To practice your craft for the good of your clients you have to have a fee. The fee is foundational to building a practice. For young and old counselors alike, this can be a difficult task. There are many reasons for this. Maybe the therapist has not integrated himself/herself as a therapist and a business person (for more on integrating these two selves read this article). For them, taking money seems to go against a desire to be altruistic in caring for the client. Another reason is that the work of a therapist is often somewhat subjective in nature and not easily quantified. If you go into a store and give the cashier money, you usually walk out with some sort of product. At a restaurant, a server gives suggestions about the menu, brings you food, and makes sure that your drinks are full. Going to the store or restaurant and receiving the services of the server are more tangible transactions than therapy.
Some clients struggle with the nebulous nature of paying someone to help them explore their emotions and deeper selves. This can lead to inadvertently or overtly making comments to sabotage therapy. They can also be resistant to paying. Often a counselor can be found attempting to justify the profession and the need to receive payment for services. There are things that can help mitigate this justifying the need for payment for the therapist and the client.
One major help is to have policies in place. Policies act as a boundary between you and your client that guides you both as to your work together. Money issues do come up in the therapeutic relationship (which I will talk about in Part 2 in two weeks) but the purpose of policies is to keep this to a minimum. Policies need to be thought through, clearly communicated to your client, and followed through by the clinician. Here are some ideas for some policies.
1.) As part of setting up a first session for a new client, take the client’s credit card information to “hold” the session and inform them that the card will be charged a fee if they fail to show up. By doing this, you are matter-of-factly stating their therapy is a fee for service situation and helps mitigate first time no-shows.
2.) As part of the intake paperwork, have the client sign something that states that they are responsible for their payments at the beginning of each session, any credit card fee, late fee, or no-show fees (I actually take credit care information and let them know that their card will be charged if there is a no-show). Again, this is an attempt to clarify for the client that there is a financial “buy in” to therapy.
3.) Ask client how they want to pay for each session in the future. For many of my clients they have me bill their credit card. I can usually do this at the end of the day or beginning of the next business day.
4.) Keep good records. If there are any questions about payment, you should have a statement that clearly shows the sessions, the amount received, and amount owed. By keeping good records you are caring well for your client and honoring their finances.
5.) Have a set number of scholarship sessions each week. If someone calls and wants to negotiate a fee but you are already seeing the max number of scholarship clients, then you can let them know that there are not any scholarship slots available. You can put them on a waiting list. Remember, you have to be financially healthy to keep your practice open to help anyone. Seeing a whole case load of reduced fee clients will not work in most cases.
There are many more policies that can help you. You will need to find what works for your practice, but without some guidelines you will make things very hectic for yourself and confusing for your clients.
What policies are you finding helpful in your practice?
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