Therapists tend to struggle with money, setting rates, and understanding the value of what they offer. Hey... We never had business training, so it makes sense. : (
How many times have you answered a phone call from a potential client and said "My rate is 150, but my sliding scale is 30-150?" Your own anxiety caused you to immediately offer a sliding scale without being asked for one.
The mental health profession is crucial, necessary, and undervalued. We as a profession tend to be our own worst enemies when understanding the value that we offer.
We all have our own money traumas, fears, cultural narratives...
As a therapist and entrepreneur who used to have a GIGANTIC gambling addiction, money has always been triggering.
Whether you are saying...
If you're a licensed therapist, then you have...
Yet you still can't understand that your time is valuable. We don't charge for 60-minute increments of our time. We charge for the transformation.
If you're still reading this, ask yourself how much you spend on your own self-care and what it does for you?
Most people say something like "I spend $100/week on a massage + tip."
As therapists, we offer ^^^ and muchhhhhhhhhhhhh more.
Let's start to understand that we are allowed to charge fees, enforce cancellations and no-shows, and more importantly, MAKE MONEY AND HELP PEOPLE SIMULTANEOUSLY!
PATRICK CASALE: Hey everyone, this is Patrick with the All Things Private Practice Podcast talking today a little bit about money, one of the most fun topics that therapists and entrepreneurs can have. Money, money, money, money, what comes up, when we start to think about this? What comes up when we start to think about our rates, how we set them, the fees that we charge? I know that there is a lot of guilt around the subject, a lot of shamefulness that comes up with our money traumas, our stories, our narratives, our anxieties. There is still a widespread belief that as mental health professionals, we don't deserve to charge money for our services, or that if we are charging money, we're taking advantage of people, or excluding people who can't afford services.
I want to kind of call bullshit on that, because we have master's degrees. We've been conditioned to believe within our profession that we don't get to charge money, and we don't get to make money. There's the running joke in grad school and in agency jobs, “You didn't get into this profession to make money.” We believe that we buy into it. Yet, when we go out on our own and start our practices, we really struggle with our fee setting, how to appropriately charge, how to determine the value of our services. I see a lot of people saying, “Charge what you're worth.” How in the hell do we quantify what I'm worth? How the hell do I create a number that accurately represents what mental health therapy can offer someone, and the training, the supervision, the licensure, the grad school hours, the mental health agency hours, the student loan debt, the ongoing CEUs. How do I determine what I'm worth, especially, in 60-minute increments and chunks of time?
We're seeing a massive movement in terms of people exiting community mental health jobs and starting their own businesses, mainly, because of COVID. I think that a lot of us get really trapped in the scarcity mentality of, “I need to leave, and I need to charge low fees so that people will call me. That's the only way people will pay for my services.” Or there's a lot of imposter syndrome of, “People aren't going to pay me, I don't have enough experience, I don't have enough letters behind my name, I don't have enough training, I don't offer EMDR.” Etc, etc, etc. The list always goes on and on. We typically cut ourselves off at the knees when it comes to talking about money. It's taboo, we feel really guilty. We're definitely in a very big anti-capitalist movement, and I get that. I'm on board with that. But you deserve to get paid. You deserve to charge a good amount of money for the services you provide. You can help people and get paid simultaneously. That can happen.
One thing I'm going to say that a lot of you aren't going to like is that the more and more communication and access I've had with therapists all over the country, in the last year or two, in my coaching, and podcasts, and everything else is I've realized that a lot of us that struggle with charging our fees, or raising our fees, or talking money, or believing that people can afford our services, I think that a lot of us have gotten into this field to heal ourselves through our work. So, it's really this polarizing belief to say, “I'm allowed to charge $200 an hour.” If that brings up a lot of guilt of, “Nobody's going to afford me, I'm going to exclude populations A, B and C. I don't deserve to do this. People shouldn't have to pay that amount for services.” It makes it inaccessible. I believe that a lot of us are still struggling to do our own work.
In order to charge our fees, we have to kind of have an understanding of the fact that we're a business owner, right? If you go into small business ownership, you're a business owner. You pay taxes, you pay city registration fees, you pay licensing board fees, you pay credit card processing fees, all the fees to keep your business afloat, rent, electronic medical records, etc, marketing. We can't subsidize everybody's therapy and keep our own lights on. That's why we see so many therapists who are really burnt out because they're seeing 30 to 40 clients a week, they can't enforce their fees, they struggle to collect them, maybe they don't build their insurance on time, maybe they just are stuck in that scarcity mentality of, “I can only charge $30 a session.”
I'm not knocking it. Everyone needs to do what they need to do to survive. But if we're creating this epidemic of burnout, so to speak, and we're all struggling with our own mental health, how are we going to take care of ourselves if we can never step away because of financial scarcity, or insecurity, or anxiety. It's really hard to step away and take a break when you're like, “I have to grind all the time. If someone doesn't show up, I'm screwed, right?” And you're not enforcing your cancellation policies, or you really struggle to, or you struggle with money on the phone. I used to do this. People would call and I would say, “My rate’s $100 an hour, but I have a sliding scale of 30 to 100.” They didn't even ask for it. I just offered it because I was so anxious and nervous that nobody was going to pay me. Of course, the person was always like, “Yeah, I'll take that. That sounds great.
And then they're talking about like the new car they bought, or vacation they're going on, or whatever, and you're getting resentful, but you're not frustrated with the client. It's not their fault. It's your fault. You weren't able to set boundaries with your fees, with your rates, and then it's a situation where you're like, “What do I do? How do I raise them? When do I start talking about rate increases?” We all have money trauma. Culturally, we have to also take into account that cultures with people who are represented in marginalized identity, there's obviously disparity in wealth, access to care, and socioeconomic status, and that's real.
But I think that we have to also understand that we can't help everybody that walks in the door. If you're able to get behind your fees and let's use $150, as an example, and you're able to enforce that, that allows you to open up space for sliding scale spots, that allows you to open up a pro bono slaughter too. It allows you to open up space, and energy to go donate time or resources to community organizations that you really believe in. We can't do that if we're subsidizing all the time. We can't do that if we can't enforce our fees, our cancellation policies, etc.
I want you all to think about this, when it comes to self-care, what do you do? What do you do for you? Especially, if you're spending money on it? Don't say like, “I go hiking, it's free.” If you spend money on it, tattoos, vacations, getting your hair done, nails, massages. Think about what you spend money on, and ask yourself why? If you're getting a massage and paying $100 an hour plus tip, ask yourself why you're going to do that? Does it create relaxation? Groundedness? It's your me time? It's self-care? It makes me feel relaxed? It gets rid of pain? And then we start to think about, do we as mental health clinicians offer that and more? Do we as mental health clinicians have master's degrees, and some of us PhDs, and licensure, and licensure hours, and supervisory hours, and student loan debt, and internship experiences, yet, we're willing to pay for other services to make ourselves feel better, yet, we can't do the same for ourselves. We can't understand that what therapy offers is so valuable.
We get stuck in the mentality that we're charging for 60 minutes of our time. In reality, we're charging for the transformation, we're charging for the light at the end of the tunnel, the hope that something can be different. We can only see so many clients as sole providers. We can't see 100 clients a week. Most of us can't see 40, because it's so strenuous. Our jobs are so exhausting. We're taking on and absorbing so much all the time. We have to give ourselves space and set boundaries, and actually practice what we preach when it comes to self-care, and taking care of our needs, going on vacations without feeling guilty, stepping away from the office so that you can recharge. Otherwise, what are we doing this for? Did we leave our agency jobs to recreate our agency jobs within our own practices? I want to really challenge you to think about this.
I work with a lot of BIPOC therapists and a lot of the narrative is like, “BIPOC individuals can't afford my services. I can't charge X amount.” But then they do, and they're like, “Holy shit, people are paying me because they value what I offer. They're valuing the safe space that I give, the support, the non-judgmental experience, the safety, the security, right?” What does therapy offer people? Not only is it a light at the end of the tunnel and hope that things can be different, it's about being able to repair relationships, being able to heal inner child wounds and attachment trauma, being able to support someone through addiction and recovery through a recovery plan, being able to help maybe salvage a marriage, and prevent divorce, and legal proceeding, child separation. Maybe we're helping someone be able to go to the dentist without having a panic attack, or drive without having a panic attack, or learn how to have healthier communication at the workplace, reduce their anger, and their anger management.
Maybe we're working on harm reduction, maybe we're providing a safe space for someone to come out and disclose their sexual orientation for the first time, and a safe space, and environment. Maybe we're working on helping a family reunify, maybe we're helping someone really work on the fact that they don't want to be a part of their family system anymore, and they have a lot of guilt and shame around it. Or you're a high-achieving perfectionistic entrepreneur who can never turn it off, raises hand slowly. We do so much, and we really seem to discount that and believe that we are responsible to heal everybody, and that's just not reality, it's not possible. That doesn't make you a bad person to turn people away, refer people out who aren't good fits for your practice. That doesn't mean you're a bad therapist or a bad human being. It doesn't mean that you're greedy.
Everyone's going to do this differently, everyone's going to charge different fees. Don't compare yourself to what other people are doing. Don't go on the internet and scroll through all the pages of people and say, “I could never do that. How is someone charging $300 an hour? Why would they do that? That's so greedy. They're taking advantage of people.” Maybe that's their population. Maybe they like working with high-achieving professionals who can afford their services. That's okay. Maybe you're going to charge $50 an hour. That's also okay. I just want you to enforce it, I want you to understand why our services are so valuable. I also want you to hear that if you're in a business, you are a small business owner, and you have to treat your business as such, or you will close up shop. I've seen it happen way too many times because people couldn't enforce their cancellation policies. There're no show policies, they couldn't raise their rates, they couldn't even talk about money without getting ashamed of having the conversation.
I want to challenge everyone to work through their money trauma, their money anxiety. Maybe you grew up in poverty, maybe you grew up homeless, maybe you grew up moving from place to place and you never had security. That's okay. I want you to honor those parts of your life because they shaped who you are. But they don't have to continue. You don't have to live in that headspace of, “I'll never have enough. I have to just scrape by.” It's okay to honor those stories, those traumas, those narratives, but let's work through them so that they don't prevent us from moving forward, they don't paralyze us. It made you the person that you are today.
I grew up very poor. I had a gambling addiction most of my life. Money has always been a sensitive subject for me, but I had to get really confident about it. People will reach out to me now as a practice-building coach and want to pick my brain for free, and I will feel guilty a lot of the time and respond. And then, I have had to really get comfortable saying, “You know what? Here's the link to my consultation calendar, go ahead and schedule something. Here's my fee, I charge 250 an hour for coaching. Here's my calendar, this is how we can work on this concern, or this question.” That can turn people off. They can maybe tell you, “Hey, you're being selfish.” Or, “Why can't you give this information away for free.” I've worked really hard to obtain this information, to be skillful in this position. I don't want to discount the fact that my services are valuable.
I think when we undercut ourselves, we're saying, “I don't believe that this is valuable.” If you call a doctor, lawyer, massage therapist, tattoo artist, even, they may make you put a deposit down or retainer, and if you cancel your appointment, they are going to charge you. They're going to do it without hesitation. Yes, we are in the helping profession. We get it and we're empathetic. But we also have to have balance. We can't give it all away. If you are giving it all away, and it feels satisfying, I'm happy for you. I just hope that it will create longevity in your career when you're struggling to get by financially, because we all know that financial stress is very overwhelming. Most of us have enormous amount of student loan debt. I myself have about $150,000 in student loan debt. I've got to pay it off, and I can't do that by giving everything away for free. I'm not a monster about it. You can set your own policies.
During COVID, when it first started, I had clients lose their health insurance, because they lost their jobs. I was not going to say to them, “Go figure it out.” We're in a global pandemic. I'll see those clients for free until they can get back on their feet. But I get to make that choice. Nobody else does. It's my business. It's my business model. It's what felt good to me at the time. I want everyone to think about what therapy offers. You can make a list that's 20 pages long. I want you to get confident talking about money, whether it be with your partner, a friend, a colleague. Start to rehearse and say your fees out loud. I want you to try really hard on phone calls to tell people what your fees are, and instead of immediately going to the, “My fee’s 150 but my sliding scale’s 40.” Just take a breath and pause. Let the client decide if that works for them. Have a certain amount of sliding scale spots, not 20, maybe four. Once they're full, they're full. Other people offer them too. That's why networking and having a referral list is so important.
Again, you can't help everybody. We can't be the Applebee's of therapy, right? Can't do it all, and you can't do it all well. I want you to really think about this stuff, stepping into abundance mentality where it's like, I'm allowed to refer people out to other providers, and then in return, they're going to refer people to me who are the appropriate fix. If you want to take insurance, take insurance. If you don't, don't, but don't feel shame about it. Make your own decisions based on what works for your business model. If you're taking insurance, think about this. In North Carolina, Blue Cross pays around $100 an hour. I know I'm not supposed to talk about rates. That's why I said around. However, if I'm charging $50 a session for clients, and then Blue Cross is paying 100, I'm like, “Insurance companies don't want to pay us. They do everything in their power not to.”
I try to think about the fact that if I'm undervaluing my services that's not great when it comes to advocacy effort and lobbyism in terms of combating the insurance companies in rate increases. How often do you see rate increase conversations? “Hey, can I write a letter to United or Cigna and ask for six more dollars? Has anyone done this before?” We're begging for scraps, so to speak. We are important, we are instrumental in how society functions. I understand that certain populations are not going to be able to pay out of pocket or afford to pay your private pay fee. Again, that's why you're allowed to create sliding scale spots, and that's why we have referral sources to community mental health agencies and therapists who maybe have lower rates, or have a sliding scale spot available.
Get really comfortable with networking with other therapists in your community. Know the other therapists so that you can send clients to them who are good fits for them. If they take the insurance the client has, if they have available low fee spot, and you don't, but don't beat yourself up about having to do that. Let's start really having a shift in this profession to believe that we are valuable. No more 30 and $40,000 a year salaries at community mental health. We're not going to tolerate it. Even fucking BetterHelp is starting to pay people more than agency jobs granted they're a terrible, terrible corporation that is exploiting therapists all the time.
However, they're starting to promote and market the fact that you can make $100,000 a year working for them. I think you have to work like 70 client hours a week, which is absolutely insane. You can do this. Surround yourself with people who can tell you that you can do this, not the people who are telling you the opposite, because that ultimately makes you second guess yourself, and it does allow you to move into that headspace that, “Yeah, this is not for me. I can't do this. This is impossible.” Whether you do a pay what you can model, a full fee private pay model, a hybrid of insurance private pay, limited sliding scale spot private pay, it doesn't matter. Make it your own. Don't compare yourself to other people, but just really start to understand what you offer and how valuable it is.
I want to talk about money more and more on this podcast. I'm going to have some guests on to do the same, and it'll be a difficult conversation sometimes, and it might feel a little bit triggering, but start to check in with yourself about why? Yes, our values are about helping people, being empathetic, and being compassionate. But we typically put ourselves to the backburner and we start to ask ourselves, “How the hell did I get so burnt out in a profession that I love?” Don't allow that to happen to you. There's room enough for everybody. We can support people and make money simultaneously. I promise you that. Thank you so much for listening to the All Things Private Practice Podcast. Please feel free to download, subscribe and share, listen wherever you listen to podcasts. You can find more of me at allthingspractice.com, or at my Facebook group, All Things Private Practice, and I will plan on talking to you next Monday. Thanks.