiences?

At the core, people of wealth suffer from the same mental health and relational issues as the rest of humanity. Surprising as it is for many people to comprehend, the super-rich struggle with the challenges of living life as sensitive and vulnerable human beings whose bodies and minds betray them with a host of issues related to their mental health. 

In this regard, the most common issues I help them address are those related to mood disorders such as anxiety, depression and bipolar disorders. This work tends to happen most amongst first generation wealth creators and in particular, founders and entrepreneurs. Starting a business is a highly stressful and chaotic endeavor that is also incredibly isolating and lonely.

Because I’m trained as a marriage and family therapist, I also work relationally to help individuals, couples and families heal from the destruction inherent in narcissistic personality disorder, infidelity, substance abuse and issues related to sexual compulsivity. In this regard, I help them navigate and process the frequent betrayal that occurs when they realize people see them as objects to be used rather than human beings to be loved.

How are you different from other therapists?

As a licensed clinician and researcher who studies people of wealth as a culturally distinct group, I believe every human being regardless of their place on the socioeconomic spectrum deserves empirically based, culturally respectful mental health care. In this regard, #mentalhealthmatters 4 everyone. Everywhere.

My patients come to me because of my research and my capacity to empathize with them in their unique identity as a person of wealth and power.  I provide them a safe, contained and empirically grounded frame to come forward with the fullness of their identities as people of wealth rather than having to hide that part of their identity for fear of being judged harshly or manipulated for it.

Instead of pretending their wealth and power don’t exist or matter, we consider it as an integral part of their identity and address it in the context of their mental and relational health.  Just as I make sure I acknowledge and respect the cultural markers of the sexual, gender and religious minorities I’m privileged to treat; I have a professional and human obligation to honor the cultural markers inherent in an identity of wealth.

The field of mental health has done an exceptional job looking at how financial stress adds to a host of mental health disorders, but until my research, it has rejected any consideration of the impacts abundant wealth has on a person’s mental well-being. As a result, wealthy people’s mental health problems are judged in relative terms and made fun of. For me, emotions are emotions, pain is pain. Placing them in the context of worthy or unworthy based on a person’s economic status is insulting, inhumane, unprofessional and unethical.

What have you learned from working with this population?

 Over the years, I’ve learned a great deal from my clients. From them, I’ve learned that wealth can be both a blessing and a curse. They’ve taught me that wealth must be managed responsibly and placed in the care of trustworthy people. I’ve learned to be grateful for my life, a life that is defined by my professional accomplishments and the integrity of my relationships rather than the amount of my wealth or the compulsive acquisition of people, places, and things. I’ve learned that while wealth holds the power to corrupt, it doesn’t have to. When properly channeled, it can be used to heal self, others and a planet that needs our protection and care.  Finally, I’ve learned that this notion that ‘all rich people are miserable and mean’ is pure rubbish. My clients are some of the happiest, healthiest and kindest people I’ve had the privilege of meeting.