A Conversation About Therapists and Money

Mary Crocker Cook, D.Min., LMFT, LPCC, LAADC

Connections CEU Institute

www.counselorceu.org

www.marycrockercookbooks.com

• https://www.youtube.com/watch?v=QF-X-BCSOaQ

Financial Behavior Types

Money Personality

• Alexis Avoider

• Oliver Over spender

• Ursula Under earner

• Hanna Hoarder

• Exercise: Get a piece of paper and draw a line down the middle, top to bottom. Label the left column “Current Financial Behaviors” and the right “New financial behavior’. Refer to your personality types and list a few situations in which you exhibited those behaviors. Be specific. When you have some examples, write down a different response that you could have exhibited in the other column. What stops you from doing THAT behavior?

Have you ever given a client a financial break on your fees, only to watch them drive away from your office in a car valued at $60, 000 or more?

Is this your car?

When Money is Our Issue?

Where’s the disconnect?

What we learned,

Experienced,

Messages we took in about who we are and what our place is in theworld.

• Financial upbringing exercise, pg 56, The Emotional Behind Money

The skill it takes to really hear the problems of another individual and the gift of guidance, feedback and the psychological tools we provide is significant. Often because the skills as a therapist come to us naturally, we feel uneasy about really charging our clients at least the going rate.

First, what exactly is our creed? We are supposed to behelpful, but what is really helpful when it comes to setting andmaintaining fees, particularly in times of financial hardship?Many therapists intuitively feel that we should be generous,even at our own expense. So how do we unscramble all thepieces to make good clinical decisions and take good care ofourselves and our practices?

Ethical ResponsibilitiesCalifornia Association of Marriage and Family Therapists, CAMFThttp://www.camft.org/Content/NavigationMenu/AboutCAMFT/ WhatisCAMFT/EthicalStandardsPartI/EthicalStandardsPart1.pdf

NON-PAYMENT OF FEES:Marriage and family therapists do not terminate patient relationships for non-payment of fees except when the termination is handled in a clinically appropriate manner.

9.3 DISCLOSURE OF FEES:Marriage and family therapists disclose, in advance, their fees and the basis upon which they are computed, including, but not limited to, charges for canceled or missed appointments and any interest to be charged on unpaid balances, at the beginning of treatment and give reasonable notice of any changes in fees or other charges.

American Association for Marriage and Family Therapy Ethics Code, 2012 http://www.aamft.org/imis15/content/legal_ethics/code_of_ethics.aspx

Principle VII Financial Arrangements

Marriage and family therapists make financial arrangements with clients, third-party payors, and supervisees that are reasonably understandable and conform to accepted professional practices.

7.1 Marriage and family therapists do not offer or accept kickbacks, rebates, bonuses, or other remuneration for referrals; fee-for-service arrangements are not prohibited.

7.2 Prior to entering into the therapeutic or supervisory relationship, marriage and family therapists clearly disclose and explain to clients and supervisees: (a) all financial arrangements and fees related to professional services, including charges for canceled or missed appointments; (b) the use of collection agencies or legal measures for nonpayment; and (c) the procedure for obtaining payment from the client, to the extent allowed by law, if payment is denied by the third-party payor. Once services have begun, therapists provide reasonable notice of any changes in fees or other charges.

7.3 Marriage and family therapists give reasonable notice to clientswith unpaid balances of their intent to seek collection by agency orlegal recourse. When such action is taken, therapists will not discloseclinical information.7.4 Marriage and family therapists represent facts truthfully to clients,third-party payors, and supervisees regarding services rendered.7.5 Marriage and family therapists ordinarily refrain from acceptinggoods and services from clients in return for services rendered.Bartering for professional services may be conducted only if: (a) thesupervisee or client requests it; (b) the relationship is not exploitative;(c) the professional relationship is not distorted; and (d) a clear writtencontract is established.7.6 Marriage and family therapists may not withhold records undertheir immediate control that are requested and needed for a client’streatment solely because payment has not been received for pastservices, except as otherwise provided by law.

So, Where Do Our Issues Come Into Play?

Some therapists may even feel relieved by charging a lowerfee. They link their own self-worth, value and effectiveness toappeasing and supporting the client in this moment of stress.

A lower fee feels like less pressure to push for change, andmore freedom to just be with the client, which is, in manycases, the best intervention anyway.

Ironically, we tend not to recognize the legitimacy of empathic listening alone as valuable and fee-worthy. Some of us operate under the idea that we need to be masters of theory or savvy interventionists in order to earn our keep. Do we underestimate the value of providing a good ear and the healing power of helping clients to talk openly and be understood?

Is therapy a luxury? Is it a necessity? Whodecides this and how? Some therapists tellme that they feel guilty charging any feewhen clients are having a difficult timefinancially. Others have shared with methat they are having difficulty paying thefee for their own therapy and supervision.

And what about our fear of losing clients, of financialinsecurity, or of ineffectiveness? It's difficult enough to haveyour own business and have your paycheck change from weekto week. To have to bring in business concerns on top of doingtherapeutic work adds to the pressure. How much do weknow about our own worries and the effect they have on ourdecision making when it comes to fees? Some clinicians thinkthey must slide to keep business.

People don't negotiate fees with the grocery store, cablecompany or the gas station.

Lawyers do pro bono work, or barter. We can make this part ofour work too, but should it really be our only way of thinkingabout our work? Why is it that many therapists' defaultthinking goes to the value being less rather than more? Ormaybe it should be as one therapist I know says, like taxes.The more you make, the more you pay.

https://www.youtube.com/watch?v=05_l0CHTJ0g(13 minutes)

How involved ought we be in a client's decision to begin orcontinue treatment?

Should we encourage clients to stay?

Is that too "sales-y"?

Do we slide our fee? (Does the massage therapist orphysician?)

Do we really believe in what we do?

Is it possible that coming to therapy actually helps peopleprosper?

Why are we hesitant to conduct business as usual when aclient is stressed?

The Question of Sliding Scale Payment in Psychodynamic TherapyPosted on July 19, 2011 by Joseph Burgohttp://www.afterpsychotherapy.com/sliding-scale-payment/

After struggling with this issue, I finally came to the conclusion that my fee should be my fee and remain the same for all clients. My reasons are two-fold:

First, if you maintain your professional boundaries as a therapist, then your own emotional needs and issues don’t enter into the treatment.

While you derive meaning and satisfaction from your work, therapy is entirely about the client’s emotional needs, not your own.

You do have personal financial needs, however, and those aremet by the client paying your fee. In other words, the actualtherapy is about the client’s needs, the fee is about yourown.

If you’re working for less than your usual fee, do you give lessto your client?

Second, while clients often become emotionally dependent intherapy and develop a parent-child transference, you are not,in fact, their parent and it is not your job to look after theirfinancial needs. Your job is to give them the best treatmentyou can.

Quite a few of us entered the profession because of anunconscious wish to cure a parent or in order to feel needed(rather than being needy ourselves); these factors mightdistort how we set our fees so they need to be understoodand sorted out.

The truth is, I need to earn money to support myself and myfamily; being appreciated for the work I do and feeling goodabout myself as a therapist are all well and good but theydon’t pay the mortgage. My expenses won’t go down justbecause half the clients in my practice are paying reducedfees.

Possible Answers When Money is an Issue for the Client

Sometimes, of course, a duck is a duck.Someone loses a job, or does not have themeans to afford a higher fee. But I haveseen many different solutions to thesewould-be obstacles to treatment. Somepeople come less often; some have to takea break for a while. Some do shortersessions.

Some therapists do online counseling, and since it's moreconvenient for them, they feel they can charge less.

Some therapists do reduce fees when the need is clear, andwith the understanding that when things get better the feewill be returned to its regular status.

Others save a few sliding-scale slots as part of their overallcaseload and reserve them for a population they feel mostneeds it, such as young adults or single parents.

In some cases, suggesting or agreeing to lowering the fee maybe communicating the idea that we agree that things areindeed pretty bad for the client, and they won't get better—that they are poor and perhaps helpless to figure out how tofigure out their money situation.

We may be sending a message of despair, not ofunderstanding and support. Other clients may feel loved orcared for, but for some it may signal that we don't value thework, or value the client.

One therapist said that after she lowered the fee, the clientstopped coming. After several attempts to reach her, the clientfinally called back and said that she felt guilty andembarrassed paying so little and so decided not to come. Itcan work the other way as well. A lower fee may leave usresenting the client, particularly if it has not been thoughtthrough enough.

Some therapists like the feeling that they are being supportiveor practical, loving even, when they are negotiating a fee. Andit may be true, since being so is the heart of much of what wedo as psychotherapists. Many of us, particularly from socialwork or social welfare backgrounds, have the idea that wemust offer up at least some of our services as charity.

This is a worthy ethic of the helping professions and our practices. However, should it be done habitually to the point where we have difficulty meeting our own obligations or goals? Our relationships with clients are important. Our time with them is sacrosanct. We work hard with concentrated effort and dedicated time. We are not (well, I don't think so) merely the mani or the pedi that could be done at home.

Can we suggest that clients look at things this way, too?

Dare we question the priority that therapy holds in theirbudgets?

Or suggest giving up something in order to pay our fee?

Should we question their leisure plans, hobbies or choices?

Should we help them to view therapy as an investment intheir marriage, financial recovery or success in life?

Do we really believe this is a luxury item or a vital part of ourclients' well being?

Shifting to Financial Success Thoughts

A shift has to first begin in our mindsand in our thinking, in order toexperience financial success. Beingaware of the limitations that comefrom conscious mind and moving ourunconscious beliefs into a state ofconsciousness is paramount.

Take a look at what making agreat deal of money creates inyour body and mind. Does yourstomach feel stressed or excitedabout the possibilities?Can you feel a sense of gratitudefor the potential of having largesums of money or for somereason is your feeling one ofguilt and unworthiness?

Sometimes religious teachings interfere with financial success.Many religions equate financial success with close to sin. Thiscan make it difficult to expect and ask for money in return forcounseling and the services we provide.

Many religious leaders are very wealthy anddo not feel that making or having money is asin. Some of the wealthiest institutions arechurch affiliated corporations. Maybe it’s notthe money, it’s what we do with the moneythat is important.

There is a great exercise that can assist you to get a sense ofwhat you would do with large amounts of money. Imaginethat tomorrow you get a check for $100, decide what youwould do with it. The next day you get $200, decide how youwould spend it. The 3rd day you get $400 and on the 4th day$800, by the 5th day you get $1600 and the 6th day $3200. Dothis exercise for 2 weeks, doubling your money each day. Soonyour check is over $100, 000. Extend the gift of money for amonth.

Now we are talking about the kind of money that can change the world. Are you a good person to be given this large sum of money? Will you do things to help others?

I know the answer is yes and it is important that you realize that you are the right person to be trusted with a lot of money. Getting used to the concept of having an abundance of money is a skill. It takes commitment and belief in yourself, to make it happen.

This brings us to the idea of solutions to the lack of moneyissue. There are two avenues to pursue.

One is to work harder which can be fulfilling in it’s own right,but it can lead to a life that is out of balance.

The other answer is to work smarter. Psychotherapists usuallyhave more then one gift to share with the world. The career asa psychotherapist offers many avenues to pursue along withthe hourly counseling of clients. Many psychotherapists aregreat speakers, great writers, great artists or dancers, or manyare entertainers and teachers.

Expanding a private practice to incorporatemore then one talent can offer more ways totouch the lives of others and also bring inadditional income. Interestingly enough,while pursuing these other avenues, mostlikely new clients will call for hourlyappointments. The variety of sources ofincome can be stimulating and more fulfillingfor the therapist.

The comfort and success a psychotherapist experiencesdirectly reflects the state of mind of the psychotherapist inreference to money. Money is a symbol. It symbolizesfreedom, power, abundance, security, and a welcome state ofgenerosity.

If the psychotherapist lives in fear of “ not enough” this will result in limited income and monetary problems.

If the therapist believes in abundance, believes in herself or himself, believes in their life’s purpose and all that their talents can do to help the world, the therapist will experience financial success.

Focusing on dreams and goals while absolutely knowing that accomplishing these dreams and goals is possible establishes an air of confidence and reliability for clients seeking help from a therapist.

The energy emitted from this type of confidence andenthusiasm is infectious. Clients can feel it and want that kindof feeling for themselves. The way to create this kind ofenergy involves actually taking the time to visualize money asa friend, as a means to create whatever you wish to create.

Each morning or evening, spend a fewminutes imaging that you actually have andfeel comfortable with large sums of money inyour bank account. Feel the gift of being ableto not only provide for yourself and for yourfamily but also how it feels to use that moneyfor the benefit of mankind. This exercise is abit like working out. It takes practice anddetermination to expand our muscles, just asit takes those same behaviors to expand ourthinking.

Secondly, you will need to refute whatever beliefs or feelingsthat come up to sabotage financial success. Each negativebelief needs to be paired with an affirmation that includes apositive belief about yourself. An example might be: “If I amfinancially successful, I will feel guilty about having moneywhen others are suffering financially. Someone else maydeserve or need the money more than me.”

The rebuttal is “ I promise to use the money in a way thatbenefits others, either by providing employment, giving tocharities or directly helping others and it feels good to be ableto do this.” Saying the affirmations out loud intensifies thepositive effect because it will hit more then one of yoursenses. The repetition of these affirmations increases onesbelief and commitment to oneself. It gets easier and morebelievable with time.

The great part about role modeling an adult view of money isthat you will become a better role model for your clients andit will become more second nature to assist them with theirmoney issues. Money is presently important in our world andas long as money is the ticket to some of the things we desire,we need to be a better “mother to our money”. Just believe inyourself, which is such a strong message we teach to ourclients.

References

• ‘And How Does That Make You Feel?’ The Cost of Therapy

http://thebillfold.com/2013/05/and-how-does-that-make-you-feel-the-cost-of-therapy/

• Lowering the Fees in Hard Times: Meaning Behind the Money

by Melissa Groman http://www.psychotherapy.net/article/psychotherapy-fees

• Fees In Therapy: Summary and Guidelines

By Ofer Zur, Ph.D.

This article is part of an online course on Fees in Psychotherapy.http://www.zurinstitute.com/ethicsoffee.html

• Janet Whitney, MA, MFT

http://www.theravive.com/research/Psychotherapists-and-Money

• Joseph Burgo, Ph.D http://www.afterpsychotherapy.com/