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Getting Paid: Talking About Sliding Scale Pricing—The Words You Use Do Make a Difference is the fourth article of the Getting Paid: Talking with Clients About Money Matters Series.
How much do you charge? What’s your sliding scale? Is that the lowest you charge? How much can you slide? How low can you go? If you dread hearing these questions you are not alone. While questions about a lower price or a sliding scale used to be asked from time to time, therapists are reporting that now they are asked these questions all the time—from just about everyone who calls. What’s problematic about this? Well, before this recent phenomenon started, sliding scale requests came from just a few—usually those with a low income or reduced ability to pay, a financial hardship or significant unexpected expense. Now a majority of those asking for lower or sliding scale pricing more often have adequate resources, income, and an ability to pay. What’s a therapist to do? Offering lower pricing to clients truly in financial need who require mental health services, is a time-honored tradition in the practice of therapy. Sliding scale and other types of price adjustments were instituted to make therapy services available to those whose economic circumstances didn’t allow payment for the full cost of services. Having these accommodations available allows therapists, at their own discretion, to adjust the amount a client pays and can manage on a regular basis Like most therapists in the mental health profession, I believe in, and support, making affordable therapy available to people who don’t have much money and those experiencing a financial hardship. Clinicians, who are committed to this, routinely offer those in need a variety of options that allow them to afford and pay for needed mental health treatment. Many therapists also work with certain clients on a case-by-case basis to offer specialized arrangements based on their particular needs and circumstances. Some of the options private practitioners use to make therapy affordable to clients in financial need are: pricing based on income; lower pricing; a percentage or number of lower priced client spaces; an allotted length of time or number of sessions of lowered pricing for a certain number of clients; flexible scheduling (three sessions per month, every other week, etc.); charging less for shorter sessions; payment plans; pro bono sessions for a client or two; charging less for sessions during slow periods of the day; special arrangements based on special circumstances; a limited number of reduced-price scholarships; sliding scale; etc. With so many callers asking about the lowest prices they have, now therapists feel even more to reduce prices because
While clinicians believe it’s important to offer sliding scale pricing only when a client is genuinely in financial need, unfortunately, when repeatedly asked about sliding scale or lower pricing, many end up undercharging, letting clients determine the fee, maxing out the number of low-cost clients their practices can accommodate, cutting prices below the minimum amount needed to keep their practice open, and feeling resentful or taken advantage of by clients they gave a lower price to and then discovered were spending large amounts on luxuries (new, high priced cars, jewelry, vacations, designer clothing; dining at pricey restaurants, etc.) after they’d claimed they couldn’t afford to pay for therapy and needed a lower session price. Sliding scale, special arrangements, and lower prices upon request were never meant to be offered as options to those who had resources, could afford to pay the full price, and who, for other reasons, don’t want to or think they should. It’s also not financially feasible for any private practitioner who wants to remain in business, to give a discount to every single client who wants to pay the lowest possible price for therapy—after all we need to keep our practices up and running, be able to cover practice and professional expenses, and support ourselves and our household. Responding to callers and clients who are asking, but don’t really need or qualify for a lower therapy rate, is a very different type of conversation than the one clinicians trained for and are familiar with—people who genuinely have, a financial need. As therapists, our task is to find the right balance of how, and how much, we can adjust session prices, for which clients, and how many—and not go out of business. In the current climate, navigating talking about prices with these clients takes more specialized skills and requires a totally different mindset, approach, and vocabulary. So, what’s the best way to respond to a caller or current client who wants a price accommodation but doesn’t need one? Money Talk: Words & Phrases to Consider Let’s look at some of the words that can make a difference when a clinician talks, writes, or communicates about money matters involving sliding scale and adjusted pricing for those with limited income—and how and why these words can affect the amount a person is willing to consider or pay for therapy services. This information applies equally to phone calls, face-to-face conversations in real time or virtually, emails, texts, social media postings, and what’s printed in marketing materials or written on a website. Yes, each of these words and phrases can have a direct effect on the perceived value of the services a therapist provides and the amount clients are willing to pay for the clinical services you provide. As you read the following information, be sure to remember:
Now about that vocabulary . . . As noted in Getting Paid: Talking Fees, Pricing, Prices The Words You Use to Talk to Clients About Money Matters in Therapy Do Make a Difference using fee, full fee, my, my fee, etc., currently seem to signal to those seeking therapy that any stated rate for clinical services is just a starting point. It’s automatically assumed therapists are open to requests and negotiating lower prices. You’ll notice that the words listed aren’t used in this article—that’s why. To review alternate wording, click the link. Using some of these suggested words may eliminate a client who doesn’t need a sliding scale asking you about one. 1. Low, lowest, lower . . . Reduce, reduced . . . Discount, discounted . . . Lowest price/prices/rates/amounts . . . reduced price/prices/pricing/rates/amounts . . . discounted price/prices/pricing/rates/amounts Are the people who call us about our services seeking therapy or shopping for therapy? In today’s world using any of the words listed seems to put people on the “I’m shopping” channel. Not exactly the best channel to be on to seek professional help for mental health issues or work, family and relationship problems, self-regulation skills, healing past traumas, addiction, recovery, anger management, parenting skills, growth, etc. It’s sometimes very easy for people to get mixed up about what type of professional help they need and what that costs. Are people looking for a professional who’s trained and skilled in helping clients like them with their presenting issues? Or are they looking for the lowest possible price for counseling? How much is it necessary to pay? What difference does the price make? These are all important questions for therapists to address when clients call about therapy and cost is discussed. As mental health professionals who are highly skilled and experienced, we don’t want to add to any confusion, so it’s important we’re aware of the words we use when we talk or write about the price for therapy services so we don’t inadvertently encourage clients to shift into a shopping for the lowest price mindset or turn into a “therapy price shopper.” Clinical services are valuable and worth paying for since stopping unhealthy behaviors, learning new skills, and how to take better care of yourself can save both money and time as well as help you take advantage of opportunities that make your life better. How much does therapy save when you don’t get divorced, lose your job, get a DUI or???? When you compare the cost and benefit from what you receive then the price may seem worth paying—even if you must rearrange your budget, put it on a credit card, arrange a family loan or payment plan, etc. Unless therapists are specializing in clients who only want to pay low, reduced or discounted prices for therapy services, in general, it’s best for those in private practice to use other words and not any variation of “low, reduce, discount” when referring to or stating pricing for therapy services. 2. Sliding Scale When in conversation or writing, substituting one of the following words in place of “sliding scale,” price . . . rate . . . amount . . . pricing . . . cost . . . charge . . . along with adjust, adjusted, alternate, alternative, affordable, special, economy, helps clients understand, and cognitively register, that this isn’t the type of pricing range where a therapist will, upon request, “slide” all the way to zero, or some other very low price. Adjusted price . . . economy rate . . . special pricing . . . cost adjustment . . . more affordable amount Using this wording usually results in fewer requests and conversations from those not truly in financial need. With these words people, usually don’t just automatically try to negotiate to make a stated price lower. Let’s look at this from another perspective . . . When you go to a doctor, attorney, dentist or other professional, do they use the term, sliding scale? Most likely these professionals use words like adjustment, introductory, limited time or another pricing term. Clients are familiar with this wording. and when it’s used, don’t automatically assume that the price stated is open for negotiation to a lower one. Nor do they experience these definitive words as an invitation to ask for a discount or adjustment to a much lower number. Now’s a good time to take a moment to think about and consider the words you are using with the people who call or clients who want to change the amount they pay, what you’ve read about this, and what your colleagues are saying about handling these things and if, and how, it’s working for them, and for you. That’s enough for today on talking sliding scale pricing and getting paid. I hope you’ve found it useful to understand how the wording you use to talk about sliding scale pricing can increase or decrease the money you earn in your practice. See for yourself how the words you use can make a difference. The next article, the fifth in the Getting Paid Series, covers sliding scale, part 2—specific suggestions about how to introduce and talk about your sliding scale, adjusted pricing and specialized alternatives. Getting Paid: Talking About Sliding Scale Pricing—The Words You Use Do Make a Difference is the fourth article of the Getting Paid: Talking with Clients About Money Matters Series: 1. Talking with Clients About the Price & Value of Therapy 2. Talking Fees, Pricing, Prices—The Words You Use to Talk to Clients About Money Matters Do Make a Difference 3. Talking Pricing, Services, Rates—The Words You Use to Talk with Clients About Your Services and Rates Make a Difference Talking with clients about therapy services, cost and payment, and the importance of making and keeping regular appointments is a vital part of therapy—and finding the right words to use professionally and clinically to convey the value of these services and the appropriate cost, time-frame, and involvement—is key to the success of every therapist’s private practice. However, today many therapists are finding that they must spend significant time and energy to reset a client’s, or prospective client’s, expectations for therapy with regard to cost, frequency, duration, participation, and involvement in the therapy process. As a result of these challenging money-driven clinical conversations, many therapists have reduced their rates significantly and are undercharging--and frequently being paid too little—for their therapeutic services. Yes, and, sadly, all too often, therapists are being persuaded to give their services away free. This is the third article in a series on Getting Paid: Talking with Clients About Money Matters:
Unfortunately, it is a common misperception that charging as little as possible is the best strategy for attracting new clients and filling a practice. However, undercharging and underearning seriously harm your business if you are mainly providing low cost offerings to clients—you and the work you do aren’t valued by these low-paying clients, you still need a lot of clients, and any new client makes very little difference to your income. If you’re in private practice you have a responsibility to find clients who can pay your rates and keep you and your practice solvent so you can do the work you were meant to do instead of spending all your time and energy trying to keep you practice full. The therapists I talk to are tired of undercharging and underearning. Therapists want to work less, earn more, and make a bigger difference. More and more therapists are seeking out clinical and practice coaching so they can take charge of clinical money conversations and refocus them on the value, relief, and life/relationship/health changing/enhancing, conflict/anxiety/depression reducing benefits that clients are seeking from in person, face-to-face therapy work with a trained professional—and they charge more and are paid accordingly. Their income increases, they attract more clients, they fill their practice. Therapists deserve to earn a good living for the work they do. The Wording You Use Can Make Difference in Your Income As in any clinical endeavor, the words you use to describe your services do make a difference. In this case, the amount a client is willing to pay for therapy with a trained professional—and in order to receive the desired result/relief/outcome. Yes, the meaning our words convey can either increase or decrease the amount of money we earn and are paid for therapy. You’ll find that people will pay in full and out of their own pocket for your services, when they believe you are the professional who can give them what they want—and the wording you use to describe your services conveys that. Money Talk: Words & Phrases to Consider Here are some examples of words that can make a difference in income when a clinician talks, writes, or communicates about therapy or money matters—and how and why these words can affect the perceived value, and subsequently, the amount a person is willing to pay for the therapy services provided as a clinician. This information applies equally to face-to-face conversations in real time or virtually, to emails, texts, social media postings, and what’s printed in marketing materials or is on your website. Each one of these words and phrases can have a direct effect on the amount a client pays you for your clinical services. As you read the following information, be sure to remember:
1. Help, Support, Advice, Listening, Guidance Many therapists, clients, and lay people refer to therapy as: help, support, advice, listening, guidance, appointment, etc. When it comes to the amount of money a client is willing to pay for each of those ‘services,’ the perceived value and worth is low since these are things that non-professionals—friends, colleagues, neighbors, parents, siblings, support groups, online forums, etc.—can, and do, provide. Exceptions to these would be: professional help/support/advice/guidance. These combinations have a higher perceived value of worth and price to clients. Contrast the words: help, support, advice, etc., with the following ones that have a higher perceived value and worth: session, service, psychotherapy, counseling, treatment, recovery, consultation. Now combine them: psychotherapy session . . . therapy session . . . counseling session . . . psychotherapy services . . . therapy services . . . therapeutic services . . . professional services . . . depression treatment . . . anxiety treatment . . . bipolar treatment . . . trauma recovery . . . professional consultation . . . etc. These terms mean business. They are definite and professional. To clients they position you as a worthy professional who is both trained and capable of giving them what they want. Other terms of higher perceived value that can be added when appropriate: licensed, certified, approved, supervised by, etc. Yes, clients will pay you more for your service when these words are added. Here are two examples of lower perceived value wording: my services, services I provide. However, when you add other words to those two phrases you come out with higher perceived value: psychotherapeutic /psychotherapy services I provide. Add another certifier to that and you then have the highest perceived value: psychotherapy conducted by a licensed psychotherapist/clinician. What word or terms do you, and your clients, prefer—or use—to talk about or describe the services you provide? Which would you or your clients pay a higher price for? 2. Ask, Get, Take, Accept, Charge I ask $ . . . What I ask is $ . . . How much do you get for a session? I can take $ . . . The fee I accept is . . . I charge $ . . . What I charge is . . . What do you charge? Are you asking or is it the cost? Are you asking or is it the price? Be professional and definite: “The cost is . . ." not “What I ask is . . .” State what the cost is for. “The charge/price/cost for/of the 60-minute session is . . .” Here it’s important to remember that a client doesn’t “give you money,” a client pays for services rendered. You have earned the money the client pays you. You’ve provided services to the client. In this case, services provided by a highly-trained professional—as therapists we have quite a bit of education, training, skills, and experience, not to mention licensure or supervision by a licensed person. Therapists deserve a fair rate of professional compensation. Here are some alternative words and phrases to consider when stating the prices for the services you provide in your practice. Using these terms positions you and the services you offer as confident and of high value and worth: The PRICE is . . . The COST is. . . The RATE is . . . The AMOUNT for that is . . .The session price is . . . the session cost is . . . the session rate is . . .The Price/Cost/Rate/Amount/Charge for that service is Decide for yourself what fits you, your clients, and your practice best. Try a few of the phrases out. See what fits you best. 3. Free, discounted, reduced, lower “No charge,” “no cost,” and “complimentary” are better wording for practice success than the word “free” which seems to mean to people that your services aren’t worth much and they should expect to receive all your services “for free,” all the time. Discounted, discount, and reduced rate are popular words. Again, they are not the best for practice success as they train people to always ask for “a discount” or reduction. A better choice in wording is “special” price/pricing or “introductory’ pricing, “a special offer” or even, “a limited time offer.” With these words and phrases, people associate your services as something of worth that are available at this pricing for a limited amount time. Sometimes people ask if you have a “lower” fee or if you will “lower” the fee or even, “What’s your lowest fee?” Some better alternative words and phrases are an “adjusted” fee or “special pricing” or “professional courtesy” pricing or even “college student” pricing. It’s important for mental health professionals as a profession to not train people to expect therapists to always reduce, discount, lower or charge the lowest fees just because a client wants but doesn’t need an adjusted fee. It’s important that therapists, as a profession, maintain a reputation for being paid well for the good work they do—work that’s worth every dollar they’re paid. It’s not a good thing for therapists to be known for charging the lowest rates in town to anyone who asks even when they don’t need a price adjustment. 4. Fee Scale—Prices, Pricing, Rates, Fee Range When talking numbers around the amounts you charge for your services, most therapists find it’s better received to refer to pricing, prices, and rates, as a “fee range” instead of a “fee scale.” Using the term “fee range” is associated with “a range of services and fees.” People seem to understand that concept easily. A fee range connotes choices and options whereas “fee scale” suggests some type of ranking or judgement. That’s enough for today about money matters and getting paid. Next time we’ll address wording around sliding scale which is a whole topic in itself! Getting Paid: Talking Fees, Pricing, Prices—The Words You Use to Talk to Clients About Money Matter in Therapy, Do Make a Difference is the second article in the series on Getting Paid—Talking with Clients About Money. If you’d like to read more, here’s the first article: Getting Paid: Talking with Clients About the Price & Value of Therapy. As a mental health professional, the words you use in money conversations matter to you, your clients, your colleagues, your employers, and to your therapy practice. When communicating about money and therapy services it pays to pay attention to the language we use in our clinical role because the meaning our words convey can either increase or decrease the amount of money you are paid as a therapist. Yes, the words and phrases you use truly contribute to the bottom line of your therapy practice. Money Talk: Words & Phrases to Consider Let’s look at some of the words that can make a difference when a clinician talks, writes, or communicates about therapy money matters—and how and why these words can affect the amount a person is willing to pay for the therapy services you provide as a clinician. This information applies equally to face-to-face conversations in real time or virtually, to emails, texts, phone calls, social media postings, and what’s printed in marketing materials or is on your website. Yes, each one of these words and phrases can have a direct effect on the perceived value of the services a therapist provides and the amount a client is willing to pay you for the clinical services you provide. As you read the following information, be sure to remember:
1. My, Me, I, You, Your My fee . . . I charge . . . What I ask is . . . What is your fee? How much do you charge? What do you charge? Do clients pay you or do they pay for therapy services or the sessions you provide? The fact is that most clients don’t really want to pay you. Clients want to pay for therapy or services or for the help and expertise that a therapist provides. When therapists pair the words, “I, me, mine, you, your,” with fees and pricing it can make paying for therapy seem like a personal interaction instead of a professional one. Many clients will pay less or feel reluctant to pay for what seems like a personal transaction of caring and help. When a therapist uses the words, “I charge,” people unconsciously think, “Ok, you charge that; how much do others charge?” Saying what you charge sounds like it’s arbitrary and negotiable. When clinicians use the term, “my fee,” the same principle applies. Making one small change—using the word “the” in place of “my, me, mine, and I”—works surprisingly well to communicate a professional charge for services rendered. The very personal and idiosyncratic “my fee” becomes “the fee.” “I charge,” becomes “the charge.” “Pay me” becomes “Paying for therapy or the session.” Which sounds more professional to you? Does “the fee” seem like it’s automatically open to adjustment? Here are some alternatives: The cost of the session is ___ The price of your session is ___ The charge for your session is ___ Using this type of focused clinical language activates the cognitive/thinking parts of the brain and helps a person operate from an integrated thinking, analyzing, and decision making mode instead of an “emotional” mode which is more feeling driven and can make these types of money matters conversations more personal, intense, and stressful for both therapist and client. 2. Fee Therapists often use the word fee to address the amount of money that is charged for therapy services provided/delivered/rendered. However, the word "fee" seems to come with quite a bit of baggage for both clients and clinicians. To most clients encountering the word “fee” in the context of therapy is synonymous with “fees are always negotiable” or that the number is meant to be adjusted to a lower amount. Substituting one of the following words in place of “fee”—price, charge, cost, amount, or rate—helps clients cognitively understand and process that this number is the actual amount it costs and that they’re expected to pay for services. With these words people don’t usually react so reflexively to negotiating to make the amount lower. Think about this . . . when you go to the doctor or dentist or other professional, do they usually use the word fee? Most likely they use words like charge, price or cost. Consumers are used to this type of pricing language and understand this is the number they must pay. People do not automatically associate these definitive words with the possibility of negotiation and adjustment to a lower number. By using this type of consumer wording, therapists can bypass the client’s automatic reflexive perception and response to the therapist’s “fee” as a starting point for negotiating payment even when no fee adjustment is realistically needed. As a result, of making this change in wording the clinician’s money conversations are usually shorter and the amount a client pays for therapy is usually higher but is still what the client can afford. 3. Full Fee My full fee is . . . My regular fee is . . . The full fee is . . . What actually does “full fee” mean? Is there a “partial fee?” Why do we as therapists say, “full fee?” Why don’t we as therapists just use fee or price or charge without the adjective? Attaching the word “full” to the word “fee” with regard to therapy causes the client to wonder, think, entertain, ask or explore what the fee that isn’t "full" is—and then clients ask you about that other fee! What a pickle for the therapist. As professionals, we don’t realize when we are inadvertently inviting discussion and negotiation about the amount of therapy payment when it’s not needed. An alternative to using “my full fee” is to use more definite and clear language, such as “The price for a 50-minute session of therapy is . . . ” or “The charge for your therapy session is . . . ” Decide for Yourself What Fits You, Your Clients, and Your Therapy Services Best Confidently take charge of money conversations by using the aforementioned professional and clinical language suggestions and recommendations tailored to your client population and clinical practice. Focus on the value, cost, worth of the therapy service to the client and their life. Remember to keep the language, wording, and focus of the clinical and professional money matters conversations on the client responsibility for payment for services needed, received and provided—not on what or how much the therapist gets or charges. Allow the client to pay a fair price for the therapy benefits they receive from you. That’s all for this article on getting paid and how the wording you use as a clinician to talk about money matters can increase or decrease the money you earn from your client work. I hope you have found it to be useful, thought stimulating, supportive, and encouraging to your efforts to get paid what the therapy you provide is worth. See for yourself how the words you use can increase the amount of money you earn from your practice. The next article, the third in the Getting Paid Series on money matters conversations, will address words to use to refer to the services you provide, to describe your prices and fee scale, and how to introduce and talk about your sliding scale. Talking Fees, Pricing, Prices—The Words You Use to Talk to Clients About Money Matters Do Make a Difference is the second article of the Getting Paid: Talking with Clients About Money Matters Series: 1. Talking with Clients About the Price & Value of Therapy 2. Talking Fees, Pricing, Prices—The Words You Use to Talk to Clients About Money Matters Do Make a Difference Getting Paid: Talking with Clients About the Price & Value of Therapy is the first article in the Getting Paid: Talking with Clients About Money Matters Series:.
There’s a lot of interest lately in addressing the issue of the amount of money clients pay, or don’t pay, per session for therapy. The truth is that, as a profession, we as therapists often undercharge, and are underpaid, for the therapy services we deliver. Fortunately, this seems to be changing as people are becoming more aware of the value of the therapy that therapists provide—and what therapy actually costs to provide. So, what is the therapy that mental health professionals provide worth to clients and in marketplace? Overall during money conversations when the price of therapy comes up, we, as therapists, need to focus on increasing people's perception of the value of the therapy services clients receive instead of routinely just dropping our fees. When clients, or prospective clients, bring up the cost of therapy services during the intake or pre-therapy conversation we have, it’s up to each of us, in our therapeutic role, to engage the client in conversation about what they actually need and can benefit from in therapy. This helps the client think through and justify paying the session rate, or continue to pay the session rate, we charge for therapy. It’s what we do in every other conversation with clients. Money matters are no different. Yes, in these money conversations the therapist’s role, or clinical task, is to help the client clarify the value of the therapy and services they need and the results or benefits that therapy can or has delivered to their lives and relationships. Helping clients look at what they benefit or gain from, don’t have to suffer, or will heal from because they are coming to therapy is an important part of these conversations when clients become over-focused on the price or cost of therapy services. It’s not just about the money or the price of therapy services, it’s part of the therapy itself. It’s definitely part of our clinical role to help client think through what they need or are coming to or are seeking therapy for and the results and benefits therapy is providing to them or can provide. When the therapist has this type of clinical client interaction, clients will often hire the therapist or continue coming to therapy even when the therapy costs more than what they originally wanted to pay or thought they could afford. Remember that clients are paying for the value and benefits that therapy provides for them, not the time—and clients want a price, a number, they can justify paying. One that’s commensurate with the service and benefits they receive and need. Do you get paid for your time or your expertise? Remember, professionals get paid for their expertise instead of for their time. Charge for your expertise and the value you provide, not just for your time. Convey to your clients that they pay for your expertise, not just for your time. Clients often forget this when they focus on money and numbers. People will pay in full and out-of-pocket for your therapy services if they see you as a trained professional and an expert who can give them or help them get what they want. The most common question I receive in my Money Matters workshops and practice coaching is how to respond when a client says, “I can’t afford that,” “I can’t pay that,” “I don’t want to pay that” or “I don’t know how I could pay that.” Good responses to “I can’t afford it” are clinically based. Work with clients, or converse with prospective clients, to find out how they could pay that amount—what it would take or what they would need to/could do to make that happen. Treat the issues that come up in these client money conversations the same way you’d treat any other client issue. Maintain your therapeutic stance and approach as you work with the client and their issues during the money conversation. Yes, I am recommending that you address client fee and payment issues as clinical issues. Maintaining your therapeutic role or position and confidently taking charge of money conversations works—and is therapeutic for the client. Focus on the value, cost, and worth of the therapy service to the client and their life. A client will pay for that. Clients do pay for that. Be sure to keep the focus of your interaction on the client paying for services they need and receive not on what the therapist gets or how much the therapist charges. Remember: a client doesn’t “give you money,” a client pays for services rendered. The client is not in charge of determining much therapy costs, the therapist is. I wish you the best in your client money conversations. They are always adventures! |
Lynne Azpeitia, LMFTFor 10+ years Lynne Azpeitia has helped therapists to live richer and happier lives through her workshops, private practice and career coaching, and her practice consultation groups which train, support, and coach licensed therapists, interns & students how to create and maintain a successful, thriving clinical practice and a profitable career Archives
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