Setting the right fees at the right time is a daunting task for anyone who is newly going into private practice. Money is a powerful communicator. Your fee schedule and how you manage it conveys far more than dollar amounts. It also indicates attitudes and concerns you have towards money, yourself, your prospective clients and your professional community.
Messages communicated by how you manage setting fees:
Your attitude about money: For many therapists, whether starting out or seasoned, charging for therapy services is fraught with discomfort. We go into the work to be healers. But we also have to make a living. It’s not at all unusual for therapists to wrestle with guilt about asking for payment, resentment that they have to even think about it or worry about what their work is worth.
Make no mistake: Your feelings about the exchange of money for your services will come through to your clients, leading to transference and counter-transference issues that can be difficult indeed to navigate.
If you haven’t already, it’s important that you work through any such issues. You are helping individuals and their families with your expertise and support and they are helping you and your family by providing you with a livelihood. It’s a fair deal as long as you are giving them their “money’s worth.”
What you think your work is worth: Some therapists believe that what they charge per hour is a reflection of their own assessment of their worth. It’s not so – or shouldn’t be. Although money can reflect market-value, it isn’t a measure of self-esteem. The two are completely separate issues.
There are therapists who charge a great deal for their services who feel very good about doing poor work. There are also therapists who work for little or no compensation but who suffer from low self-esteem.
Ideally, there is a balance between making a living and making a valu-able life. Optimally, your income supports your family while the quality of your work gives you reason to feel good about yourself.
Your self-care: Your fees need to take into account the fact that you will not be paid for every hour you work on a case. Collateral work often involves conversations with other providers, paperwork, your own supervision and perhaps visits at hospitals or schools. You need to charge enough to cover that time or you will have to take on many more client-hours than is reasonable in order to be financially stable.
This is a prescription for burn-out for you and a lower quality of your work for clients. If you are exhausted, you won’t be able to do your best work.
Your relationship with your clients: Collecting a fee makes it clear that your relationship with a client is a business one; not a friendship or a mentoring relationship; certainly not a love relationship.
Yes, therapy can be friendly, mentoring and even loving but bottom line there is a healthy boundary between therapist and client that supports the trust necessary for therapeutic work.
Paying the bill or handing you cash reminds the client of your role in his or her life. Receiving that payment serves the same purpose for you.
Your intended client base: Your fees have impact on who can see you. For this reason, many therapists create a fee system that encourages a demographic mix.
High fees will limit your client base to those who have a safety net not available to others who are less financially secure. High insurance co-pays will similarly limit the population you serve to the well-off. That’s not a bad thing: People with a great deal of money also suffer from mental illness or traumatic experiences and deserve and benefit from his help.
Setting low fees or maintaining a sliding scale signals your commitment to people who are disempowered and with limited resources.
Who you decide to serve is a highly personal decision that is embedded in your values system and your assessment of the realities of your community.
Your place in your professional community: The community of therapists around you also attaches meaning to your fee. (Yes, word does get around about who is charging what).
Your decisions about how much you charge may determine who will be interested in knowing you and working with you. To my mind, this is unfortunate.
There are many reasons besides perceived status that therapists chose their fee scale but it is a reality to bear in mind. Take the time to assess your professional peers and whose company you want to keep. Consider how you will market yourself so your expertise and interests, not your fee schedule, is the basis on which those other professionals judge you.
Your commitment to ethics: Your professional code is there to protect you and to protect your clients. Read the document. It includes information about the ethics of fees. Make sure you understand it. Make double sure you adhere to the code.
This website provides links to each profession’s statement about fees.
Your beliefs about insurance company involvement: To opt in or opt out of insurance company payments is both a practical and a values-based one. Depending on where you practice, it may be more difficult to attract clients if you don’t participate in insurance panels. Then again, the confidentiality issues involved in accepting insurance may determine in part whether you want to do so.
A therapist’s relationship with each company is a legal as well as ethical one. Do your research. Understand the implications of joining insurance panels or opting out. It’s not simple. If you do decide to participate in insurance panels, be sure you understand the constraints, if any, on your personal decision-making regarding a client’s use of their insurance before you accept the client.
Money matters matter. Careful consideration of the above issues can help you create a fee schedule you can live with and defend should you ever think you need to.