• Paul Hokemeyer has been a therapist to the ultra-rich for the last decade.
• There are certain issues his clients experience because of their wealth, which he shared with Business Insider.
• These include feeling valued only for their money and internalizing negative stereotypes.

A therapist to the ultra-rich shared what his clients talk about in sessions, from the wealthy father troubled by his children's entitlement to a man who feared leaving his home in case people asked him for money.

Paul Hokemeyer, a licensed marriage and family therapist who for 10 years has worked with clients with a net worth of at least $30 million, told Business Insider that his typical client is middle-aged and with inherited wealth. Only a handful of his clients have earned their own money because, in his experience, such people tend to feel more in control of their lives.

He previously told BI that ultra-rich people "suffer from the same mental health and relational issues as the rest of humanity."

But there are certain problems his wealthy clients talk about in therapy that are specific to their ultra-high net worth.

Feeling objectified

"The most common comments I hear from my clients are along the lines of 'people aren't interested in me, they are only interested in my money,' or 'my children are just waiting for me to die so they can get their hands on my money,'" Hokemeyer said.

"People of wealth are expected to provide. When they say no or create boundaries around what they are willing to give, they are perceived as villains," he said. The constant expectations on ultra-wealthy people can be exhausting and lead to painful, transactional relationships.

Hokemeyer gave the example of a father in his 80s whose adult children had spent their €40 million inheritances and expected him to continue to bankroll their extravagant lifestyles by taking money from their own children's inheritances. He started drinking heavily to manage the stress and the guilt he felt about his children's entitlement.

Hokemeyer helps clients address the sadness and disappointment they feel toward their relationships and create boundaries with people who rely on their financial support.

Feeling isolated

"While providing material comfort, wealth and power elevates people into a very isolated and too frequently self-destructive sphere of existence," Hokemeyer said.

There are a tiny number of ultra-rich people in the world — about 627,000, BI previously reported — and they can feel excluded from the rest of society. Plus, dealing with constant demands from others can lead them to retreat from normal life, he said.

One of his clients with a huge fortune from manufacturing stopped going out because he felt constantly accosted by everyone, Hokemeyer said — even in his apartment building's elevators, where his neighbors kept asking for charity donations.

"Over time, he became severely depressed and morbidly obese. He came to see me after suffering a near-fatal heart attack and realizing he needed to make some significant changes to reconnect with other human beings," he said.

Substance abuse

Hokemeyer finds that people of wealth often suffer with substance abuse problems, because they have easy access to intoxicants and because they can use their resources to avoid negative consequences.

This means that clients tend to come to Hokemeyer for help when those consequences have become "dire," he said — when their health is severely compromised, they've lost a lot of money, or their spouse has left them, for example.

The path out of substance abuse can be tricky for these individuals too, because, being used to being in control, they often resist treatment.

Feeling vilified

From teachings in the New Testament and Buddhist beliefs to the popular phrase "eat the rich," Hokemeyer said that we are surrounded by images of wealth as a form of moral decay and wealthy people as selfish and corrupt.

Many of his patients internalize these negative stereotypes and feel they are bad people, he said. So he works with them to address any guilt or shame they feel about their net-worth and to develop personalized ideas of what is healthy, within the context of their wealth and social status.