Category: Increasing Cash Flow

Getting Paid: To Have an Office orNot have an Office—That's the Question on Many Therapists’ Minds Today

8/29/2020

While some therapists continue to work with clients face-to-face in a therapy office as a result of stay at home orders across the country, a majority of mental health professionals find themselves working virtually with the clients in their practice doing video or phone sessions. This has caused many clinicians to wonder if they still need an office for private practice and if they should keep paying for an office when they only work with clients virtually now.

Facebook, Linked In, Instagram, Craigslist, and other therapist forums are full of postings by therapists who are vacating their offices and terminating their leases or who are looking for someone to take over a full time single or group office space lease. There are also numerous for sale postings for therapy office furnishings—couches, therapist chairs, desks, end tables, lamps, waiting room furniture, and wall art.

The therapy office landscape has definitely changed.

Months ago, therapists who sublet their office space and were only working virtually with clients, made the decision to jettison their offices as they quickly gave notice and stopped paying rent. Since office space has been plentiful in the past these therapists weren’t worried about subletting an office in the future should they desire to resume in office therapy sessions with clients. About 40% of clinicians in private practice usually sublet office space. Time will tell whether subletting an office will be as easy and inexpensive as it has been in the past since no one can predict how many therapists will retain their physical office space after practicing virtually.

Those therapists new to practice who leased their own office as well as those clinicians who depend on subletting office space to others to pay their office rent each month let their offices go and terminated their leasing agreements right away, too, since they no longer had the funds to pay their office rent while working virtually. About 10% of therapists were in this category of reluctantly, but necessarily, sacrificing their offices.

For about 10% of clinicians, there is no question of them giving up their office or not paying their office rent whether or not they are working with clients in person or virtually. They made their decision right away, too—they're keeping their offices. This group seems to have it the easiest when answering this question, as it’s a no-brainer for them to keep their physical office.

Currently many clinicians with longtime practices and full caseloads are questioning themselves as to whether they should continue to pay rent for an office or if they are wasting the money. A full 50% of therapists, with or without a full practice, are currently in the process of figuring out whether it’s prudent to give up their office space and eliminate their office rent expenditure.

This is an agonizing decision-making experience for this group of therapists who have a lease agreement with them as the sole signatory. This is the question that is on many a therapist’s mind and is being discussed with colleagues and in many therapy forums online. The answer comes after a lot of soul searching, number crunching, and scenario planning.

How does a therapist go about deciding whether or not to continue paying for an office location for their practice when they’re not working with clients from the office premises?

By reevaluating your practice.

A subgroup of therapists has decided that after doing virtual work with clients these past few months, their practice will remain virtual, no office space needed. This will be about 10-15% of therapists, overall and 10% of those who rented space full time. The answer to the question of an office for these therapists is an easy one, no physical office just a virtual one.

As therapists ask themselves whether to keep paying rent for an office or to relinquish it and stop, most are focused on the financial aspects. “Why should I keep paying for an office if I’m only seeing clients virtually and tele-sessions are either free or low cost? Isn’t money being wasted.”

Another aspect to consider besides the financial one is what a clinician actually needs a physical location and address for. Many therapists are opting for a low-cost P.O. Box address as their practice and mailing address when they don’t want their home address listed. For most professional things this works out fine, however, there is concern that some insurance companies may not pay therapists or reimburse client superbills for sessions without an actual physical address. Rumors abound. It’s always good to check with the insurance company for their requirements.

More concerning for private pratitioners is how the internet search engines rank practices and websites without a physical address. Current information is showing that Google searches show results in a searcher's local area first, so the concern for therapists is whether or not their practice listing is being included in as many search listings if they don't have a actual physical address. We’ll have to see how this plays out.

Overall, the biggest things to consider when evaluating whether or not to continue renting an office are time, money, and effort. How much time will it take to find, furnish, and set up an office that works for my practice if I give this one up? How much will I save if I give this office up and set up a new one later—include costs for moving, internet, cleaning, insurance, parking, etc.?

A clinician who has a month-to-month agreement with a low rental rate with an office that’s the right size, in a good location with easy and inexpensive parking, good ventilation, and soundproofing, may find it’s less costly and time consuming to pay office rent for a full year or even two, than to move out and find and set up the office again a year or two later. Crunch your numbers for this answer.

Another clinician, one who’s looking to make a change and find a better office space with more fitting parking, soundproofing, and ventilation, may find it’s much more beneficial and cost-effective to end their lease and look for a new office space when the time comes.

Think about what fits best for you as a clinician and business owner, your clientele, and your practice. The world is full of options for you to have the practice you desire. Take some time to figure out what’s best for you now.

Enjoy this opportunity to reevaluate 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 pressure 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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Getting Paid: Talking with Clients About the Price & Value of Therapy

1/25/2020

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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!

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Getting Paid: To Have an Office orNot have an Office—That's the Question on Many Therapists’ Minds Today

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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

Getting Paid: Talking with Clients About the Price & Value of Therapy

Lynne Azpeitia, LMFT

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