Category: Best Practices

Getting Paid: Guiding New Clients into Teletherapy in Your Telepractice

6/3/2020

How to Talk with Potential Clients about Doing Teletherapy in Place of In-Office Sessions

The biggest challenge therapists say they’re facing with telementalhealth, is how to talk with potential clients about doing teletherapy in place of in office sessions.

Since therapists now have telepractices doing video and phone sessions instead of face-to-face sessions in their office, they’ve discovered that having the initial contact--the intake or pre-therapy phone or email interaction—with a potential client is, and needs to be, a little bit different than the interaction a clinician is used to having when orienting a client to beginning in-office therapy sessions.

While clinicians are skilled and practiced in what to say and cover with potential clients during the first contact for in office therapy, now when potential clients call inquiring about therapy, therapists who aren’t doing in-office sessions find their biggest dilemma is what to say to introduce teletherapy video and phone sessions—and how to respond effectively to those potential clients who are resistant or reluctant to schedule an appointment or pay for these sessions.

When therapists aren’t seeing clients in their offices, what can they say to introduce potential clients to doing therapy through teletherapy sessions? What’s the best way to respond to a potential client who seems reluctant or resistant to engage in video or phone therapy when the therapist isn’t seeing clients in person in the office? What should a therapist say to a new client to orient and prepare them for video or phone therapy sessions?

As you know, when clients come to therapy they are entering a new world. They are moving from a familiar way of operating to the therapy context where different rules apply. Our job as therapists begins with helping clients enter, become familiar with, and safely navigate the therapeutic context. We are their guide.

For successful therapy, clients need to experience a safe enough environment where they can be free to examine things and share their feelings. For most clinicians and clients this previously occurred in a therapist’s office that had been specifically created to insure a safe, confidential, and supportive environment.

Now that the therapy office is a virtual one with therapist and client in a different location, no longer does the clinician arrange for privacy and provide the Kleenex, bottled water, tea, coffee or snack; decorative pillow to hug, comforting blanket and client chair or couch. Gone, too, is therapist greeting the client in the waiting room and the comfortable small talk on the way to the office. Clients, prospective clients and the general public are familiar with and know what to expect from in-office therapy; teletherapy not so much.

With teletherapy it’s extra important for us to remember that when clients begin therapy and enter the therapeutic milieu via telehealth their experience of changing contexts is much more complex than with in-office therapy sessions. This means that not only are new clients moving from a world where they behave in certain ways to a place where they are expected to think and act differently in the therapeutic setting, with telementalhealth this includes adding another layer to that—a video screen or a phone and the therapist and client being in two locations. That’s quite different from driving to, parking, sitting in the waiting room, and walking into a therapist’s consulting room where therapy occurs and the client is taken care of in person by the therapist.

How can a therapist re-create that experience with teletherapy and convey to clients and prospective clients that it works? For most new and continuing clients this shift to creating and utilizing a virtual space for therapy takes learning and practice under guidance and direction of a competent therapist—and that starts with the very first phone conversation when Teletherapy is presented.

As you read the following information, be sure to remember:

Only do and say things that fit for you, your clients, and your practice—and always within legal and ethical guidelines.
You can ignore everything written in this article and still be successful. Discover what works for you, your clients, and the practice setting you work in.

1. When therapists aren’t seeing clients in their offices, what can they say to introduce potential clients to doing therapy through teletherapy sessions?
When doing in-person therapy sessions, during the intake conversation, therapists usually disclose their credentials, review the address and location of the office, frequency of appointments, session length, cost, type of payment accepted, directions to the office, where to park, etc.—and discuss why the client is seeking therapy to make sure it’s within their scope of practice.

When teletherapy is involved, whether or not a client has requested video or phone sessions, it’s up to the therapist to introduce, disclose, and orient the client to not only the usual therapy information but also the video and phone delivery model, treatment methods, and limitations of the telemental health services the therapist provides (Section 2290.5 of the Code). How every therapist does this is different.

Regardless of whether a client requests telementalhealth services, or the therapist is informing the client that therapy will be conducted remotely by video or phone, the opening statement and disclosures are the same.

Most therapists begin with a simple general statement like, “During this time of social distancing and stay at home orders I provide therapy through telementalhealth video and phone sessions.” Some also include, “In-office sessions may be resumed at a future date and I will let you know when that becomes an option.”

2. What should a therapist say a new client to prepare new clients for video or phone therapy sessions?

After an opening statement saying why teletherapy sessions are the sole therapeutic format, stating your own version of the following information is helpful and covers required disclosures:

Teletherapy is similar to in-person therapy and studies show it’s just as effective.
All the same therapy methods I use for in-person sessions work for video and phone sessions.
All that’s needed for teletherapy is a place that’s private where you can talk (at home, work, or in your car) and a device—phone, tablet, laptop, desktop, smartwatch—with internet access or a good phone connection for phone sessions.
To get you started with teletherapy, I can show you how simple and easy it is to do therapy with your computer, tablet or phone—at home or any other location of your choosing.
I will guide you through the process, just as I would for in-person sessions.
With video your session is on the secure platform I use as my virtual office. I email you the link, or phone number I use for your session and help you with any issues that come up.
Even before social distancing and stay-at-home orders, I’ve worked successfully with clients who have chosen phone or video sessions when out of town or not able to come to the office (unusual work schedule, sick child, not feeling well but need a session, etc.).

This is the type of information and guidance that clients and potential clients rely on therapists to provide to guide them into teletherapy that’s safe, confidential and effective.

3. What are the things therapists need to address with potential telementalhealth clients during that first pre-therapy interaction/intake?

Aside from informing the client or prospective client about teletherapy by introducing, disclosing, and orienting the client to the usual therapy information, and the video and phone delivery model, treatment methods, and limitations of the telementalhealth services the therapist provides, the California BBS: Standards of Practice for Telehealth also state that before the delivery of teletherapy the therapist needs to obtain verbal or written consent from the client for those services.

In addition, the therapist needs to document in the client notes that informed consent was obtained from the client. This is more specifically stated by the BBS, in Section 5,b.

That’s enough on introducing and talking with clients about doing teletherapy instead of in-office sessions. Next time we’ll focus on how to respond to a potential client who seems reluctant or resistant to engage in video or phone therapy when the therapist isn’t seeing clients in person.

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Getting Paid: Teletherapy Survival Tips for Clinicians

5/23/2020

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Teletherapy . . . Telehealth . . . Telemedicine . . . Telemental Health . . . Telepractice . . . Televideo . . . Internet Therapy . . . Online Therapy . . .

Teletherapy is everywhere. Like it or not, telehealth is here to stay during the current crisis—and is likely to stay in some form after it ends.

What’s a therapist to do? How can a therapist survive, and better yet, thrive, while doing so many live teletherapy sessions with clients?

Many therapists are now working from home for the first time doing therapy with clients using online video or telephone platforms in place of in person sessions. While working from home as a Teletherapy provider allows therapists to have a flexible work schedule and many other conveniences, the shift to virtual comes with many new challenges and stressors as we're adapting to what’s going on in the world and to this new setting and medium.

While Teletherapy is still therapy, it has idiosyncrasies. When doing a remote session it’s a much more exacting, labor intensive process for a skilled therapist to work effectively with the same things they do in person. Facilitating therapeutic communication and interaction is definitely different when you and your client aren’t in the same room—it requires another kind of focus, concentration, and energy. Add to that the fact that most therapists are now juggling a work-from-home therapy practice alongside home and family life while everyone's at home, too. The result? Therapists are reporting how exhausted they are after providing Teletherapy services to clients.

Teletherapy exhaustion, burnout, and fatigue are real.

Why is delivering Telehealth services so tiring? Conveying professionalism through a Teletherapy portal in your home requires that we develop and utilize a therapeutic telepresence and a “web-side” manner while conducting sessions through a screen—and that’s very fatiguing. Therapists are also finding that Telehealth delivery does not lend itself to the same type of marginless in-office scheduling where clients are seen back to back without any breaks.

Teletherapy is a much more strenuous delivery system than in-office therapy. That shouldn't be surprising since it’s well documented that sustained and prolonged use of digital devices—computers, tablets, smartwatches, smartphones—for video sessions and meetings leads to exhaustion, computer eye strain, dry eyes, focusing fatigue, and neck, shoulder, and back pain.
Here are tips for reducing the fatigue, stresses, and challenges of telehealth and conducting video therapy sessions, groups and meetings. Think of these tips as a menu of options. Try the ones that suit you, discard the ones that don’t.

Teletherapy Survival Tips for Clinicians
1. Teletherapy relies on a strong internet or phone connection.
Poor internet or phone quality is one thing that not only makes clients upset, it negatively impacts therapeutic communication, the therapist client connection, and the outcome of therapy. Anytime video gets glitchy and skips, sputters, gets pixelated or freezes the image—or the audio stops, develops, an echo or keeps cutting out—it becomes difficult to maintain therapeutic communication and the therapeutic connection diminishes.

Therapists need the best, most reliable internet connection—and Telehealth delivery platform—that they can get. Whether poor quality is on the client or therapist side, the experience of therapy deteriorates without solid audio and video. Poor internet or phone quality definitely interferes with progress, the outcome of the session, and the the therapeutic alliance.
Before scheduling a session, be sure to check whether the client has a good enough internet or phone connection, and the right type of equipment/device for video sessions, otherwise a different type of Teletherapy is needed.

2. Create the right environment for you.
Just as your office set-up is a key part of your in-person practice, how you arrange your remote office can make a big difference in your sessions.

Make sure you are in a space private enough and secure enough from other people interrupting. Close doors and windows for privacy
Consider silencing anything that can be a distraction or that will make it difficult for the client to hear you clearly--background noise, barking dogs, phones, etc.
Position and adjust your desk and chair. Make sure they’re at the right height, with your back supported and your feet on the floor. Save yourself from the physical strain of poor posture caused by less that ideal set-ups.
Use the largest screen you can for video as this diminishes eye strain, fatigue, and muscle tension. Position your computer or device so the video screen is at arm’s length. Make sure the height and center of your video screen is in a comfortable position for your eyes, head, and neck.
Have the right lighting. Make sure your computer is in a place to avoid glare.
Turn off email and any other application running in the background.
When working on the computer make text bigger so you can comfortably read from a distance.
Adjust your computer display settings for comfort—brightness, text size, contrast, etc.
If you must type notes during session, consider muting your audio. Keyboarding is loud, especially when both therapist and client are using headphones.
If you decide to use headphones, consider those with a noise-canceling feature. Headphones are a good idea for maintaining client confidentiality, too.
Test your equipment, links, and Telehealth platform before each session. Consider what clients will see by testing out your camera set-up and lighting.
Have ALL your materials ready—and have a backup plan for technology glitches.

3. Create the right environment for the client.

Inform your client about what they can expect during their Telehealth session. Let them know what platform you use for sessions. Inform them ahead of time if they need to download any additional applications.
Consider offering new clients a free short session to test everything and to briefly educate them about how you will conduct the session.
At the beginning of the session make sure the client is not driving and is in a space private enough, and secure enough, to ensure confidentiality —and so they will not be interrupted. Make sure that there are no children or adults in the room unless they’re part of the therapy.
Verify and document the client’s current address/location in case a crisis is disclosed and you need to respond by getting client help from emergency responders.

4. Ways to reduce exhaustion and minimize fatigue, dry eyes, computer eye strain, focusing fatigue, and back, neck, and shoulder pain.

Take a moment for yourself before opening the session. Allow yourself some time—a few minutes—to stretch and prepare for the client. Then, just like you would in your office, take the time to greet your client with your full attention.
Periodically exercise your eyes during video sessions to reduce eye strain. Ease your visual focus on the screen and look at something far away, then something close, then something far away again. Do this a few times during each session.
In between sessions stand up, move around, stretch your arms, legs, back, neck, and shoulders to reduce tension, muscle fatigue, and pain.
Take regular screen breaks to keep from tiring your eyes. Constantly looking at the screen and using your eyes for long periods of time without resting them causes Focusing Fatigue and increases eye strain. Consider wearing computer glasses to reduce your eye strain.
To reduce fatigue, if you can arrange to, take some kind of break for a few minutes between sessions to walk around or stretch. Getting your blood flowing reduces the mental fatigue that's caused by the physical fatigue of your muscles.
To keep from getting computer-related dry eye, keep your eyes moist by blinking regularly or using eye drops. Drink enough water so you don’t get dehydrated.
Schedule short gaps (5-10 minutes) in between sessions. A zero break schedule can leave you incredibly drained at the end of a full day of clients or meetings. Building in transition periods with a few minutes of movement and a mental break between sessions can refresh you. Consider scheduling a longer break after three or four sessions.
When attending meetings or conducting groups, choose “speaker view.” Direct your attention primarily to whoever is speaking—so the person speaking has more of your attention and the others are more peripheral.

5. Consider using phone sessions.

Think about and assess whether video is really the best option for you and the client. Sometimes a phone session is better.
Being on a phone session can also be a better choice/method/platform for a client who wants to talk to a therapist but isn't comfortable being on camera.
Phone sessions can also be especially helpful for those clients or therapists who have slow internet speeds or when there are online or mobile video glitches.

While many therapists have made the switch to offering Telehealth services, the transition to Teletherapy takes getting used to! Although we miss the rhythm of our usual practice, our clients, and our office, we recognize our good fortune in having jobs and being able to continue to provide therapy.

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Getting Paid: Telehealth & Keeping Your License: Things to Remember from the BBS

5/23/2020

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Today, during the COVID-19 public health emergency, the majority of licensed and registered mental health professionals in California have shifted to providing psychotherapy services using telehealth. Most are new to telemedicine and what’s required by the California Board of Behavioral Sciences (BBS). Questions abound . . .

What telehealth platforms can I use during the COVID-19 public health emergency? What communication technologies are still prohibited? What communication products or technologies can I use if I want a HIPAA compliant telehealth platform for my practice? What things am I required to do with each client when I begin telehealth services? What am I required to do with clients at the beginning of each telehealth session?

The answers to these questions and more are in the three following BBS telehealth documents presented here in full for easy use and reference—with links to the original documents.
Read them. Comply with them. Keep your license, and yourself, free from unprofessional conduct and disciplinary action.

1. BBS: Standards of Practice for Telehealth California Business and Professions Code
All persons engaging in the practice of marriage and family therapy, educational psychology, clinical social work, or professional clinical counseling via telehealth, as defined in Section 2290.5 of the Code, with a client who is physically located in this State must have a valid and current license or registration issued by the Board.

All psychotherapy services offered by board licensees and registrants via telehealth fall within the jurisdiction of the board just as traditional face-to-face services do. Therefore, all psychotherapy services offered via telehealth are subject to the board's statutes and regulations.
Upon initiation of telehealth services, a licensee or registrant shall do the following:

Obtain informed consent from the client consistent with Section 2290.5 of the Code.
Inform the client of the potential risks and limitations of receiving treatment via telehealth.
Provide the client with his or her license or registration number and the type of license or registration.
Document reasonable efforts made to ascertain the contact information of relevant resources, including emergency services, in the patient's geographic area.

Each time a licensee or registrant provides services via telehealth, he or she shall do the following:

Verbally obtain from the client and document the client's full name and address of present location, at the beginning of each telehealth session.
Assess whether the client is appropriate for telehealth, including, but not limited to, consideration of the client's psychosocial situation.
Utilize industry best practices for telehealth to ensure both client confidentiality and the security of the communication medium.

A licensee or registrant of this state may provide telehealth services to clients located in another jurisdiction only if the California licensee or registrant meets the requirements to lawfully provide services in that jurisdiction, and delivery of services via telehealth is allowed by that jurisdiction.
Failure to comply with these provisions shall be considered unprofessional conduct.

2. BBS statement on HHS Telehealth Announcement of Enforcement Discretion
U.S. Department of Health and Human Services (HHS) Announcement
of Enforcement Discretion for Telehealth Remote Communications
The Office for Civil Rights at the U.S. Department of Health and Human Services (HHS) has announced that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communication technologies during the COVID-19 public health emergency.
During this time, covered health care providers subject to HIPAA may provide telehealth services, in good faith, through remote communications technologies that may not fully comply with HIPAA requirements. This applies to telehealth provided for any reason, whether related to health conditions related to COVID-19 or not.

What Telehealth Platforms Can I Use?
HHS states that covered health care providers can use any non-public facing remote communication product that is available to communicate with patients. This includes popular applications that allow for video chats, such as the following:

Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks. Providers should enable all available encryption and privacy modes when using these applications.

What Platforms Are Still Prohibited?
HHS still prohibits using communication products that are public-facing. Therefore, do not use these types of platforms. Examples of public-facing communication products include, but are not limited to, the following:

Facebook Live
Twitch
TikTok

I Still Want to Use a HIPAA Compliant Telehealth Platform For My Practice. What Are Some Examples Of These?
HHS provides some examples of products that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. (They stress that they have not reviewed the BAAs for the below entities, and that this is not an endorsement, certification, or recommendation):

Skype for Business (Now called Microsoft Teams)
Updox
VSee
Zoom for Healthcare
Doxy.me
Google G Suite Hangouts Meet

HHS Notes That HIPAA Applies Only to Covered Entitles and Business Associates. How do I Know If It Applies To Me?
HHS provides the following bulletin HIPAA Privacy and Novel Coronavirus. This topic, HIPAA Applies Only to Covered Entities and Business Associates, is covered toward the end of Page 5.

Where Can I Find More Information?
You can use the following links for more information from HHS:

3. Telehealth: BBS General Information & Requirements for Licensees & Registrants
About Telehealth

Under law, “telehealth” is the mode of delivering health care via information and communication technologies, including, but not limited to, telephone and/or internet
Licensees may deliver health care, under their scope of practice, via telehealth, under certain conditions
Licensees are responsible for understanding all applicable laws, to deliver health care via telehealth
Failure to comply with any provisions regarding telehealth may be subject to disciplinary action by the Board

Comprehensive Requirements and Applicable Laws
Detailed explanations regarding telehealth requirements, for licensees and registrants, are contained in the following statutes and regulations:

California Code of Regulation Title 16 §1815.5: Standards of Practice for Telehealth
Business and Professions Code §2290.5

Clients in California
This section applies to clients who are physically located in California.

Individuals providing psychotherapy or counseling, either in person, via telephone, or via internet, must be licensed in California.

Clients Outside of California
This section applies to clients who are physically located out-of-state.

California licensees or registrants who wish to engage in telehealth with a client located in another jurisdiction need to check with that jurisdiction to determine its laws related to telehealth, and if licensure in that jurisdiction is required. Several states currently consider a client located in their state to be under their jurisdiction. Therefore, a practitioner needs to comply with that jurisdiction’s laws in order to avoid any potential violations of those laws.

Inform and Consent
Prior to the delivery of health care via telehealth, the provider initiating the use of telehealth shall:

Inform the patient about the use of telehealth; AND
Obtain, and document, verbal or written consent from the patient for this use

Confidentiality

All laws regarding the confidentiality of health care information and a patient's right to their medical information shall apply to telehealth interactions.

Additional Info
Additional information regarding telehealth is contained in the following statutes and regulations:

California Code of Regulation Title 16 §1815.5: Standards of Practice for Telehealth
Business and Professions Code §2290.5

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Getting Paid: Tips for Getting the Word Out About You, Your Practice & Your Expertise

5/23/2020

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Getting the word out about your therapy practice is important. To be successful in private practice, you need a steady stream of clients—QUALITY referrals that are a good match for you and your practice. Letting people know what you do therapeutically and how you can help them, not only helps fill your practice, it helps you help more people.

The more people who know about your therapy services and expertise, the easier it will be for those who need your services to find you and get the help they need. Consider the ways you can let colleagues, prospective clients, and referral sources know about you and your services.

1. Getting the word out about your practice is a community service.
Getting the word out about your therapy services and expertise is really about letting people in the community know about you, your practice and your services. It’s educating those in your community—your peers, prospective clients and referral sources—about what therapy is, who you serve in your practice and how you help them.

Tip: When clients go to your website, directory listing, and social media pages, what they are really looking for is: Who are you? What can you do for me? How can I contact you? Make sure your content on your website, directory listings, and social media pages gives them that information clearly and easily.

Tip: It doesn’t matter what you do to get the word out about your practice and services but you have to do something. Since you have to do something, ONLY do the things you like.

Tip: Remember, only do what fits or makes sense to you to get the word out—and always within legal and ethical guidelines! It’s okay to make things up to do that you like. However, you will have to try things out to see what you like.

Tip: Be sure to make the act of promoting yourself and your skills and services energy producing instead of energy draining.

2. Getting to know people in your community and letting them get to know you, the services you offer, and the type of work you do, brings in quality referrals.
People who already know about, like, or trust you are more likely to refer to you than anyone else. People trust their friends and people they know so that’s why word of mouth,whether in person or online, is the most valuable source of referrals for your practice.

Tip: Connect with local businesses. Introduce yourself to other local business owners who are your neighbors. One therapist I know who moved into a new office went to each one of the businesses around her—introduced herself, met and got to know the business owners and or those who worked there, found out about their businesses and gave them her business cards and brochures.

Tip: Join a professional organization or association. Attend meetings of professional groups, associations or organizations to get known in your community. Become a member. Volunteer. Register and attend a conference.

Tip: Post your professional and or practice information to a directory. GoodTherapy, Psychology Today, LinkedIn, etc. Remember that Linked In is social media for professionals, and is a trusted source for professional services and referrals.

Tip: Either donate products or volunteer your services to a worthy cause and get your name and the name of your practice out there to new people while doing a good deed.

Tip: Consider getting some promotional products with your name, website, phone number, email, and or practice specialties on them to hand out. Pens, notebooks, notepads, post-it notes, shopping bags, led flashlights, etc., are all favorite types of promotional swag that people appreciate.

3. Tapping into existing relationships is the fastest way to fill and grow your practice.
People trust other people and the experiences they have so that’s why when people hear from a friend, someone they know or a professional they trust, about a service or product they choose that one over others. For therapists, the first few referrals after you open your private practice will usually come through in person connections and relationships you’ve already built.

Tip: Build an email list. Who should you put on it? Include those you meet while networking but don’t stop there, add close friends, acquaintances, family members, extended family; neighbors, acquaintances. Professionals you have personally used—medical professionals such as doctors, physical therapists, psychiatrists, dentists, dental hygienists—as well as business professionals who are lawyers, estate planners, financial planners, as well as nutritionists, doulas, Lamaze instructors. Personal trainers, Pilates instructors, meditation instructors, massage therapists, aestheticians, hair stylists. Those who attend your church or who worked with you in the past as well as elementary, middle and high school teachers and coaches. Mentors, past clinical supervisors and professors, classmates and supervision group members. teachers, guidance counselors.

Tip: Send regular emails to your list to keep them informed of what you are doing in your practice—do this at least three times a year. Or start a free monthly email newsletter and send it to your email list.

Tip: Utilize Your Email Signature. Make sure your email signatures contain contact information for your business—links to your website, upcoming workshop, new book or audiobook, podcast, video, YouTube channel, etc. This makes it easy for people to know more about you and what you offer.

4. Consider using some type of social media to get the word out.
Today there are a lot of people who are looking for help—and most of them aren't asking their friends or family for referrals. They are looking on the internet at websites, social media platforms (Facebook, YouTube, Instagram, Messenger, Snapchat, Twitter, WhatsApp,LinkedIn, Tumblr, Tik Tok, Viber, Pinterest, etc.) and closed groups, discussion groups or forums (Quora, Reddit, etc.).

Because social media helps you build relationships, using social media to get the word out about your services allows you to showcase skills and expertise and to build relationships with existing and potential clients and referral sources.

When you post a variety of content on social media (blogs, articles, videos, quotes, podcasts—your content as well as other’s), you can build recognition, connect with your peers, referral sources, and potential clients to show them that you are trustworthy. You’ll definitely get some interest in your work from this—people will love your content and want more.

Tip: Not all social media platforms may be suitable for your business. Different customer segments frequent different social media. There's no point in spending time and money on promoting your business on a social network that your customers don't use.

Tip: When you blog or write articles regularly, social media is a great place for you to share that content. You can also share articles that you find interesting, inspirational quotes, podcasts, and videos that you think those following you would enjoy. All these are great relationship builders.

Tip: Record a video blog post and put it on your website or upload the video to YouTube. Record a Facebook Live or Instagram Stories short video. People love this content and enjoy getting to know you through what they see and hear on the videos.

5. Track what’s working and then do more of it.
Know the results you get from each thing you do to get the word out and repeat what works. Quit what doesn’t work.

These are all fairly low cost and not too time consuming tips for getting the word out. See which ones you enjoy doing and that work best to fill your practice.

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Getting Paid: Fast, Easy, Convenient, & Cost-Effective Ways to Get Paid & Increase the Cash Flow in Your Practice

1/26/2020

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When clients pay for therapy in your practice, what type of payment do you accept?
Check? Cash? Credit Card? Debit Card? HSA or FSA Card? Money Order? Yes, they still issue money orders.

Today there are so many options to choose from for client payment. How do we decide which one is best for us and our practice? What are legal and ethical options available to therapists to get paid fast and not have to pay too much in bank or credit card charges?

This is the sixth article in a series on Getting Paid: Talking with Clients About Money Matters:

Not too long ago clients handed their therapist cash or a check before or after the session; were sent an invoice/billed at the end of the month; and then mailed or brought in their check or gave the therapist cash at the next therapy session.

Should you consider adding or changing the type of payment you accept for therapy charges?

How can a therapist decide which forms of payment are best for their therapy practice?

With whatever types of payment you decide to accept in your therapy practice, it’s important to look at how much it costs you or saves you—in time, energy, wait time for funds, as well as charges/money—to process those funds and get them into your practice bank account.

Therapists, like most small business owners, are always wanting to know what the best way is to get paid and increase their available cash. They want to know how to get their funds into the bank as quickly and easily as possible and how to pay the lowest possible amount to do that. Having earned this money, therapists want to take home as much of it as possible, save time, and have more clients.

In fact, the most common reason therapists give for accepting only check or cash is that it costs money (just under 3% of each transaction) to take credit cards. And, as you have probably heard, most therapists do not like to--or want to—pay any credit or debit card, or other type, of processing charges since this amount is subtracted from what the therapist is paid.

However, contrary to popular lore, whatever type of payment a therapist accepts for therapy sessions, it costs the therapist something. At the very least it costs time, energy, effort, and time before the funds can be accessed, and it can also cost money per transaction. How is it worth it for a therapist to take card and electronic payments and pay those transaction fees?

Giving your clients more ways to pay can increase the number of clients in your practice and improve your cash flow.

It's a fact that most clients expect to be able to use credit or debit cards when paying for things. Today’s clients, whether no matter what their age, find it convenient to pay via credit or debit card, or directly from their HSA or FSA. If you do phone, video or other types of virtual or remote sessions, credit card and electronic payments are essential because they enable the client to pay you before or after the session.

More payment options that are convenient means more access to care for a larger number of people—and result in more clients in your practice.

Whether a therapist accepts payment by electronic means--credit card, debit card, e-check, wire transfer, Zelle, Venmo, etc.—depends on both the therapist and clients’ preferences and needs. Many therapists find that their number of paid weekly client hours increase when they accept credit cards. Clients often like to get rewards--points or miles or cash back—when they pay for therapy.

If you don’t accept credit cards but accept checks or a bank transfer of funds, clients who want the rewards can use Plastiq. With Plastiq a client can pay with a credit card—and even split the charge between two different cards—and the therapist is sent a paper check or receives a bank transfer right away, just as if the client had paid with a credit card. Another benefit to the therapist with Plastiq is that the client pays the credit card processing fee, the therapist doesn’t. Many therapists love that because it means they receive all the money paid for the session.

For therapists, card and electronic payments can mean freeing up more time, energy, and effort—and quicker access to funds because of the following:

Instant payment, so less hassle getting paid
Less time spent every week going to the bank to cash or deposit checks and cash
Less time scanning checks into your bank app
No waiting for checks to clear.
1 or 2 days, at most, to have the funds deposited in your account
Autopay features available for payment or invoicing
Having a card on file for missed appointments or late cancellation

One way to increase income from your practice and not have to pay any transaction fees is to have your clients pay you using Zelle or Venmo.

One therapist I coached added Zelle to his practice in addition to credit cards as a payment option and increased his take home earnings $100 per month because he didn’t have to pay that amount in credit card fees. That was a very easy way to bring in $1200 more that year. Another therapist in one of my practice development groups added Venmo as a payment option when a client suggested it. When using Venmo, the client pays through the app at the end of the session—just a couple of clicks—then there's a ding on the smartphone, the therapist receives it, opens the app, clicks on the amount of the balance. then clicks on the deposit button. Voila! Two days later it’s in her account. If she wants it instantly then she clicks on the instant deposit button and pays a small fee, then it’s deposited in her account shortly after that.

Here are some descriptions of options for getting paid spelled out:

Client hands you cash. You record it, use it, or deposit it at the bank.

Client hands you a check. You record it and deposit it by phone or tablet app or at the bank.

Client hands you a credit card, debit card, HSA or FSA card. You enter the amount, swipe the card or enter it manually, have the client sign. Credit card company deposits the money in your bank account a day or two later.

Client uses Plastiq app and sends/gives you a Plastiq check or immediate bank transfer. Plastiq charges the client’s credit card, the client pays the 2.5% fee, client receives the credit card rewards/points/miles on their card.

Client pays you in office by Venmo. You receive the amount immediately, click on transfer balance, a day or two later the money is in your bank account. No transaction charge. If you use instant transfer then there is a small charge. Note: If you use Venmo in your practice make sure your privacy setting is on “Private” or everyone in your network and your client’s network will know how much they paid you, what for, and when.

Client has a credit card or debit card on file with you via your Electronic Health Record Provider or Ivy Pay, you enter the session info and price, the amount is automatically charged to the client’s credit card--if it is not expired--and the money is put in your bank account in a day or two.

Client pays you in advance for a number of sessions by either credit card, debit card, check or cash. For the time it takes to receive it, see above examples.

Client receives therapist sent—through email, text or app--the invoice for credit card, debit card or electronic check payment right before or after the therapy session; client clicks on the invoice and pays the amount. A day or two later the amount is in your practice bank account. Offered by PayPal, Square, etc.

Client receives end of the month billing. Therapist sends invoice after the month’s sessions—by mail, email, or app—and the client sends or make a payment by a physical check, e-check, money order, credit card, debit card, etc. For the time it takes to receive it see above examples.

Credit Card processing companies that therapists report using are: Square, PayPal, Stripe, Ivy Pay or their bank. These companies also process debit cards and bank funds. These processors charge/keep a small percentage of the dollar amount of the transaction, usually just under 3%. Some therapists use a credit card terminal to swipe or insert cards—this is purchased from the card processor by the therapist—others use an app on their phone or tablet. I use the Square Terminal in my office and have it on my desk; it’s easy to read, insert cards in, and processes very rapidly. Very professional, convenient, and easy to use.

Venmo and Zelle transfer funds from the client’s bank account and deposits into the therapist’s bank account. They do not charge/keep any amount from the transaction. However, for instant transfers, Venmo does charge a small amount, equivalent to a credit card processing fee.

Plastiq, as described, charges the client’s credit card and deposits the full amount, no charge to the therapist, into the therapist’s bank account. The credit card processing charge is paid by the client in addition to the amount the therapist is paid.

HSA (Health Savings Account) and FSA (Flexible Savings Account) Cards are debit cards and are processed the same way. Clients who have HSA and FSA cards like to use those because they aren’t taxed on that income since it can only be used for qualified healthcare expenses—therapy is one. HSA and FSA cards help clients with high-deductible health insurance plans cover their out-of-pocket costs. Another thing to note about HSA cards is that contributions, up to the yearly IRS limit, can come from the client, the employer, a relative or anyone else who wants to add to the HSA.

So now you’ve had a presentation of a number of the options available to therapists for getting paid fast, and in easy, convenient, and cost-effective ways. By no means does this article include every option available to therapists as there are many more not mentioned here. Should you decide to add some new payment options to your practice it will, I’m sure, give you added time, money, and clients. See what differences these new options bring to your practice.

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Getting Paid: Introducing & Talking About Sliding Scale, Adjusted Pricing & Specialized Alternatives—The Words You Use Make a Difference

1/26/2020

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What’s your sliding scale? Do you have a sliding scale? How low is your sliding scale? What’s your discounted rate?

These words are often the first thing a therapist encounters when a potential client calls, emails, texts, or DMs about therapy.

It’s no surprise that mental health professionals find this a jarring and highly awkward beginning to an interaction about starting therapy—and that therapists, themselves, have many questions, about the best way to respond effectively, both clinically and professionally, to these potential clients during this important first contact.

In fact, the most often asked question I encounter in Money Matters Workshops and at LA Practice Development Lunches is: “What’s the best way to respond when the first thing a caller—or a text, email or message—asks about is a discounted rate or sliding scale?”

As I wrote about in Talking about Sliding Scale Pricing, 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.

Just because clients are anxious about the price or cost of services doesn’t necessarily mean therapists should automatically give a price accommodation. The price a client can afford and the price a client wants to pay may not always be the same thing.

It’s often hard for us as helping professionals to remember that helping a client doesn’t always have to mean giving everyone who asks a reduced rate or routinely offering the lowest possible price for therapy. It also can mean helping people find a lower priced type of treatment and referring them.

While I wholeheartedly support the values that the term “sliding scale” represents, that professionals can help people in need by sometimes--at their discretion and when their schedules allow it—charging less or making other specialized arrangements, so that people can still get affordable help when they need it, I also firmly support mental health professionals charging and being paid a fair price for the professional services they provide to clients.

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.

This is the fifth article in a series on Getting Paid: Talking with Clients About Money Matters:

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. Yes, the meaning our words convey can either increase or decrease the amount of money we earn and are paid for our professional services.

You’ll find that more 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:

Only do and say things that fit for you, your clients, and your practice—and always within legal and ethical guidelines.
You can ignore everything written in this article and still be successful. Discover what works for you, your clients, and the practice setting you work in.

1. Pricing & Adjusted Pricing: Specialized Options Based on Income and Financial Need
When therapists talk about the price or hourly rate for services and clients ask about sliding scale or a discount or even the lowest amount that can be charged, that’s a good time for the therapist to talk about the price of therapy and options for those who need a price accommodation to pay for therapy sessions.

When therapists do make price accommodations for those in financial need, using words and phrases such as

adjust the price/amount/rate . . . adjusted price(s)/pricing/ amount(s)/rate(s) . . . adjusted cost of services /therapy/sessions . . . alternate price(s)/amount(s)/rate(s) . . . special/specializedprice(s)/rate(s)/arrangement(s)/accommodation(s)
enable potential clients to understand that it’s okay to discuss a different price but that it’s not guaranteed to everyone upon request.

It’s also possible for a therapist to say that instead of a sliding scale, they offer different type of specialized pricing or rates for those with lower income or who are in need, when their schedule allows. Clinicians can do this by sharing the type they offer.

Some examples are:

College Student price/rate
Teacher price/rate
Unemployed price/rate
Professional Courtesy price/rate
Introductory price/rate
Retired price/rate/pricing
Limited time price/rate/arrangement
Family & Friends price/ rate
Cash Payment price/rate

2. Low Cost Options as Alternatives or Additions to Sliding Scale
If a therapist decides not to offer a sliding scale or wants additional choices to go along with a sliding scale or specialized rates, here are some of the options that mental health professionals in private practice are using to make therapy more affordable and accessible.

1. Pricing Based on Lower Income or Financial Need

Adjusted cost/price/amount/rate for session(s)/ services/ therapy
A set number or unlimited number of sessions or amount of time

2. Fixed Number of Lower Priced Client Spaces

A certain number of places or a percentage of the practice

3. Shorter Session Length for Lower Price

40 or 45 minutes Instead of 50 or 60 minutes

4. Less Frequent Scheduling/Flexible Scheduling at Full Price

Three sessions per month, every other week, etc.

5. Specialized Session Pricing

A lower price is paid during slow periods of the day or week

6. Scholarships

A lower session price
A set number or unlimited number of sessions or amount of time

7. Payment Plan—for full adjusted session prices

Pay a set amount now and another amount when therapy ends until balance is clear

8. Special Arrangements Based on Special Circumstances

9. Pro Bono Sessions

For 1 or two clients
A set number or unlimited number of sessions or amount of time

These are just a few of the arrangements available for affordable therapy options. It’s up to each private practitioner to decide what will work best for their own practice, and clients, when their schedule permits.

3. Words & Phrases to Consider for Presenting Pricing & Adjusted Pricing
These days the term “sliding scale” seems to come with a lot of baggage for clinicians, clients, and those seeking therapy. For many lay people, the word “sliding scale” means: the price can slide all the way down to zero; the rate will, of course, upon request, always be adjusted to the lowest possible price regardless of the financial need or available resources of the asker; and therapists will always give a lower price to anyone who asks because it’s their job to take care of people’s needs.

An alternative to using “sliding scale” is to use more definite or declarative wording:
For those with a lower income or who demonstrate a financial need—and are eligible, pricing based on lower income . . . special arrangements . . . specialized price/prices/pricing . . . price accommodation(s) can be discussed/made. The adjusted price for a 50-minute session of therapy is . . . The charge for your therapy session is . . .

Here are three examples of what can be said when callers or clients ask about or mention a sliding scale, discount or reduction. These are meant to be tailored to what works for you, your practice, and clientele.

Example 1
1. There are A/1/2/3/couple/few places/spaces/openings when my schedule allows it
2. For clients who pay/receive/qualify for/ are in need of
3. An adjusted fee/alternate price /special rate/economy rate, etc.
and
4. Those are filled/there aren’t any openings/I can put you on the waiting list
or
Those are reserved for low income and those who have a financial hardship when possible/when available/ when my schedule allows
5. To qualify for those, you’ll need to submit proof of your household’s income—pay stubs/ tax return/bank statements etc.

Example 2
1. There are A/1/2/3/couple/few places/spaces/openings/slots when possible/when available/ when my schedule allows it
2. For clients who pay/receive/qualify for/ are in need of
3. An adjusted fee/alternate price / special rate/economy rate
4. You don’t seem to qualify for those.
5. We can talk about other options to be able to manage paying the session cost—less than weekly sessions/shorter length sessions/group therapy/family loan/ credit card payment/
6. If you’re not able to work out paying the session price/If you don’t want to pay the session price
7. I can refer you to a low-cost counseling center, free clinic, training center, or counseling practice specializing in low income clients.

Example 3
1. If you’re not able to pay this session price
2. I don’t offer a sliding scale or adjust the price for a session
3. I can refer you to a low-cost counseling center, a training center, free clinic, or counseling practice specializing in low income clients.

By using this type of wording, the therapist will be conveying the message that the stated cost of services is the actual price and not just a negotiation starting point when no fee adjustment is realistically needed—but that some pricing accommodations are available to those in need of them. As a result, of making this wording change the clinician’s money conversations are usually shorter and the amount decided upon is usually higher but still what the client can afford.

Only Do What Fits You, Your Clients, and Your Therapy Services Best
Confidently take charge of money conversations about prices by using any of aforementioned professional and clinical language recommendations that work with 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 or how much the number is. Allow the client to pay a fair price for the therapy benefits they receive from you, the highly skilled and trained professional that you are.

See for yourself how the words you use can increase the amount of money you earn in your practice while still serving the community and keeping your services affordably priced.

The therapists I coach and train find that when they can set a session price that works for their practices and clients, they stop undercharging and reducing the price for every client but limit accommodations to a certain number of clients when their schedule allows it—and refer those who can’t or aren’t willing to pay the clinician’s set minimum amount--their practices fill (and stay full) and they earn more money while helping more clients.

I encourage more clinicians to consider taking the risk to do this—set the session price at a rate that represents the worth of the therapy and professional services they provide; have a set minimum that no adjusted pricing goes below (you can still have a pro bono client or two at your discretion); and refrain from adjusting session prices for every client who asks—it benefits both clients and therapists as well as the profession.

That’s enough about how to introduce and talk about sliding scale, adjusted pricing, and specialized alternatives.

I hope the information presented about how the wording you use as a clinician to talk about sliding scale pricing can increase or decrease the amount of money you earn from your client work has been useful—and that you’ve found this article—and the others in the Getting Paid Series—to be supportive and encouraging of your efforts to be paid what the valuable therapy services you provide are worth in the professional marketplace.

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Getting Paid: Talking About Sliding Scale Pricing—The Words You Use Do Make a Difference

1/26/2020

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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

They want to help people get the care they need
They’re sensitive to the underlying assumption that clients expect the therapist to take care of them by lowering the therapy session price upon request
They don’t want to come across greedy, in it for the money or with a “the meter’s always running” mentality
They fear that if they don’t accept low prices they won’t have any clients or be able to fill their practices

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:

Only do and say things that fit for you, your clients, and your practice—and always within legal and ethical guidelines.
You can ignore everything written in this article and still be successful. Discover what works for you, your clients, and the practice setting you work in.
These suggestions are meant for use with clients who aren’t low income and don’t have a financial need since most therapists are aren’t having much difficulty with fee conversations with clients who can’t pay for therapy without an adjusted price.

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

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Getting Paid: Talking Fees, Pricing, Prices—The Words You Use to Talk to Clients About Money Matters in Therapy Do Make a Difference

1/25/2020

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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:

Only do and say things that fit for you, your clients, and your practice—and always within legal and ethical guidelines
You can ignore everything written in this article and still be successful. Discover what works for you, your clients, and the practice setting you work in.

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

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Networking, Marketing & Referrals: Tips, Information & Encouragement for Filling Up Your Practice

1/25/2020

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When the vacation or holidays are over, it's time to focus again, and get back to work.

I bet you could use some tips, inspiration, and encouragement to get your networking and marketing going so that you can fill your practice.

So, let’s get right to it!

1. Set Aside Time for Networking and Marketing.

Tip: Track what’s working and then do more of it—repeat what works. Quit what doesn’t work or work well enough.

2. Networking is simply making professional friends and acquaintances.

Don’t wait for opportunities to come to you, make yourself targeted opportunities.

When going to a networking event or a lunch or meeting, decide on your networking goals before you arrive: Who do you want to meet and talk with? How many new people do you want to get to know?

Tip: Read How I Came to View Networking Events as Social Meetups

Tip: Make list of 10 contacts you want to meet—people you want to know or be known by in your community. Then find ways to meet and develop mutually beneficial relationships with them.

Tip: Find others who might be in contact with or serving your ideal client from other professions; find allied professionals who serve your client population or ideal client. Get to know them and let them get to know you, the services you offer, and the type of work you do.

3. Marketing is what you do to help clients—and referral sources—find you, and to get clients coming to you instead of you running after them.

Remember that people are not going to look hard to find you or to find out more about you. Make it easy for them.

Tip: Follow the Two Golden Rules of Therapist Marketing:
1.) Make the act of marketing energy producing instead of energy draining;
2.) Only do marketing activities that fit for you, your client population, your type of practice or service—and ALWAYS within legal & ethical guidelines.

Tip: When clients go to your website, directory listing, and social media pages, what they are really looking for is: Who are you? What can you do for me? How can I contact you?

Make sure your content on your website, directory listing, and social media pages addresses that.

Tip: To market effectively, you need to know two things: what you offer and who needs what you offer.

Think about what you want to be known for, the treatment options you want to be known for, and the target populations you want to attract as clients. Share this content in a way that will get it—and you and your practice—noticed and that will help you build your practice.

3. Referrals: Don’t just rely upon clients, friends, colleagues or potential referral sources to automatically know that you welcome their referrals.

It’s up to you to let them know and to educate them about who are good referrals for you and your practice.

Tip: Directly mention that you welcome referrals by using a brief, and thoughtfully scripted, phrase or statement. This can produce significant results for your practice. You can say things like:

“My practice is built on referrals and I would welcome any potential clients that you think would be good for me to work with.”
“I would appreciate it if you passed my name on to anyone that you feel I could help.”
“Please don’t hesitate to mention my name to others you think I might be able to help.”

Okay, reading time is up. Now it’s time to get out there and increase your visibility in the community so that your new clients can find you when they need you! Happy practice-filling.

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Full Practice, Ideal Clients, Money, Vacation

1/25/2020

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If I’ve learned anything from attending networking events and hosting a monthly practice development lunch, it’s what licensed and pre-licensed therapists and related professionals want.

Top of the list are: full practice or good job; work they love; ideal clients; enough money to support themselves, family (this doesn’t have to mean having a partner or children), and practice without struggling too much; a reasonable number of hours along with time away from work for personal and family life, vacation, networking and professional development, as well as for other individual or professional pursuits

Therapists are willing to work hard for all the above—starting with graduate school and continuing through gaining hours for licensure, and post-licensure or certification, then through the accruing of years working, and the maturing of their career.

How can, and do, professionals attain these highly-desired benchmarks while still serving clients, the profession, and the community?

The good news is that it can be done with any type of practice that suits you best: cash pay, insurance, sliding scale, part-time, online, coaching; day, night, weekday or weekend; rent your own office, share, sublet full day or half day or hourly, etc. It’s your choice. In fact, having the successful practice you want depends largely on the practice being suited to you and the clients you work with.

So how do you grow and fill a practice?

Local networking.

Consistent, effective, and ongoing, local networking is the best way to get known in your community and the fastest way to grow a practice and keep it filled.

What is local networking and how does it work? Local networking is one of the most natural ways of interacting with people—and most professionals find this a comfortable way to get known in their community.

Local networking means raising awareness about your services and getting the word out about how you help people and doing this by regularly connecting with everyone you know and keeping them up-to-date with what you’re doing in your practice or career and maybe even inviting them to check out your website, social media, blog, article or podcast.

Local networking means letting those in your community know what you do and how you help people—relatives, friends, neighbors, social and community contacts, colleagues, those at church or temple, people you worked with at previously or were in graduate school with or a placement—don’t forget professors and supervisors.

Each one of these people is a potential referral source for your practice. Find a way to keep in contact with them and to keep them current on you and your practice. Building your contact list, e-mail list, referral sources, and resource list is a long-term project. Start today!

Getting the word out about what you do and the services you offer to the community also involves meeting new people and making new friends as you increase your practice’svisibility and grow your network.

Who you know, those who know you, and those who refer to you are valuable resources for filling your practice with clients who need your services and will pay your fees.

Think about it this way, when people know about your practice, and are familiar with your services, they can find you or refer to you when a therapist with your skills and abilities is needed.

This type of networking is viewed as a community service, so make sure your community knows how you can be of service to them. The more people, businesses, organizations, and professionals in your community who know about the work you do the faster your caseload will fill.

Local networking can take a variety of forms, in person, online, digital or print advertising, talks, blogs, podcasts, YouTube videos, and any type of social media or online forum. It’s up to you to decide what works best for you, your practice, client market, available time, and budget. Take your pick. You get to choose. Try things out, then see what works best for you.

Local networking also means becoming familiar with your community and how your potential clients move through it via churches, schools, sports programs and teams, athletic and country clubs, theater arts, colleges, yoga centers, hospitals, libraries, parks and recreation, employee assistance programs, and many others.

Understanding the needs of potential therapy clients in your area and how those needs are being or not being met makes practice building easier.

Since therapists are an important part of every community, it’s important that we be visible so that our clients can find us when they need our services. The therapists I know who have a full enough practice with a consistent influx of clients are those who are known in, and know, their communities and keep up regular contact.

Local networking also includes getting known in your professional community. Joining and attending your professional organization is a great way to get connected with other professionals in your area and to develop and maintain relationships and friendships as well as referral sources for your network.

Through monthly networking events, workshops, member events, newsletter articles, classified advertising, and e-blasts, special interest groups, support groups, and special events, Professional organizations provide many networking opportunities for therapists and related professionals to get known in the community and develop themselves and their relationships.

As you can see, filling your practice with the clients you’re meant to work with requires that you find a way to connect with your community and let them know, on a regular basis, that your practice exists, what services you offer—and how people can go about contacting you when they desire your services.

This success formula for attracting new clients, filling your schedule, earning enough income, and having vacations, consists of raising awareness about your private practice in your community.

So, go ahead, announce your presence to the world and raise community awareness about your private practice. Be sure to keep me posted about your progress. I look forward to hearing about your success — and your vacation!

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Getting Paid: Guiding New Clients into Teletherapy in Your Telepractice

Getting Paid: Teletherapy Survival Tips for Clinicians

Getting Paid: Telehealth & Keeping Your License: Things to Remember from the BBS

Getting Paid: Tips for Getting the Word Out About You, Your Practice & Your Expertise

Getting Paid: Fast, Easy, Convenient, & Cost-Effective Ways to Get Paid & Increase the Cash Flow in Your Practice

Getting Paid: Introducing & Talking About Sliding Scale, Adjusted Pricing & Specialized Alternatives—The Words You Use Make a Difference

Getting Paid: Talking About Sliding Scale Pricing—The Words You Use Do Make a Difference

Getting Paid: Talking Fees, Pricing, Prices—The Words You Use to Talk to Clients About Money Matters in Therapy Do Make a Difference

Networking, Marketing & Referrals: Tips, Information & Encouragement for Filling Up Your Practice

Full Practice, Ideal Clients, Money, Vacation

Lynne Azpeitia, LMFT

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