This is the 1st post in the series
Reduced Fees, Sliding Scales, and Lessons Learned
When I first went into private practice, I tripped over several issues when offering my services for a reduced fee. Before you begin advertising that you reduce your fees for clients, there’s a few things you may want to take into consideration to avoid the same mistakes that I made. Here’s the first one . . . .
Are You Meeting Your Own Financial Needs?
Generosity is certainly admirable . . . if you can afford it. Airlines tell you to put your oxygen mask on before you try to help someone else with 
theirs. And, you cannot afford to give your services away if you cannot afford the rent and electricity for your home and your office.
There are other ways to do good in this world and hopefully you are doing them. But make sure that you are financially sound before you go trying to meet your clients’ financial needs.
And, if you are out there already doing good in this world without or in addition to reducing your fees, why don’t you take a moment to let us know about your good works!
Hi Tamara, this is so true! The temptation is to think ‘I’ll offer lower fees to get clients’, but it is extremely difficult to increase fees later on. Best to decide what you need to survive (in a week or month), how many hours you need to bill, and how much per hour. I started a bit high at first, but have adjusted my fee schedule and I am very comfortable with where I ended up. If necessary, I am also prepared to ‘add value’ to my fee by including small extra services/resources.
Dianne
Hi, Dianne! It’s good to hear from you again. Unlike you, I started way too low in setting my fees. It took me about a year to find the courage and the wisdom to set appropriate fees.
Dianne, adding extra value and perks to your services is so smart! I hope to do a post on just that later in the year. I’m wondering . . . what are some of the “extras” that you provide for your hourly fee?
Newbie here! I am considering offering my cash pay clients a free session (every 5th session) vs a reduced rate. I am in network with one insurance company and aware that I cannot charge different rates to different clients (cash vs insurance). I am uncertain if this is acceptable or legal. Any thoughts for me?
Hi, Lottie! Before you start offering 5th session free, I’m curious about why you would do that?
Does you physician or attorney offer a free 5th hour?
I’m asking you to consider what your real motivation is in doing this because for most of the therapists I’ve spoken with offering that free hour (whichever hour it is) is about fear – fear that there aren’t enough clients who will be interested in their services.
So get really clear about your motivation before you go on down this path.
I am not an attorney and definitely not providing a legal opinion here.
What I can do is tell you that from an ethical standpoint, you may offer every 5th session free to all of your clients – or none of your clients.
But, you can’t pick and choose which ones to entice with your free appointments.
It really is all or nothing.
If you motive really is solely to help people out financially, you might want to check out a simpler method by offering some of your work through Open Path Psychotherapy Collective.
Whatever you decide, Lottie, thanks for dropping in!
I hope you’ll be back often to chat!
Hi Tamara, I offer a free 30 minute consultation, and try to provide something that the caller can take away and use immediately – a parenting tip or information about a community resourse. I usually follow this up with a quick email or letter outlining our discussion, my suggestions and recommendations. I also ask if people want to receive information about upcoming workshops and events.
In subsequent sessions, I may provide supplementary written information either during the session, or as a mail out. I may offer a discount for one of my workshops or extend the session for a few extra minutes. It is all about being flexible, building relationships, and adding something the client will value, instead of lowering fees.
Looking forward to hearing what other are doing in their practice.
Dianne
Nice job, Dianne! You offer LOTS of freebies and add-ons. I’m sure that makes working with you memorable long after your work together is done! I particularly like that you leave them with something tangible. I tell other therapists that we sell chunks of time that reflect our training and our experiences.
If that’s what you sell, too . . . chunks of time rather than something tangible, then sending your clients home with something that they can actually put there hands on (physically) like a handout or a letter or a chotsky that relates to the work you are doing . . . makes a big difference in your client feeling like s/he got her money’s worth.
It’s not logical but it’s true. None of us like to pay for “nothing” and when we purchase other folks’ time, we are often tempted to diminish the value of it. Having a little piece of (great quality) paper or gizmo as a reminder of what we really got makes us feel better.
Thanks so much! Hope you’ll join us often and help contribute to our conversation! Although we are psychotherapist-focused, we do have chiropractors, nurses, dentists, massage therapists, and even CPA’s that join us from time to time. Your perspective as a nurse is welcome to join the conversation!
What do you think about having small beverages (like bottled vitamin water) handy, in a glass door mini-fridge, avail to clients as a “freebie”? Does this violate any norms of doing therapy? or perhaps hot tea in the winter? Not for the therapist to drink – only the clients.
i like the ideas here. As we move into living with the downward shift in our economic environment, many of us will have to consider going from a standard, consistently quoted fee to some version of a sliding fee scale. Re-designing how we practice is on the horizon.
Hi, Paula! Thanks for joining us here. I have to say that the economic struggles of the last few years are just one more reason to re-design how we practice in mental health. There are positive and exciting reasons to reconsider how we package our services, what we promise in our services, and what we even choose to address in our services. And, although change is often scary and difficult. It can also hold new and promising discoveries, too!
Hi, I know that this is an older thread but here’s hoping I can get some advice. I’m actually the office administrator for an LCSW for a very small practice. She has been using reduced rates so far, and I think we would both find it easier to get along with something more standard. Do you have any advice on how to break it to patients that your rates are changing? The reason the reduced rates have been offered for so many is the same reason it’s going to make it difficult to recalibrate our fee scale.
Any advice would be helpful!
Hmmm . . . . Hi, Rachel! And, welcome to Private Practice from the Inside Out! I know quite a few therapists’ admins that lurk here. I’m so happy to actually have one speak up! Thanks for leading the way!
This is so strange . . . I know I responded to your comment here last week but I don’t see it. So sorry! Let’s try that again! I definitely have suggestions. Here’s a few:
How Do You Know If Your Clinical Fees are Set Just Right? Tighten the Screw!
What to Do When It’s Time to Raise Your Fees
How to Inform Clients When Your Fees or Reimbursement Policies Change
Rachel, if this doesn’t answer your questions, let me know and I’ll try to help you out. Also, I hope you won’t be a stranger and that both you and your LCSW will be dropping in often to chat. This is a terrific place to network, give and find support, and get answers to get “unstuck.”
Hi Tamara,
When I started practicing,I offered reduced fees, as nearly all the calls I received were people asking for reduced fees. I later found out that none of my peers offered reduced fees, and they still got clients, and I was getting a reputation as having low rates. I have learned a lot since then.
Ahhhh, Sue! I so remember doing the very same thing! Once I saw that therapists less skilled than me who certainly had far less experience than me were comfortable charging the usual and customary fees, I got on board, too! As we learn better, we do better!
Then you discover there are therapists less skilled than you who are charging over and above the usual and customary fee. I am talking about extorionate rates, and you wonder how they do it. This really made me think about what I am worth.