There Are 14 Responses So Far. »

1. 

   Comment by Lewis Galway on 19 September 2006:

   I have noted that almost every therapist I know, works two jobs. Or if they are in private practice, they have a day job, or a night job, also. I have wondered that this is due to the field being notoriously low paid? I have heard, that back in the “good old days,” say, the seventies, that someone with a license could make a good living in a private practice. Then with the wonderful good old third party payment cut-backs, it hurt us all. It might not hurt to have some kind of a union? I know that a lot of counselors that I know, do not join their local and/or national professions organization. Then they cry about not making enough, not having reciprocity, and not being able to bill out services.
2. 

   Comment by terri david on 19 September 2006:

   I feel confident and have moved my office to a beautiful new location and I am a specialist in the treatment of addictions. Whenever I ask for the high fees only a couple of clients stick it out and that is not at the fee that I actually want. It is the one under that. I kept it at a number that can easily be taken out of the ready teller!! They either cut back or stop coming and I still find it hard to get clients to commit. I am still trying to get referrals for clients who can afford and value me and my services. I have been working for over sixteen years. I have activated a relapse prevention group and am trying to market groups in my field of expertise and will not accept insurance, just cash. It is still difficult. I am slowly making some progress but not yet satisfied and do not have enough private pay clients. There is an underlying fear that you will lose the client altogether so you settle for less or insurance. I am getting totally fed up with the insurance carriers. I am always running after unpaid claims to me. Very frustrating and you have to keep from bringing in that transference.
   Thanks for listening.
   Terri David MFT
3. 

   Comment by Lorraine Platt, LMFT on 19 September 2006:

   What happens externally is simply a reflection of what’s happening internally. If we value our education and expertise by charging a respectable fee, we attract clients who respect us and have money to pay our full fee. Making a good living as a therapist does not mean we don’t care about our clients. It just means we care about ourselves too. This means everyone is flourishing. This eliminates burn out and resentment and allows us to serve more people more efficiently. It also means we are living as a positive example for creating an abundant life in all areas. YES!
4. 

   Comment by Jodi Blackley on 19 September 2006:

   I think there are several things that impact the feelings behind the discussion of fees.

   First, insurance companies have dominated the health care field. Many people obtain jobs based on the quality of their benefits. Many pay hundreds of dollars a month to receive good benefits and there is this mindset that they “have to use them” regardless of the risk involved. Insurance has little value on the reimbursement rate given to therapists. It can be as low as 50% of the therapist’s UCF. This puts therapists in a sticky area: get on insurance panels and at least get clients, or go completely private pay and live with the anxiety of getting clients in the door? This ends up with many therapists feeling frustrated.

   Another issue is how many people look at therapy with such a stigma that they don’t value the benefits of therapy and do not feel that therapy is worth the money many of us charge. It can make it difficult for therapists to value the service they give when the clients don’t value it before they walk in the door.

   Finally, there is the issue of our own “stuff.” I remember when I first entered PP and a client would give that deafening “pause” when I told them my fee. My own “stuff” would kick in and immediately, I would start talking about sliding scales in hopes that it would appease the client.

   Now, I don’t slide my scale at all except for college students at my local alma mater. I truly believe I’m worth what I charge and if clients cannot pay my fee, I’m happy to provide them with low-cost referrals. I find that clients who pay my fee value the therapy more and I value my clients more…both financially and therapeutically.
5. 

   Comment by Paul Aaron, LMHC, CASAC on 20 September 2006:

   I just started a private practice here in New York, NY, in addition to my day job at a Brooklyn mental health agency. I have one new client who pays me upfront with a check. I have to deduct $14.00 for room rental for each hour I rent to see clients. I am reluctant to accept insurance based on what I know from other therapists in the field. I have yet to fully market my services to potential clients. It takes time, money and effort to build a sustained and viable private practice. I’ll give it my best shot.
6. 

   Comment by Dan Metevier on 20 September 2006:

   I had the good fortune of doing internships in private practice environments where I had to, among other things, learn to ask for the money. This made me feel like a prostitute for quite a while, but as my confidence grew (slowly), I got used to it. I work hard at trying to keep my self-confidence up and believe in the value of what I do. Although I do take some insurances, I play a mental trick on myself by thinking of therapists who take insurance as “not as good.” (I recognize the inconsistency, but “hey, whatever works!”) Although I’m just beginning to market myself to “ideal clients,” it has helped me to have the attitude that a “specialist” is worth more (that is, “I am worth more”). Lastly, in retrospect, my graduate school experience (with the exception of the “prostitution” aspect of my internships) almost seemed to work against developing the mindset needed to market oneself and operate a practice as a business with a target market. Thanks to Casey and others who fill the gap left by graduate school. Thanks for listening; I feel much better now.
7. 

   Comment by Susan Kimball on 20 September 2006:

   My question is about posting fees on my website. I’m changing the body of my website and notice that others don’t even address fees that way. I wonder if it scares off people. I am getting paid more but still slide my fee but not below a certain point. What bugs me is that I never go into my MD office and trying to reduce their fee. Why do others expect us to slide our fee?
8. 

   Comment by James Jackson on 20 September 2006:

   Regarding therapists and isssues of money: I think you’re right about some emotional attachment associated with charging a fee for “helping” someone. I think many factors are at work here, including a philosophical altruism on the part of therapists who may be more inclined to concerns about the actual helping than about financial matters. Some therapists may also feel guilty about charging someone for their services because they are not sure that what they have to offer is qualitatively different from, say, a concerned family member. The client’s lack or presence of a family support system may impact this as well. Also, wistful glances backward at the 70’s, while understandable, may also lead to a feeling of helplessness. Finally, somewhere along the way we are conditioned to accept the fact that our services are not valued on par with other helping professionals…
9. 

   Comment by D. Barnes on 20 September 2006:

   Like Nancy, asking for what I’m worth has become less of a problem for me as I’ve matured as a person and as a therapist. I think it would be particularly helpful if graduate programs offered courses specifically on business management/mindset for helping professionals in private practice. After practicing for 25 years I am blessed to say that I make a good living now, well above the average cited in Casey’s introduction. My clientele consists of a combination of cash only and insurance benefitted individuals. The difference between my fee and what the insurance pays is dealt with on my tax return as a loss. I’ve learned to keep my overhead low and my practice ethical and effective. But, as always, I want to get better at my craft…. and make more money as well. I work four days a week so I can attend to other interesting things in my life.
10. 

    Comment by Sharon Roseman on 20 September 2006:

    I think that one of the reasons that the average therapist is getting older is that we don’t make enough to save for retirement. So we keep on working.

    Regarding private practice fees, I accept some insurance and would be happy to accept more, but here in Fort Lauderdale, the panels have been closed for years (I keep applying anyway). I lose more than half of potential clients because they want to go to someone in their insurance network. I offer very reasonable sliding scale fees, lower than most therapists in my area. But most people tell me they can’t afford the fees, or they end up having to drop out prematurely because they can’t afford to continue. Basically, the people who call me either have insurance they want to use, or can’t afford private therapy. Several of my clients even moved away to seek more affordable housing.

    I love my work and will keep on going. Networking, particularly with colleagues, has been invaluable.
11. 

    Comment by Ralph Notor on 20 September 2006:

    Yesterday, I was working with a client who I was referring to a psychiatrist for a med eval. This MD is only private pay and I have worked very cooperatively with him over the years and like him a lot. My client asked why the MD did not take insurance and I replied that he probably does not want the hassles of all the paperwork and does not want to accept the discounted fee that the insurance companies require. I said this all matter of factly as I was writing down the MD’s phone number to give the client. Afterward, it hit me that I had just announced that I was willing to take the discounted fee. What does that say about me?
12. 

    Comment by J. Allen on 22 September 2006:

    Over the year, as I think of my practice as a “business” I do better and better about setting clear fee expectations. But family messages about money, service to the world and care for people without basic life needs often need to be revisited. Each time I do something that strengthens my fee policies I try to give myself credit for “reworking my money beliefs”. It’s not easy but each time I take a new step I know that I am taking better care of myself, my practice and my family responsibilities.
13. 

    Comment by Ellen Edelman on 22 September 2006:

    Those of us who were hippies in the late 1960’s enjoyed our ‘hippy’ status, lived through the age of flower power and often bartered to give and receive services.(If we had to find an electrician, plumber, carpenter, or even a dentist we would informally
    agree to pay for services and a handshake would seal the deal.) It is unfortunate that business does not
    operate by those rules any longer. (Yes, of course there is an occasional exception and a pro bono every
    once in a while is fine and good for both business and spirit.) But we, in the helping professions, must
    realize that we are also business people who deserve to be reimbursed well for our professional services.
    IN order to be taken seriosly as professionals we need
    to release ourselves from hippydom and join with our
    clients in clear, loving, contractual agreements that provide all parties with the highest yield. I have discovered that If you state your fee for service clearly and present it confidently clients will trust that you are the expert that they want to be their
    coach or therapist. Thanks to Casey I have learned that I deserve to be well paid and I can now be an
    occasional hippy….if I choose.
14. 

    Comment by VANESSA BROWN on 12 October 2006:

    I have just read the previous messages, and I am finding myself agreeing to the very clear and helpful comments of my colleagues. I have recently started part time private practice in Brooklyn, NY, and I am marketing to all five boroughs of NYC.

    I am finding my experience in marketing my practice to be unique in some ways: I am openly bisexual and have many years of experience working with the gay, lesbian, bisexual, and transgender community, as well as the heterosexual communities.

    I also had the opportunity to provide crisis counseling, outreach, and psychoeducational services to NYC residents traumatized by the events of 9/11 and funded by FEMA.

    As an African-American woman, I am also aware that there is a lack of mental health professionals in communities of color. I have been marketing my practice for the past five months now, and I am sure to include my unique experience and training in all of my marketing materials. I also offer a sliding scale, keeping in mind the value of my services, and so far I have been able to work out fees that are mutually beneficial for both myself and my clients.

    I am lucky to have been able to earn an undergraduate degree in both marketing/business and psychology, so I actually find myself enjoying the marketing process!

    I am currently volunteering my group facilitation skills to existing support and discussion groups in the NYC area. I have been invited to facilitate stress reduction and guided meditation groups for two of these groups so far. I have also been invited to speak at a panel addressing sexual orientation at Columbia University, which will hopefully prove to be a very successful networking opportunity.

    I am going to continue to be as visible as possible, network consistently, and try to remain flexible and open minded, and accepting that self promotion and marketing my services is an ongoing process, and I am working on making sure I spend time each week for this and including it into my schedule.

    Thanks for listening, I also highly value networking, and I am very glad that this online community exists, it is so important.

    Be well,
    Vanessa Brown, MA

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