#054 - Private Practice: Getting Paid

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I remember being in my first few months of private practice and after a tender and heartfelt session my client stood up to leave and hadn’t paid me. I had no idea what to do, what was the right thing to say that honored our work together and honored that I got bills to pay? I felt the conflict of a new therapist; I loved this work, cared for my clients, and needed to pay my bills! I didn’t know how to hold the space in my practice for the complexity of being in private practice and navigating the complexities of money.

Over the years I have had all sorts of situations arise where money needs to be addressed in a way that acknowledges the deep spiritual and emotional work we are doing and the logistics of running a small business and being self-employed. Below are a few scenarios that me, and many other therapists, have encountered and some ideas on how to navigate them. These are just some of my experiences, you may have some even better ideas and I’d love to hear them. Just comment below and share the wealth!

1.     Your client stands up, hasn’t paid, and begins to leave, like my story above you can awkwardly try to say something like “Hey are you gonna pay me or what?” (I’m from Massachusetts, and this is probably how therapists would talk to their clients!) Or you could try something like, “Would you like to pay by check, cash, or card?” Way better! You client most likely just forgot and a gentle reminder is always helpful.

2.     You have a set rate that you are not sliding much from, and all your lower sliding scale spots are filled up. A consultation with a new client feels really right to you, they say they can’t afford your full rate, but you would like to see them and feel willing to slide a small amount to see this client. Instead of saying “How about $X amount of dollars?” try saying, “My regular rate is $X and I am willing to slide a bit to see you, how much would work for you while finding a rate that works for me too?” What I have seen time and time again is that while I might think the person is looking for a $50 discount, they might just be looking for a $20 discount. Because of my own money stuff I may suggest a price that is far under what they feel comfortable paying.

3.     The 24-hour cancellation policy! This one seems to trip up a bunch of therapists, and yet I do believe it is important to be really clear on this one. For those who don’t know this means that if you cancel with your therapist in under 24-hours then you pay your therapist their full fee for the missed session. Here is how I navigate this one: I offer one free missed session per calendar year. If my client misses a session and its without 24-hour notice I will say, “Great, thanks for letting me know, I offer one free miss per calendar year would you like to use that now?” I want my clients to have some choice in this piece that can be hard to navigate. Then if it’s a second miss per calendar year I’ll say, “Hey, I see you used your first miss in March, shall we just take care of this in our next session?” There are two caveats to this one for me, if it’s a pretty big emergency I will wave the fee, and that is obviously very subjective as to what’s a big emergency. And if I miss a session, forget to put it in my calendar, being sick and cancelling the day of, then I will offer their next session free. It seems only fair!

4.     Probably the biggest one and the most difficult to navigate is when a client says, “Yes, you’re here for me, but only because I pay you.” This can be very difficult mostly because there is a piece of truth to it. I can’t see everyone for free, I do have to make a living, and for me the relationship with each of my clients goes far beyond the amount of money they pay me. I will show up and go to the same lengths with a client who pays me $25 a session, as I will with someone paying me my full rate. The key here is that being in private practice I choose who I work with. At the first consultation I am aware that if I work with this person I will spend a significant amount of time with them, thinking of them, and expend emotional energy to walk this healing journey with them. In the conversation brought about by the above statement I will convey that I have chosen them as much as they have chosen me, that they matter to me, and I am invested in our relationship. Navigating this intersection of finances and intimacy can be challenging and each situation will show its own nuances, so I encourage you to explore your own truth of how money and intimacy has shown up in your life and how it will be touched when a client presents this statement.

There is much more to write about this topic, these are just some things that have worked for me. As always know that your relationship to money will show up in the office just as much as your clients relationship to money, so get curious!