Why did you become a therapist or counselor? Most mental health professionals will answer, without missing a beat, “To help people,” “To support people through difficult situations,” or some variant.
But by now you may have realized your desire to help others sometimes conflicts with the fact that your profession is still just that—a profession. You might operate your private practice with a primary goal of providing compassionate mental health treatment, but you still must cover your costs and make a profit. This knowledge may lead to struggles with difficult decisions, such as whether to accept insurance or offer a sliding scale fee structure.
When you’re first starting out, you might feel nervous discussing counseling fees, insurance, types of payment you accept, and other fee policies. Here, we’ll go over a few tips to help make those dreaded money discussions a little easier for you and your clients.
How to Answer Common Questions About Counseling Fees
1. Outline your policies clearly from the beginning.
Whatever fee structure or payment policy you decide on, it’s important to communicate those clearly. Creating a document that thoroughly covers your policies is a good first step. Go over this document verbally in the first session to make sure your clients understand the policies. Have them sign it, then give them a copy and keep one for yourself.
Ask clients if they have questions about policies instead of waiting for them to ask—they might not. A fear of awkward financial discussions on both sides can contribute to misunderstandings later on.
2. Be specific when answering clients’ questions about fees.
When answering questions about fees, be clear with your clients. Saying something like, “I do offer a sliding scale, but it’s on a case-by-case basis” can be vague. A client in a difficult financial situation may want to know whether they can continue in therapy if they can’t pay for a few sessions right away. Clearly explain any financial hardship or reduced fee policies and the circumstances in which you’d implement them.
If you terminate therapy after a certain number of unpaid sessions, make sure they’re aware of this. If they begin to skip payments, it may help to remind them, in writing and verbally, that you’ll have to put a hold on therapy until they pay for missed sessions.
In general, it’s easier to have these discussions when problems arise if you’ve already touched on these things early in therapy.
3. Clarify your sliding scale and/or no-fee policy.
Choosing to offer sliding scale therapy fees is a decision every therapist has to make. When starting out, you may already intend to save space for clients with less income, recognizing that many underserved populations don’t seek therapy because they lack financial resources.
You might also plan to save a few no-fee spots for clients who can’t afford to pay any amount. But you do want to keep your practice running, so you may choose not to offer a sliding scale until you’ve built a firmer financial ground for yourself.
Cedar Barstow, MEd, CHT, DPI, who practices therapy in Boulder, Colorado, explains how her approach to counseling fees has changed over time: “When it comes to my fee for therapy, I've gone through a professional development process. First, I had a sliding scale … so that people who need therapy wouldn't be turned away because they can't afford it. Then I understood that with a simple sliding scale, I wasn't internally valuing myself and my training, experience, my skills enough. So I now charge $120 for a session.”
When new clients ask whether you offer a sliding scale, you may struggle to explain why you don’t, or if you do offer a limited number of sliding scale session spots but they’re all full. You may feel guilty when letting clients down or rejecting them, but honesty is all you can offer.
For example, you could say, “I intend to offer a sliding scale when I have a certain number of regular clients, but at this time I’m not able to do so.” Or, “My sliding scale session spots are currently full, but if one opens up, we can talk about a lower fee at that time.”
Some professionals develop creative approaches to offering low-cost therapy. Cedar explains, “If $120 would be a hardship for the potential client, I negotiate individually to a lower fee, and then, when appropriate, I ask them to do some volunteer work of their choice to compensate for the reduced fee. I feel valued and content with this.”
4. Be ready with a list of colleagues to whom you can refer a client, if it becomes necessary.
It can help to have phone numbers for colleagues who practice similar types of therapy and do offer sliding scale spots. If you’re able to recommend a therapist you know, this can make it easier to turn clients away. Just be sure to check in with these colleagues from time to time so you don’t refer a client to someone who no longer offers a sliding scale.
What If a Client Refuses to Pay for Therapy?
At times, a client may have trouble paying for therapy. This may not be a problem if it happens once or twice, especially if someone is struggling with financial or related issues, including unemployment, homelessness, or poverty. You may allow a client to skip payments for a few sessions until their financial situation has stabilized, offer one or two free or reduced-cost sessions, or temporarily offer some other arrangement.
But if a client persists in not paying and you haven’t come to any sort of arrangement, you may wonder how to address the topic of their growing debt. This can affect therapy success. Here are some tips to handle the situation:
- Go over your fee policy and point out, respectfully, what you agreed to in your first session.
- Consider an online payment system that charges the client for each session electronically. Charging therapy fees electronically can reduce missed or forgotten payments and eliminate awkward conversations.
- Be polite but firm when asking for payment. Bringing up payment can be difficult, especially after an emotional session, but it’s important to follow your policy.
- Include a note in your fee policy about unpaid sessions. For example, will you stop providing therapy after two unpaid sessions? When fees have reached a certain amount? Uphold this boundary with all clients.
You may dislike the idea of turning away someone in need, especially when therapy is progressing well. Consider providing phone numbers for low-cost therapy resources or websites of crisis helplines and community or online groups when someone can’t pay. Your client may want to continue with you, but you can’t continue providing therapy if the client isn’t upholding their end of the therapeutic relationship by paying for sessions.
What If I Need to Raise My Fee?
It may become necessary for you to raise fees over the course of your career. Giving your clients this news can create anxiety for you as well as your clients. These tips can help the process go more smoothly:
- Consider avoiding raising fees for existing clients as long as possible. Let them know of the upcoming fee increase during a session, then provide them with a written or email notification. Then let them know you’ll continue to work with them at the current fee for a set period, such as 3 months or 6 months, before the increase takes effect.
- If possible, maintain free or low-cost therapy spots for the clients who need it.
- Try to raise your fees at a specific time, such as the beginning of a calendar year, when you’ve obtained a new qualification, or trained in a new approach.
- Offer a brief, professional explanation for the fee raise. Perhaps you’ve chosen to see fewer clients for personal reasons. Maybe the demand for the type of therapy you provide has decreased, leading to fewer clients. Or maybe your landlord raised the rent for your therapy office.
Not all clients will be concerned by fee changes, but some may respond negatively. It can help to prepare yourself for all possible reactions, as financial matters do have potential to affect the therapy relationship.
Therapy is a service, and you’re a trained professional. It’s important you receive adequate payment for the service you provide so you can continue providing it. But it’s also essential to separate financial matters from therapy to avoid confusion in your relationship with your clients. Setting aside time for payment at the beginning or end of each session can help
Clear discussions about payment, before therapy even begins, are essential to the success of good therapy. Unclear payment expectations can have a negative impact on the therapeutic relationship. In a worst-case scenario, someone may choose to leave treatment early and could develop an overall negative impression of therapy, which can make them less likely to seek out therapy again in the future.
If you feel unsure about discussing financial issues with clients, or if you feel anxious when thinking about bringing up unpaid bills with clients, consider talking to a supervisor or therapist trained to support other therapists through issues that arise in counseling.
References:
- Hanks, J. (2012, July 3). Talking to clients about raising your fee. Retrieved from http://www.drjuliehanks.com/2012/07/03/talking-to-clients-about-raising-your-fee
- Stevens, L. (1998). When money comes up in therapy: Two ways to make your fee policies clear and easy to talk about. Psychotherapy Networker. Retrieved from https://www.psychotherapynetworker.org/blog/details/1402/when-money-comes-up-in-therapy
- Zur, O. (n.d.). Fees in psychotherapy and counseling. Zur Institute. Retrieved from https://www.zurinstitute.com/fee-in-counseling-intro
- Zur, O. (n.d.). Fees in therapy: Summary and guidelines. Zur Institute. Retrieved from https://www.zurinstitute.com/fee-guidelines
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