5 Ways to Earn More Money With Sliding Scales

Do you slide too often? Are patients choosing to pay too little most of the time? Are you complaining about the money you earn as a result?

Let’s take a look at 5 ways you can earn more money with your sliding scale…


In a self-pay practice, sliding scales are a great way to help people who can’t afford your full fees. However, if you always offer it, most prospective patients will take you up on it even if they don’t need one. In order to rectify this problem, I recommend only offering your scale when a client clearly demonstrates need. Always explore all of their potential resources with him or her before jumping to the conclusion the person needs a sliding scale. The patient will take the easiest solution. However, there may be a mutually beneficial solution that takes a little exploration in order to get there.

2. Average Session Fee

When you offer a sliding scale and you don’t know how much you want to collect on your average session fee, you won’t be able to determine how much money you’re expecting to earn in a month. Make sure to create a budget based on how much you want to collect from the average client session. This practice will help you determine how much you can slide and still earn the money you need.

3. Negotiation

There are different ethical considerations when thinking about what patients will actually pay. If you only offer a full fee practice, this point is quite simple. In sliding scale practices, it gets more complicated. I can guarantee that if the scale isn’t talked about effectively, most new clients will pay somewhere in the middle to the bottom of the scale. If that’s okay with you, then there’s no problem. But many therapists I talk to complain about the thousands of dollars they are losing here and there, because of patients’ choices around what they can pay. There are a couple of solutions to this dilemma.

You can offer a scale based on income levels. Outside of asking for tax returns, which is highly unusual in our profession, you are putting a lot of trust in a client you’ve just met around the financial health of your own business. Anecdotally, clients will choose lower ends of the scale even if they make enough money for higher ends of the scale. It’s not because they see this option as if they are outright lying; it’s simply that they don’t feel that the higher fee will generate enough value in their lives to be financially viable.

The alternative to this approach when a patient says he can’t afford your services is to simply ask what his budget is per month for therapy. This places him in a position to consider how much value he places on therapy. It then places you in a position to work with the monthly budget of the client and where you feel they fit in your scale.

4. Change in Economic Status

One common mistake around scales is not explaining that the scale is intended to help the client at his/her current income and budget levels. If you let the client know from the start that you would appreciate revisiting the discussion of fee if they are able to pay more in the future, you will have many clients return to it on their own when they can afford your full fee.

5. You Can Say No

Sometimes, the patients that can’t afford you are not a good fit for you. If you don’t know when and to whom you should say no, you will experience burnout. If it’s simply not a good fit and you overextend by seeing a client for less than a fair exchange, you will resent the client over time and not be as available to other clients. In the long run, this situation can hurt the overall financial health of your practice.

Sliding scales allow private practitioners to see people from many different social contexts. If scales are offered carelessly, the therapist will struggle financially and often end up in client dynamics that feel off. However, when done effectively,  it’s both rewarding to the therapist and the client.



5 Ways to Earn More Money With Sliding Scales

Keith Kurlander, MA, LPC

Keith Kurlander, MA, LPC is the founder of a company dedicated to empowering therapists to achieve their highest potential in private practice. With this in mind, Higher Practice provides therapists with all of the necessary business tools and emotional support needed to succeed. You can download our free guide called How to Fill a Practice In 90 Days.


APA Reference
Keith Kurlander, K. (2017). 5 Ways to Earn More Money With Sliding Scales. Psych Central. Retrieved on September 18, 2020, from


Scientifically Reviewed
Last updated: 20 Apr 2017
Last reviewed: By John M. Grohol, Psy.D. on 20 Apr 2017
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