Back in April, I wrote How to Avoid Collection Agencies When Your Clients Owe You Money. Last week, Ruth wrote in to ask a follow up question that most of us will need to face at one time or another so I decided I would respond to it in a post. She wrote . . .
Thanks for all your great blog posts and information, Tamara.
I have a young client whose parents neglect to pay often. The co-parents, who are in charge of payment, live in a different town and don’t call back or respond to emails. They paid a month late recently and then pre-paid a session, which I thought was going to send us on the right path, but now they are a couple of sessions behind and not responding again.The parent who brings the child to sessions is easily reached and responsive, but not in charge of payments.
I have subsequently cancelled appointments until we can come up with an agreement for payment. I would be willing to keep seeing my client with even just a conversation about payment…but am getting nothing. Am I in the wrong to cancel appointments, or am I letting this get out of hand?
Any advice is appreciated.”
This is one of those issues that most of us face during the early years of private practice (or even in agency work). My understanding is that you are not “wrong” to withhold professional services due to lack of payment unless the client is at immediate risk to himself or others. Having said that, it’s important that you check with your jurisdiction’s laws and your own professional codes of ethics to make sure.
When I have encountered similar situations in the past, I have found that my own transference has contributed significantly to the problem. Consider some of the following . . . . Do you feel like you are providing a valuable service to your young client? Do you believe that your fee is reasonable and fair? Are you comfortable discussing conflicts related to money with your clients? If your answer to any of these is “no,” then you have some work to do on your own issues.
And, there are other things to consider, too. Does your disclosure statement adequately address payment and non-payment for your professional services? If not, this may be your “wake-up call” to clean it up. Consider including not only your fee, but also how you will be paid, how you will handle clients’ financial needs, any provisions for reduced fees, when you will be paid, how you will interact with third party payments (including long distance parents as well as managed care), how you will handle outstanding balances, your billing procedures, how you will handle no shows, etc.
If you have not clearly addressed these things in your disclosure statement, now is the time to amend it to include them. Then, send out your revised policy to each of your clients along with a letter explaining that this policy will go in to effect in the next 30-90 days. Have clients sign an acknowledgement of receipt, understanding, and intent to comply or be prepared to refer those clients elsewhere.
To address the current issue, I would send a letter by Registered Mail to the co-parents that are responsible for payment (with copies to the custodial parent on behalf of the client) notifying them of your attempts to contact them.
- Detail the dates and what attempts were made as well as their non-response.
- Express your concern for your client and the importance of establishing fluid communication. (Perhaps they want to be more involved in treatment?)
- Consider whether it is clinically appropriate to share specific risks / concerns related to this break in treatment and future implications for the client.
- Reiterate your payment policy and explain that treatment is being withheld until full payment for professional services already rendered. (Be prepared to detail the services you have provided.)
- Consider requiring all future services for this client being pre-paid.
Allowing clients to incur significant balances for your professional services is rarely (if ever) about the client and almost always about our own issues with money and boundaries. During my early years in mental health, I don’t think I would have or did see this as being true. However, after 20+ years in private practice, I can say without hesitation that this has been true for me and also for my supervisees 100% of the time.
[And, because I continue to hear stories every week from therapists who are
struggling with their own issues and boundaries related to money, I’m considering
hosting a tele-class or group to talk about these matters. If you would be
interested in joining that discussion group, leave me a comment below letting
me know you would like to attend. When there’s enough interest, I’ll put the
finishing touches on it and let you know the cost and details!]
I think you are absolutely right to take the steps you have taken. Sadly, it is the young client who is possibly “picking up” how his blended family mis-treats professionals that are helping him.
Do they also go grocery shopping without their pocketbook and expect to leave the store?
I find most clients expect to pay for professional services and are willing to pay—but every so often, and for me it was a blended-family situation like yours, where problems crept in.
Hi, Kristene! Had to chuckle at your grocery shopping analogy. It’s true, isn’t it? And, they rarely think of not paying as “stealing.” However, like you, I rarely run into this issue. What I know now . . . that I didn’t know in my youth is that rules are made for the exceptions and not for the typical situations.
Have a great day!
Tamara,
I’m in my second semester of graduate school so I haven’t dealt with money issues yet. However I know they’re out there. I would definitely be interested in attending a tele-class or group to discuss money matters.
Thank you for offering this!
Kyle
Thanks, Kyle! I’ll keep you in the loop.
I don’t remember seeing you here before. If you are new to Private Practice from the Inside Out, welcome! I hope you’ll drop back in to introduce yourself and tell us where you are in school. And, don’t forget to tell your classmates, too, that this is an online community that welcomes therapists-in-training, new private practitioners, and the seasoned ones, too! Happy to learn from you and also share what we know so don’t be a stranger!
Thank you Tamara. This article hit home for me and I am relieved to hear that I am not the only therapist out there struggling with financial boundary issues. I get frustrated with myself, feel lame and wishy-washy at times. It does not feel businesslike, is personally uncomfortable, and certainly not doing justice to my clients. I am most definitely interested in the program you mentioned regarding money matters in private practice.
Lisa, welcome to Private Practice from the Inside Out! you are not alone!
Thank you for taking time to speak up and join the conversation. Dispelling the myths around this issue is the first step in resolving it! I have certainly been there and most other colleagues I know have spoken openly about the struggle to keep our professional hat on and our boundaries clear. It’s what our clients need (even when they don’t know it) and it’s what we deserve. I’ll be back in touch about the upcoming money matters group!
Sign me up for that class…I would really like to work on my money related issues. Currently, I don’t have my own private practice but will hopefully soon. I do work for an agency that offers free counseling. This may a bit off topic but I find that friends take advantage of me being a therapist. Heck, they even call it “therapy” when they want to go to lunch or set up a phone call. It is seldom reciprocal. I do often use my skills in talking with them and make jokes about charging them. Maybe this is more of a boundary issue, rather than money….but it came to mind when reading this so I thought I’d say something…
I have never gone to the doctor or massage therapist and tried to get out without paying. I did one time attend a class that I thought was free to the public and learned once I was there it was a $20 charge. I didn’t bring any money with me and was a bit upset that it wasn’t clear that there was a fee. In fact, I didn’t learn until the end of the class that it was $20. It was rather embarrassing. She did have some other things coming up that sounded interesting and told me not to worry about not having the fee. I never went back to any of her classes and I’ve since moved….so I won’t. BUT the point of my discussion is that when we are CLEAR about our fee, it avoids embarrassment for the client which helps them continue with services more comfortably. Am I making sense?
Ohhhhh, Jamie! Thanks for dropping back in – You’ve been away too long! And, thanks for making this last point. All too often we find ourselves blaming the client or the referral source or someone other than ourselves when really it is our own stuff that gets in the way! And, when it comes to money, it’s easy to blame the client for repeatedly “forgetting” her check, friends for “using” us as free therapists or the insurance company for their “lousy rate” of reimbursement when the truth is many of us have our own difficulty in owning our worth, asking for what we are worth, accepting less than we are worth, or failing to set healthy boundaries.
That’s exactly the type of thing we’ll be addressing in this group. It should be a rich series of discussions for sure! I’ll be back in touch with details about the upcoming group as soon as I finish putting it together!
Looking forward to it!!!
Tamara,
Thank you for a very enlightening post. I’m finding phrases similar to this one “it’s important that you check with your jurisdiction’s laws” in a lot of my different discussions with coworkers and supervisors. The only way that I have found to actually find any of this information is to ask a congressperson. The problem is that they rarely respond. Up until now, I have been able to find specific answers to questions in other locations, but with this issue of using collections, I would like to know what is truly allowed. In the Pennsylvania LPC law (Chapter 49), there is some discussion of using collections, but it is phrased such that it, too, posits that this needs to be done within legal limits. I do not have the exact phrasing immediately available, but that is the general idea (asking the licensure board leads to a quote of the standard). So, short of having a lawyer on retainer, where am I supposed to find out what is legally permissible?
Thanks! I look forward to seeing what you post next!
Hi, Lauren! Thanks for dropping back in this evening. You are right . . . issues like this really are difficult to ascertain at times.
You are asking a question that really is going to vary by jurisdiction and, quite possibly, also by specific mental health discipline. I’m going to tell you what I do. Then, you are going to have to decide how you want to go about determining the ethical standards of your discipline, the community standards for your particular geographic location, the best practices of your profession, and the legal statutes and rules (both federal and state) that apply to you. I think that’s the best I can do.
I keep up-to-date with my discipline’s ethical standards through my membership with the American Counseling Association. As the nation’s largest professional association for professional counselors, they establish and routinely update the Code of Ethics that I am required to follow. I can’t stress how different our profession would be without the leadership and lobbying that this organization does on behalf of counselors in the United States. Their publications and website provide ongoing sources of information to its member related to the changing climate and requirements for counselors. Additionally, members are able to purchase liability insurance (and thus have access to free legal counsel). Regardless of your discipline, it’s important that you join and maintain an active membership for your particular discipline’s national professional association. [And, should you find yourself holding membership in more than one professional association – like the American Counseling Association and the American Association of Christian Counselors, whose ethical codes conflict in spots – my understanding is that you should err on the more conservative side of practice (And I do not mean the religiously conservative or politically conservative side. Instead, I mean that you need to practice according to the more restrictive guideline.)
I practice in accordance with my community standards of practice by staying involved with my local colleagues, consulting with peers that practice in my geographic area, and have sought supervision locally as well. Geographic-specific networking groups for therapists, clinical consultation groups, professors in the mental health disciplines near you may all provide in-put on your community’s standards of practice. As you might imagine, the community standards of practice in a local frum community might differ differ significantly from those of Los Angeles County in California.
Best practices in the field of mental health continue to evolve. I stay apprised of those as best I can by reading professional literature, listening to professional podcasts, and attending professional workshops and conferences. Most of which require fees to access. All of the professions, including that of mental health, require (by definition) the ongoing professional development and training of its members. When choosing your continuing education, it’s good to keep in mind that “best practices” need to be included in the mix.
The state and federal statutes and licensing board rules are, in some ways, actually easier to ascertain and pin down than some of the other standards that impact our behaviors as mental health professionals. I believe all states have their state statutes online and available to the general public. The same is true for those of the federal government. Likewise, state licensing boards typically post their licensing rules online. Unlike your state board in Pennsylvania (and mine in Colorado), some states have mental health licensing boards that will actually provide detailed explanations of those rules and standards. I’m sorry that yours, Lauren, does not. I do not have an attorney on retainer. However, if I do not clearly understand the rules and laws pertaining to a counseling-related issue, I will make a phone call to a mental health-savvy attorney, and willingly pay for 15 minutes of their time to consult on the phone.
I didn’t do that in the early years . . . . Instead, I made “educated” guesses, rationalized my choices alone in my head, and sometimes asked my equally-inexperienced colleagues. That wasn’t very smart. And, somewhere along the way, I learned that paying for those phone consults were investments in my sanity, my risk management, and my own professional future. In fact, if I was starting over, I would set aside an hour’s worth of my resources to consult with an attorney every year because the truth is we all have an hour’s worth of questions – especially in the first 10 years of practice – and too many of us just wing it and hope for the best.
There are, of course, other ways to find out what is legally permissible . . . some professors ( but how do new professionals really know which ones stay current on the law?) and books on jurisprudence (but those are few and rarely state-specific and rarely are they current) . . . . So, I go back again to say that when you don’t know where to access or understand the law, you need an attorney to interpret and expound upon the laws and rules.
I know it’s probably not what you want to hear, Lauren, and it’s true that most of these resources incur financial costs. However, this is the cost of doing business in mental health. There are many “soft” and hidden costs that we incur . . . costs that our clients have no idea about . . . and often new professionals have no idea about. It’s why, in part, a solo practitioner in mental health needs to charge fees that, at first glance, may seem greedy.
Thanks for joining in this thread of conversation, Lauren. I so appreciate your voice at the table!
Thank you so much for the reply. I hadn’t thought of asking HPSO about this particular issue, and I think that is where I will start, as this idea of fee collections does ultimately fall back on liability.
As much as I figured you probably would recommend contacting an attorney, I don’t have any idea how to find one who is actually savvy in mental health issues AND able to explain things in layman’s terms. How do I manage that? How did you come across the person who you’re currently communicating with? I wonder if that person has any connections to mental health lawyers in other areas. I do wonder what their fees are, but if I can pay for 15 minute time blocks, maybe it would be affordable if I could not find answers elsewhere.
I have a question about the structure of your blog webpage itself. As of now, the checkbox to notify all follow-up comments via e-mail is below the “Post Comment” button. Have you ever considered putting the checkbox above the button? I forgot to check it yesterday simply because I did not scroll down low enough to see it.
You are so welcome, Lauren! Hey . . . you are asking about how to find a mental health attorney and that’s a question that every mental health professional – especially new ones – should be asking. Hope you don’t mind that I want to actually address this in a post.
And, thank you for suggesting a way to improve the layout of the commenting section of my blog. I’m always looking for ways to improve the website and make it more user-friendly. I’ll take a look at it and see if there’s a way to make that a more obvious option. (It really drives me crazy when I go to someone else’s blog and they don’t have a way for me to follow a particular thread of conversation. I would be curious to know how many of you use that “follow up” feature on blogs.)
I would vouch for a “how to make a living in this business” support group myself, especially being new to private practice and coming from an agency setting it has certainly brought up money issues i didn’t know I had even though I researched, planned and read a lot about fees and boundaries with clients, I think that until I actually went into private practice I didn’t quite understand how much of a change it was to go from clients who don’t pay out of pocket for services and clients who do.
Haha. Jill, I so know what you mean about not even knowing that you had money issues! That was definitely me, too! It’s a reaction that many therapists have. I would love to have your energy in the group and really appreciate you taking the time to note the mental transition that takes place when moving from an agency setting to private practice. I’m working out details right now and will let you know when it’s launched.
Tamara,
I find myself with a different, yet related dilemma. I don’t really have this issue with clients that come into my office, but with my mental health consultation contracts. Generally I bill once a month at the end of the month which means I am paid at the end of the next month (standard time frame). Because my contracts rely on federal and/or state funding, there are times when payment remittance goes beyond that next month. One site in particular was provided services in every month beginning in November, and I did not get my first check (partial) until April, and that was after I had to track them down.
My CFO (who is also my husband) wanted to suspend services wayyyyyy before April until they paid the past due. Because my consultant contracts make up the bulk of my practice income, I did not want to have any time where I wasn’t working because that would impact future month’s payments. This is such a challenge for me, and I find myself being owed several thousands of dollars each and every month.
Hi, Carla! Welcome back. Hey, this is another one of those comments that many of our readers will want to read so I’m going to pull it out and make a blog post out of it. Hope you don’t mind! I’ll try to get it posted on July 12!
GREAT!! I look forward to reading it!
Thanks for this blog post, Tamara! I read it when you first posted it and realized I forgot to comment on it. I’m still working on getting paid from my client, but they have finally picked up the phone, which is nice. 🙂 I’m also still seeing the client–I only skipped one session.
I’m currently doing some inner work and money is one of the topics. Like Jill says above–I thought I had researched this topic and done my work….but apparently not. Will keep plugging away, and in the meantime–I’ve attracted two new clients! So, I think it’s worthy to work on this issue for sure!!
Thanks for your time.
Ruth! So glad to hear back from you! Thanks for dropping back in to catch us up. So glad that your have been able to re-engage the parties responsible for your client’s fees. Nice job!
And, good for you for taking the time to look inward as well as outward related to money matters and the two new clients, too. I so appreciate you being willing to be so transparent with us so that we can all learn together!
Best wishes to you on your journey!