Twice recently, while discussing with therapists who might be their ideal clients, the question of clients’ ability to pay came up. Or rather, it didn’t come up. Neither of the therapists in question mentioned ability to pay as a criteria they would consider in forming an idea of their ideal client. And yet, both of them were struggling to earn enough in their practice.
Unless you’re lucky enough to have a trust fund, or an understanding and wealthy partner, most of us need to get paid for our work, especially if that work is going to go on for some time. So, in my view, the client’s ability to pay is important.
When I asked the question, each was surprised, and both agreed that it was an important factor. Isn’t it interesting, though, that it wasn’t something they thought of? Other possible criteria tripped off their tongues with ease: presenting issue, client’s age and gender, the client’s desire and willingness to do the work. But ability to pay? No.
As a profession we can be highly ambivalent when it comes to the matter of money. We need to earn a living, but many therapists seem to feel that it’s wrong to be paid out of people’s misery. A cartoon posted on Therapy Tales commented “I suspect that therapy is the only profession where the service provider feels somehow obliged to work for free.” They’re right. Doctors, Priests, Teachers, Social Workers and Funeral Undertakers all get paid. What’s so different about therapists?
Perhaps this belief that it’s wrong to take money out of other people’s hardship is masking a reluctance to be seen as having needs of our own, or a fear of being thought of as “only interested in the money”? A commenter on ShrinkRap says that talking about money is more difficult than talking about sex or suicide, and I suspect that’s true for many of us. We can talk about sex or suicide because they are client issues. It’s usually easier to talk about someone else’s problems than our own. Talking about the fee for therapy brings into the open my need to earn a living, and it can be hard to make a stand for having our own needs met, perhaps in the face of the clear and pressing needs our clients may present.
And then again, maybe we make this issue far more complicated than it needs to be. Maybe it just comes down to a question of appropriate boundaries. Boundaries are the therapist’s responsibility and are part of the holding frame within which the work is done. We set out the boundaries at the outset of the relationship, including our fee (if there is one), and our policy about cancellations. We move the boundaries only if we are satisfied that it is appropriate to do so in the interests of the client.
It is the client’s responsibility to pay the agreed price for the service that they want and have asked for. And if they can’t pay? Well, that’s just grist for the therapeutic mill, we talk about it. I can hear the arguments against…what if the client is suicidal…what if they have a financial crisis…what if a child is involved? what if…? You have to decide as a therapist whether you’re willing to change the boundary for this client in these circumstances. If it’s a short term thing, then you may decide to take the bounce. On the other hand, if it’s likely that the client will not have the resources to pay you going forward, you may decide to wean the client onto another service that doesn’t charge, or charges less. And who knows how the client may benefit from your decision, whichever way you go!
From a business perspective, it’s even simpler. What business are you in? Providing therapy services for free? Or providing therapy services for a fee? The choice is yours. You can choose to provide your services for nothing, but that is very different from not charging because you’re unable to hold the boundary, or unable to say “no.”
One practitioner told me that after we spoke about this issue, she found herself becoming much clearer about the fee boundary, and as a result, felt freer to be totally present to the client. Interesting isn’t it?
If money is an issue in your practice, either because you don’t earn enough, or because you struggle to talk about it, I’d be glad to help. Please contact me here to avail of your free 20 minute consultation or to make an appointment or browse my services to see what would suit..