Dear Therapist, Stop Letting Guilt and Discomfort Drive Your Fees

You're on the phone with a potential client, and you’ve really connected with her. She sounds both excited and relieved that you “get her.” She asks about scheduling an appointment, but you tell her before you schedule, you want to make sure she is aware of the cost of treatment. You state your fee, and she pauses. Her slight hesitation seems to stop time.  

As waves of guilt and fear surface, the barrage of negative thoughts begins.  Your sharp- tongued inner critic pipes up: “You can’t charge her that much!  She is hurting!  How can you take advantage of her pain? Did you hear that pause? She is shocked. SHOCKED at your rate! She’s probably wondering just how big your head really is to think you are worth that much money.” Suddenly, despite all the work you have done around feeling comfortable with your rate,  you blurt out that if the fee is too high. you can offer her a discount.  You aren’t really sure what her reaction is; you’re busy beating yourself up for offering a discount when you know you can’t grow your practice if you keep reducing your fees.  As you complete the call, a couple cold, hard truths set in:

1. You don’t know that she was objecting to the fee.  As a matter of fact, she was probably writing it down or thinking about how much money she has left in her HSA--not silently judging you.
2. You don’t know if she actually needed a discount...and you hope and pray she never goes on vacation.
3. If you don’t start charging your clients enough to sustain your business and your sanity, you aren’t doing them or yourself any favors. 

So what can you do?  If you are ready to change the way you think about charging clients your full fee for the skilled work you do with them, please consider these points:

1. Therapy makes people way happier.  Several years ago, I shared a fascinating journal article from Health Economics Policy and Law article with my Facebook colleagues. Guess what? Research has demonstrated that engaging in four months of psychotherapy makes people just as happy as receiving a $40,000 raise.  Yes, you read that correctly.  Therapy makes people happier people--and substantially so. Therapy truly creates happier lives. It's not hyperbole.  Read it for yourself:  Boyce et al. Money or mental health: the cost of alleviating psychological distress with monetary compensation versus psychological therapy. Health Economics Policy and Law, 2009; 1 DOI: 10.1017/S1744133109990326.

2. Americans spend oodles of money on consumer products and services that either do not improve their lives or actually detract from their overall health and well-being. People spend money on stuff that makes their lives more stressful, less healthy, and dangerously disconnected from what really matters.  I was floored when I read the 2015 US Census Bureau statistic that showed a new and disturbing trend: Americans now spend more money on eating out than they do in grocery stores on an annual basis. I imagine most of the eating out is on the run while trying to cram experiences/more "fun" into their harried, disconnected days. People spend lots of money on the pursuit of pleasure, too--all in the hopes of bringing them happiness.  Lavish vacations they can’t afford. Alcohol. Seven dollar lattes. Lap dances. Lottery tickets. The newest, hottest electronic gadget.  Another new car. A bigger house to fit more of those gadgets and impress the in-laws... You get the point: people spend lots of money on things that harm  them and can’t make them happy. Making room in the budget for therapy will actually give them less money to use destructively, while resolving the need for the harmful spending and making positive changes that actually make them happier. 

3. People value services more when they invest not just time and energy but money, too.  And the more they pay, the more committed they tend to be. Remember that free E-course you downloaded? How are you doing with it? How about the $35 DIY website-in-a-jiffy course? How's that one coming along? You were miserably sick the morning of that training you paid $795 to attend.  Did you make it?  You betcha--with snot rags and a jar of Vick’s Vapo-rub in hand. (Bonus that no one wanted to sit in your row, too.  Sooo nice to stretch out & have elbow room when you learn, isn’t it?) We value what we pay for ourselves, and the more the financial investment, the more effort we tend to give it. And the more we value something, the more we are willing to invest in it financially. The same holds true for your clients.  

4.. Discounting your rate discounts the perceived value of therapy, your time, and your belief in the client's ability to heal.  Fair warning: this might hurt a little.  Ready? Here we go.   You are an important model for your clients. If you are quick to discount your rates because you are uncomfortable, what are you saying to your clients? Unfortunately, a lot of very untrue stuff you never would knowingly say to them:

- It’s completely okay for you not to value your investment in therapy.  The work we will do together won’t be exponentially worth the financial and time investment you’re making, even though it should be.

 - My ability to help you find your strong footing is really limited because I am still struggling to find my own.

    -You are so messed up that it's going take a really long time for you to get
better, so I have to discount the rate, or else you'll go broke.

   -Feel free to walk all over me.  I’m kind of a pushover.  Those rules you signed in the consent for treatment?  My attorney made me put them in there.  I won’t enforce them,  especially if you give me any push-back.  By the way, it's okay to let others walk all over you, too. At least you won’t be uncomfortable in the moment. You can deal with the long-term resentment later. 

Ouch, right?   If any of these statements got under your skin, I invite you to sit with what came up. What about that particular statement is hard to swallow?  Yes, it’s entirely possible that I’m just a judgy jerk who knows nothing about your situation or why you make the decisions you make in your practice.  But what else is a possibility? What if there is something useful for you to examine within yourself that is igniting this emotional reaction?  If you allow yourself some time to sit with it, you may work through it on your own and find yourself never, ever sliding your fee for just anyone who hesitates when you talk rates.

5. Speaking of judgy, it’s a little presumptuous to assume a client can’t afford to pay your fees.  Unless you are a human financial barometer, you have no way of knowing  the person on the other end of the line can’t afford your fees. People pay for what they value, and therapy is no different.  With the insurance industry continuing to make money and give less and less value to members, clients oftentimes expect to pay out of pocket, and they are generally prepared to pay good money for the outcomes you can offer. Even if the person is unemployed, for every ideal client, where there's a will, there’s  a way. And sometimes, there’s a supportive family member who believes in them enough to give them funds for therapy. 

 6. If most or all of your clients pay your full fee, you have more time and energy to be more charitable to those in need.   You love helping people and hate that money stops some people from being able to see you. Great!  If you are charging your full rate to most clients, you may be able to afford to offer a true sliding scale slot.  Donate an hour of therapy a month through an organization like Give An Hour.  Volunteer to run a community mental health group.  Serve on a Board for a non profit organization.  When you are making the kind of money you need to make to sustain your practice, you will have more room to serve your community, making a greater impact on those who truly need your help.

7. That expert level training you have undertaken wasn't cheap, and to augment your skills and keep up with the latest clinical interventions, you have to make more money per client.  How many advanced trainings have you taken over the years as a private practice therapist?  How many certifications do you have or are you working toward?  My guess is plenty, and you have more ahead of you.  Most therapists spend tens of thousands of dollars on advanced trainings over the course of their careers, and this is above and beyond the graduate school tuition, practicum work, internships, and required ongoing continuing education they must obtain.  How much do you budget for advanced training every year? How many years have you been in private practice?  How many years do you expect to be in private practice? I budget $5000 a year for advanced training and have been in private practice for 12 years.  That's $60k spent so far.  By the time I retire at 60, I will have spent $135k, just in advanced training.  How about you? If your training budget does not allow you to take the trainings and obtain the certifications you desire, it's time to consider increasing your fees and not offering any discounts until you have this budget nailed down.  You strive to be the most skilled therapist you can be because you want your clients to get better quicker.  Your fees should support this goal.

8. Every private practice owner needs a little extra support every once in awhile.  If you find that no matter what you try, you still struggle with asking clients to pay your full rate, don’t be afraid to seek the help of a competent business coach.  Wondering if coaching is worth the investment?  Do the math.  How much money have you lost because you discounted your rates over the years?  How much will you continue to lose every year?  Let's say you have 1000 sessions in a year's time.  If you have discounted the rate by only $20 each session, that's $20,000 you've left on the table.  You may be only a few coaching sessions away from seeing a significant return on your investment.  When you are ready to seek assistance because you recognize the value of professional coaching, help awaits.

To find out how Brainspotting for business blocks can help you get past this and other business struggles, click here to schedule a consult with me now.


This information is being provided to you for educational and informational purposes only. It is being provided to you to educate you about business coaching topics and Brainspotting for Business Blocks and serves as a self-help tool for your own use. It is not personalized business coaching advice, nor is it medical or mental health advice, legal advice, financial advice, or spiritual advice. This information is to be used at your own risk based on your own judgment. For my full Disclaimer, please go to https://www.bethmedina.com/disclaimer.