It may be perfectly all right . . . and even admirable to reduce your fees to accommodate clients’ financial needs when you are able. However, before you reduce those fees, take time . . .
- To assess your own sense of
value and worth. Make sure it’s not muddying your decisions about fees. - Likewise, don’t be too quick to assume that your client needs a reduced fee . . . they may just need a more flexible payment plan.
- Consider ways that you will limit the use of a reduced fee for you client.
- And, understand that how you choose to offer / accommodate the need for a reduced fee affects your community’s perception of you and your work.
I’m sure there are other things to take into account when clients have financial needs, but these are the ones that I tripped over when I first went into private practice. I hope you’ll add to the list by sharing your experiences with reduced fees, sliding scales and the lessons you have learned.
This is a great and very important post. I recently attended a training for therapists where we were instructed to charge as much as possible for our services, because if we don’t, we will feel burned out and taken advantage of (see the post below). That being said, I often feel funny charging as much as I now do. I wonder if I am really worth that much, and I am quick to offer a reduction, even if the client does not ask for it. And I still regret these reflexive decisions on my part to offer a reduction. The client sessions I feel best about are those that pay my full fee. The lower the fee I am charging the client the less I want to see the client and the more I resent the client. I wish I never opened my big mouth. From now on I will try to be more selective about whom I offer a discount to and in those cases, how much of a discount I offer. But I still need to figure out what to do with my current cases that are paying a discounted rate. How can I get them back on to a full fee or otherwise make myself feel better about the current rate?
Hi, Chuck! Welcome to Private Practice from the Inside Out and thank you for dropping in to chat! I’m curious about the advice you (and other mental health professionals) received to “charge as much as possible” to avoid burnout. The research out there does not support this. In fact, my understanding and first hand experience is that failing to charge enough is actually a symptom of not valuing the services that you provide. This is a topic that my clients know all too well and one that I want to blog about next month.
I’ve written you a quick email this morning, Chuck, thanking you for bringing up this topic. I’ll be writing more about burnout and how to deal with those folks who are already paying less that you know you are worth in May. However, if you would like me to link back to your email or a website, please let me know. I’m happy to push a little search engine traffic your way as a “thank you.”
I appreciate your thoughtful contribution to the conversation, Chuck, and hope you’ll be dropping back in here often to chat.
I personally wonder how people manage sliding scales and make decisions about who pays to full fee and who pays the reduced fee. Also when you submit to insurance companies would you submit your top fee or the lower fee, or somewhere in the middle.
Hi, Jill! It’s good to hear from you again! I’ll be writing more about reduced fees for clients next month. However, in the mean time, you might find this series of posts to be of some use, Reduced Fees, Sliding Scales and Lessons Learned.
And, I wrote Ask Tamara: Setting Different Fees for Different Clients to help you remember not to charge different clients different fees based solely on whether they are cash-paying or filing on their insurance. That means you always put your Usual and Customary Fee on any paperwork submitted to managed care.
Tamara,
One of my mentors, Dee Marquette, shared a nice formula with me for deciding how to meet the ethical responsibility of giving and serving a population who may not be able to afford her regular fees. She reserves a certain number of spaces for lower fees. Hence, if a full client load is 20-25 then 2 or 3 spots are reserved for sliding scale.
I have adopted the same formula. However, it is importance to stick with a consistent number. Also, I have a list of affordable programs in the area if a client cannot pay my standard fee. One such program is at People House, which is where I lease my office. The fees are from $15-$40 per session. Also, I refer clients to local colleges and university who have interns in training.
Thank you,
Brenda Bomgardner
http://creatingyourbeyond.com
brenda@creatingyourbeyond.com
Brenda! It’s good to hear from you. I do the same thing and hadn’t even thought to detail them here. Thanks so much for taking time to share your tips! If I get a lot of other suggestions, I’ll collect and rewrite them into one blog post for easier reference.
Anyone else got anything to share?
It’s quite interesting to read this (from the other side) as a patient of a therapist that has recently reduced the fee of our session, especially the comments on this post.
Recently, I lost my job and my therapist immediately offered to reduce the fee for me … and the first sentence out of my mouth was, “you’re worth so much more than that!” I think that the original dynamic between the therapist and client is important – and will determine a lot of how the therapist would view that decision … or so I would hope!
Amanda, how did I miss seeing your comment here? So very sorry for the delay in responding. Thank you for dropping in here to share the other side of reduced fees. And, I think your comments are right on target. While there are standards of practice and laws for a mental health provider to consider, there are also clinical issues and experiences that should also be taken into account – not the least of which is the relationship between the client and the therapist. It all matters, doesn’t it?
Hi Tamara-
What a lovely, clean, and easy to navigate site you have:). There is a wealth of info here–I only wish I had this resource when I started my PP…
This is such a fascinating topic. How people view money is such a psychologically-laden process. I have met so many therapists who are quick to reduce fees just to get clients in the door. I remember reading a forum about this, and one therapist was adament that doctors, dentists, attorneys, and CPAs don’t offer a sliding scale/reduced fee, so why should we?
It’s a tough one. My first client told me she couldn’t afford my rate. When I asked what she could afford, she quoted a rate that was about $15.00 lower than what is considered standard sliding scale for my state and license (California, LCSW). She also happened to be a very difficult client on my levels. I did regret my decision to agree to her rate. That said, I saw that as my fault, and I did not “blame” her for paying lower, after all, I agreed to it. We didn’t need to bring another issue into the psychotherapy room…;). It was a lesson learned, and I’ve never reduced my rates below the standard sliding scale again.
I’m glad that Amanda’s therapist was able to accommodate her. It’s the ethical thing to do in this situation, and it sounds like the relationship will be stronger as a result.
Hi, Linda! Thanks for joining in the conversation here! Money talk is always psych-laden, isn’t it?! And, I’m embarrassed to say that anything-to-get-the-clients-in mentality was true for me in the beginning of my practice at least as it related to money. I suspect it’s true for many new therapists whose throats go dry at the thought of asking for $100 or more for an hour of work. That sounds like so much money, doesn’t it?!
What they / we often don’t take time to think through is how very expensive it is to get your Master’s or Doctoral degree, obtain post-graduate supervision (often paid for out of your own pocket), obtain a mental health license (as well as certifications), continue to obtain highly specialized training throughout your career, engage in ongoing clinical consultation (typically at your own cost), renting office space, furnishing your office including technology, obtaining your own health and liability insurance, obtaining legal / risk management as needed, contracting with an answering service, and often supporting administrative or other clinical professionals as well.
Going into private practice is not cheap. There are lots of things you can do to run your practice efficiently but it’s never cheap.
The comment about doctors or other providers is very well off the mark. Around 50 percent of all healthcare providers offer up to 50 percent of free work. In fact, I would say that a doctor now works 14 hours a day finishing their paperwork in the USA – due to many factors but one being we are now reduced to charting experts and no longer are clinicians. We chart for wealthy owners to make them money. I give away free care constantly as a nurse and am building in a 1 per 4 model, for every 4 clients that pays, I give one FREE service. You do your, however, but don’t you dare for once think you are the victims when people can’t afford your services. I wish I could command those prices and my education and experience levels save lives. I would never imagine saving a life based on a full fee. It’s my pleasure and have plenty of clients I never even bill at all.
Hi, Dana! Thank you for joining the conversation here at Private Practice from the Inside Out!
It’s always good to hear from allied health professionals to learn about differences in our practices so thank you for your service.
I am interested in your comment – “Around 50 percent of all healthcare providers offer up to 50 percent of free work.”
Can you point me toward a source for this?
I do recognize that both physical health and mental health professionals are increasingly working more with charting and less time with patients and it is frustrating.
I’m sorry that you are unable to imagine charging a fee or full fee for your professional work; I cannot imagine the financial strain that must put you / your family under.
I look forward to hearing from you!
I am so very happy that I read this blog. The comments help to reinforce some discomfort that I’ve encountered as a new therapist. Yes, it’s very uncomfortable to ask for $100.00 per session or even $80.00, however we deserve it. I don’t want to repeat what has already been said, but I do agree that other professions do not offer sliding fee scales and starting practice is not cheap. But what are the options when you have a low caseload let’s say between 3-4 patients. Should you then lower your fees in order to accept new referrals and accommodate patients financial situations?
Hi, Raymond! I have no idea how I missed your comment and Amandas! So sorry for the delay in responding. It’s always good to have your voice here.
I, too, struggled with asking for what was the Usual and Customary Rate (UCR) for my services when I got started and I see especially new therapists struggle to do the same. Prior to private practice, most of us earned no more than fifteen to twenty dollars an hour; and, now we are asking for one hundred!
However, before you give in to your discomfort, you should consider a few different things . . . .
1. Countertransference i.e. how does your history with money affect how you feel about charging the UCR in your community?
2. Countertransference i.e. how does your own sense of value and worth complicate you asking for the UCR?
3. Can you pay your bills and live comfortably charging less than the UCR when you are seeing only 3-4 clients?
Math is not my strong suit, but in my head seeing fewer clients does not equate to charging lower fees. Instead, if you are wanting to lower your fees, you need to either be seeing enough clients that you can afford to do so or you need to be charging more per client . . . so that you can comfortably offer some reduced fee slots.
Is there anyone else out there who is doing the math differently?
Raymond, I have struggled with the same questions and issues as you. I do believe I am worth the $100 full fee, but I also know that there are many out there who cannot afford mental health care at this rate. My caseload had gotten up to about 15 people for awhile, but has recently dropped back down to about 4-5 clients per week, mostly due to the economy. So I am accepting more sliding scale fee clients, but wonder if I am selling myself short.
I think all this indicates a need for me to redirect my marketing efforts, in order to make myself more attractive to people who can pay the full fee.
Hi, Lois! It’s nice to meet you! Thanks so much for dropping in here to chat!
You know, one of the hallmarks of a successful mental health practitioner in private practice is his / her ability to “read” the market and be quick to respond. If you’ve been in practice for a while, it may very well be time to update and retool your marketing efforts so that they reach and resonate with the right clients and referral sources.
There are many ways – not just one way – to build your private practice. “Selling yourself short” in whatever way that looks is never the right answer.
Lois, I hope you’ll drop back in often to gather a little inspiration and share your experiences here at Private Practice from the Inside Out! I look forward to hearing your voice!
The ACA ethics code states that we cannot deny services based on a client’s inability to pay. Obviously no one is expecting you to work for free and I will refer people to a community counseling agency if they cannot afford to pay anything. My costs in PP are very low. I have a home office, I get my health insurance through my husband who gets it free from his work, my malpractice insurance is $300 a year, I get free CEUs from goodtherapy.org, and got low student loans. I went to a state college because I knew I would be making $30,000 a year initially right out of school. I also worked two full time jobs while in college to reduce my debt as much as possible. I left graduate school only owing 20,000. I also made and maintain my own website. I realize not everyone can do this, but what I’m saying is I was able to cut my costs down a lot.
I know I am a good therapist and really pride myself on the quality of my work, however starting out I was not attracting any clients. I decided the problem was just that people simply didn’t know about me yet. I decided I would take anyone even if the best they could was $25. I figured that was better than lolling around the house. Besides, I love what I do, right? No matter how much they’re paying, I give everyone my best. This has caused people to tell their friends about me and write enthusiastic testimonials about me once they finish therapy. I could still use some more clients, but I feel confident that providing excellent services will cause word of mouth to do the marketing for me. Some may disagree with me here, but I think it’s okay to offer deeply discounted services if you are only seeing five clients. Think of it as free marketing at the very least.
jpcounseling.com
Good morning, Marina! Thanks for dropping in here to chat early this morning!
You’ve obviously been proactive in making some choices related to your career path. Good for you! I am surprised to see you stating that your private practice has come with low costs because most of us have higher than average overhead because of the many “soft” costs incurred. Nevertheless, you have made choices that apparently allow you to afford to provide quality services at deeply discounted fees. Good for you and your clients!
I do, however, want to note that giving away your time is not “free” marketing. It may be wise . . . . It may the the compassionate thing for any one of us to do. But it is definitely not free. If you are seeing 4 clients at $25 / hour each once a week for a total of $100, you have probably spent another 4 hours prepping for those clients, completing paperwork, incurring liability risks (for 4 rather than 1), and managing / marketing your practice.
A different choice might be to charge one client $100 / hour (knowing that you’ll spend another hour prepping and completing paperwork) and choosing to spend the other three hours marketing your practice by networking, blogging, and making new connections on and offline that can help you fill your appointment books or you might spend it by learning new things, spending time with your family, or building your own resilience.
One choice is not necessarily “right” and the other is not necessarily “wrong” . . . and, in fact, there are still other choices / solutions along the way. What’s important here is to note that there are many right ways to build a practice rather than just one.
Congrats to you, Marina, on your success! I hope you’ll drop back in often to share your thoughts and insights on your journey!
Hi Marina, Thanks for sharing your experience. I recently joined Tamara’s website and I been reading previous post. I love your website!
Tamara
I just wanted to say thank you for this wonderful website! I am learning so much browsing the blogs and comments. I am an LPC, just recently moved to the Castle Rock, Co area and I’m considering starting a private practice. I’m looking for ways to make connections with other professionals in the area. Do you have any suggestions for online groups in the South Denver area?
Definitely, Erica! Welcome to Castle Rock! There are now lots of ways to connect with professionals in the area. Here’s my top 3 three suggestions for online groups in South Denver . . . .
1. Check out the Denver Therapists Network. It’s a fabulous resource of both seasoned and new professionals in mental health!
2. If you are on Google+, check out the Colorado Psychotherapists community. It’s new and growing.
3. Check out Boulder Psychotherapy Institute networking list. It’s a good list to be on even though it’s a bit too sales-y and not clinical enough to suit my taste. It will allow you to see services / resources being offered.
And, if you are looking for face-to-face networking opportunities in South Denver, know that there are tons of these, too! I hope this helps you find your tribe and I look forward to meeting you soon!