You pick up your phone – take a breath. You’re about to return the call of a prospective client. Yes, yes – you’ve done this before, but this time … it’s different.
You’ve run the numbers (for the 16th time).
You’ve talked to a consultant.
You’ve discussed it in case consultation.
You’ve posted about it on FaceBook.
You. Are. Ready.
To charge your (gulp) FULL FEE.
You, me, the therapist next door – we’ve all gone through this. We’ve rehearsed it in our heads, practiced out loud with our partners: “My full fee is…(*cough*)…One fifty.”
You’ve promised yourself – even if you really like the person on the other end of the phone, even if their problem is just the type of therapy that you love, this time… no matter what… you won’t give in. No more. It is time to charge your full fee.
You call the client back. Everything goes well. She is lovely – complex, insightful, nuanced, open to your questions.
And then she says it. “What’s your fee?”
You’ve gone over this moment so many times. You know what to say. You’ve gotten support from all of your peers, your supervisors, clinical theory, itself!
Yet. You find yourself saying,
“Me?! My full fee?! Oh, um, my FULL fee is… heh… one fifty. (Beat) But, I mean, what can you…, I mean, given the state of the economy – the price of oranges, can you believe it?! What can you afford? Is $65 fine?! $20?! Whatever…WHATEVER! I mean, I do have a sliding scale. Do you need that?!”
Somehow you’ve found yourself sliding your scale, once more, down…down so far. The client has tentatively agreed to your egregiously low fee and, even though it’s nice to have a referral come through…you are filled with regret the moment you hang up the phone.
Therapists & Money: A Love Story
For those who know me personally, or who have been following me on social media, ya’ll know that I have been on a crusade for the past few years – well before I was even licensed.
My mission: To understand what the fuck is going on with therapists and money.
Don’t get me wrong!
I, too, have struggled with these very same feelings when it comes to charging for my services. I entered this field to help people, for the love of Jehosaphat. I didn’t enter this field to get rich.
Okay, maybe that’s not entirely true.
Part of my desire to become a therapist was born of the dream that I could both help people and help myself. I loved the idea of being my own boss, with my own snazzy little office, a schedule that I set and an income that I was in charge of (no more nutty middle managers using me to play out their power tripping fantasies)…all the while working with individuals that inspired me – who could and would pay me to do work that I had been, in some form, doing all my life.
But, somewhere along the line, something happened.
It began to feel shameful to imagine – much less speak openly about – my desire to make a good income as a psychotherapist.
Throughout the years of grad school and then the years…and years… of internships…it began to feel like I should feel lucky to even…well, exist. Shoot, I couldn’t even allow myself to imagine more: Get paid?! To help people?!
After thousands – and I do mean thousands – of hours of free or incredibly low-wage labor, it became really hard to justify my own worth. Much less charge for it.
So, I began a quest. An Epic Value Quest.
This article is long. I won’t lie to you. But it will definitely be worth it.
Because you’re worth it. *CHING*
This article is not for you if:
You long ago sat down with a financial planner and determined how much money you needed to support your current lifestyle (including paying off student loans), your projected lifestyle (including vacations, retirement, that new car, monthly massages, dinners out and regular trips to see the ole family back home).
….And then you set your fees accordingly, nary a blink of the eye.
This article is for you if:
- You are afraid to look at your finances, period, let alone your private practice P&L.
- You think P&L stands for “Poppin’ and Lockin’”
- You are afraid to charge your full fee because you “know” no one will pay it.
- You feel guilty about charging your full fee because you are “too inexperienced.”
- You determined your full fee by “assessing the market.”
- You decided your full fee based on… “Ya know, what I feel comfortable charging.”
- Your full fee is kind of a joke, because, well, like only 2% of your clients pay it.
- You’re about to join an insurance panel because $50 per session is better than… well, nothing.
- You worry that charging a “high” fee means you’re taking advantage of those poor, unfortunate souls who just need help.
- You’re running around like a chicken with your head cut off, taking too many clients for too little pay, all the while taking on more and more volunteering positions, wishing you could take a vacation, but you can’t actually afford the loss of income and your cat needs to get surgery because she has an ingrown claw, but who can afford that shit?!
- You hardly get any referrals, so when one does come in, for your ever-so-bruised professional ego, you slide lower and lower again just to have someone, someone, to justify keeping your practice going.
- Despite the fact that you are technically a business owner, you often come to the conclusion that you need to get a “real” job.
If you are in the category of people who do not need this article – please send me an email NOW. I would love to hear about the world of sunsets and tulips, cotton candy and yoga that you delight in. Seriously. Let’s talk.
If you are in the second category – the “Tiffany, get out of my head. You’re freaking me out” one – then let’s take a journey together.
In this article, I will not only explain what is happening that keeps us cloistered in a world of money dread and private practice overwhelm, but I will also talk about what the therapists who live in that world of lightning bugs and first kisses (read: those who charge really good fees) know that you don’t.
What You Will Gain By Reading This Article
1) You will be able – once and for all – to figure out what your fee should be;
2) And then actually charge that fee: a fee that is in line with the reality of your financial situation
(read: pay off your loans, take vacations, afford decent health care, pay the full fee for your own therapy, along with consultation, massages, nice dinners out, and nice Christmas gifts for those you so desperately love who have supported you throughout all of this.).
So, without further ado…
Myth #1: It’s important to “assess the market” before setting my fee
I’ve talked to a lot – and I mean a lot – of therapists about how they came up with their fee. While a lot of you admit that you stitched your fees together via a combination of anxiety, insecurity, guilt and…well, more anxiety. Some of you…SOME of you proudly declare that you set your fees after “assessing the market.”
You assessed the market, did you?
Unless you’ve spent tons of hours using these metrics to pull together a stunning portfolio with indicators about the viability of therapy in your area… you haven’t really assessed the market.
You’re terrified (I know, I’ve been there) to sit down and figure out what you need (and want) from your private practice and then plan your business accordingly.
For those of you who feel ashamed admitting that you’re scared to set your fees, breathe a tiny sigh of relief. You actually have a bit of an advantage over those who proudly declare that they’ve set their fee after “assessing the market.”
99.999% of therapists* who argue that their fees are appropriate because they “assessed the market” first actually set
their fees based on anxiety, guilt and insecurity – but they’ve developed an elaborate web of illusion and sparkles to convince themselves otherwise. Because it’s too uncomfortable to tolerate their money anxiety, they found some fancy business term like “assessing the market” to justify their fee setting.
While assessing the market actually entails hours upon hours of complex work, what those therapists who claim to have “assessed the market” really did was look at a couple of Psychology Today profiles and asked a few friends what they charge – in order to justify the fee that they had already internally decided before doing said “market research.”
In reality pretending to “assess the market” is just a handy way to brush away any anxiety you feel about setting fees that line up with your current and projected financial needs because it’s scary to:
1) Actually sit down with a budget and see how much you need to be charging in order to cover your current and projected financial needs (yes, this includes student loans, retirement, healthcare, and that trip to Thailand) and then;
2) Charge that fee.
Miranda Palmer, co-founder of Zynnyme.Com and creator of the Business School Bootcamp for Therapists shared this pearl of wisdom with me,
“Setting your fee based on what others are charging is no guarantee of success. In fact, if the other people aren’t making a livable wage from that fee- it simply guarantees you won’t make a livable wage either. It is time for therapists to unite and embrace the math of a business plan based on expenses and plausible income.”
* There are those some who have actually assessed the market – created a thorough business plan, with hours of market research – and it’s likely that these therapists moved into therapy after having spent many years in corporate America. And, even more likely, these therapists are not reading this article because they have quickly established a thriving practice that takes care of their financial needs and, at this moment, are preparing for their third Ted Talk.
Kudos to you, the Esther Perels, LMFTs of the world, who illustrate the limitless nature of our profession!
If you’ve been relying on the argument that you assessed the market, but are now realizing that maybe you haven’t, do not fear. Read on. I’ll take you through the step-by-step process of setting your fee based on YOUR needs and then show you how to carve out your own market.
Tiffany, how do I get that guide?
Myth #2: I have to wait until I am “experienced” enough to charge my full fee
The truth is, you’ll never be experience enough… or smart enough or brave enough or ‘perty’ enough, because, well, you’re kind of a perfectionist.
You’re always striving to do better, to grow, to achieve – and that’s so awesome!
Untiiiil…. It gets in the way of your business.
The idea that you have to wait to get to some fantasied point before you are “qualified enough” is one of the ways you hold yourself back.
We all do this in some form.
You see a world that is saturated with people who have higher degrees than you, who have certifications in things like “Targeted Radial Electromagnetic Focusing for Survivors of Emotive Bruising,” who definitely have more years under their belts and then you think,
“Damn! Who am I to be charging $200 per session?!”
Maybe some handy dandy facts are in order.
In my survey of over 100 people who have been in therapy, “finding a therapist that I trust” was far and away the number one thing clients looked for.
Yup – even over a therapist’s “level of experience” and “cost” of therapy.
While you’re sitting around, picking that pesky scab on your elbow, and worrying that you don’t have enough experience to charge your full fee, someone out there is desperately wishing they could find you! YOU – the therapist who they trust.
Why would they trust you, over all of their options?
I don’t freaking know!
We are drawn to people based on a magical combination of smell and hopping cells and weird childhood experiences.
Who are you to question it?! The fact is, there are people out there who just want to find a therapist they can trust. Someone just like you.
I’m not going to promise you that you are enough already because I know you won’t believe me. But I will say let you in on a little secret.
By honestly determining (and then charging) appropriate fees, you will grow into being enough.
Remember, there are people out there who really need help, who have had terrible experiences in therapy and are really desperate to find someone they trust. By making sure you’re taken care of, in terms of your own financial stability and emotional well being, you’ll be prepared to put yourself out there with confidence.
If you’re not quite sure how to figure out what your fee needs to be, rest easy. I’ve put together The Therapist’s Guide to Setting Fees (Guilt Free), Get it.
Myth #3: I have to be on insurance panels when first starting out
Who told you that?!
You might choose to be on insurance panels because you’re anxious and you want clients yesterday and you don’t trust that you have what it takes to bring them in without being on a panel.
But keep in mind, this is a choice.
The fact is, you can build a full-fee, cash-pay practice that let’s you thrive financially.
People do it all the time. People like Molly and Dori and Aden and Katherine.
Sure, you certainly have to do more than sit back and wait for your phone to ring -and maybe doing a little marketing and a some coffee dates and joining a training or two isn’t worth it for you. That’s totally okay.
Just be honest about your choices.
For me, and a lot of therapists who are successfully running their practices, the idea of taking a small co-pay, and being beholden to the constraints of insurance policies and doing all that damn paperwork isn’t worth it. For others, the security of knowing you’re going to get steady clients, even if the pay isn’t all that great, is all you need.
Whatever you decide, remember it is a decision.
Sometimes our choices don’t actually feel like choices. I often hear therapists talk about being at the mercy of insurance companies and it really feels like they have no other options.
If you find that you’re feeling frustrated and hopeless by the offerings of insurance panels, talk to colleagues who have successfully built up a private practice without being on insurance panels and ask them how they did it.
One of the best ways to discover that it is possible is by talking to others who have done it!
There are plenty of examples of therapists who opted to skip the panels and quickly built up financially rewarding practices… like Chris and Christina and Erika.
If you’re on Facebook, you can also find tons of encouraging communities where therapists are happy to offer encouragement and support around building up cash pay private practices. For starters, check out Allison Puryear’s “Abundance Practice” Group on FB!
Myth #4: It’s my ethical obligation to offer a sliding scale as a way of “giving back.”
This is one of the most harmful myths of our field. The idea that the only way we can give back is through lowering our fees in our business.
It is time for a paradigm shift around this one.
When I’m talking to therapists, I So.
“I became a therapist because I want to help people and give back. I want to offer sliding scale spots because I want to work with all kinds of clients, including those who cannot afford $175 per session.”
Then I go on to ask you all kinds of other questions, specifically around your quality of life-
And what do I find?
You’re overworked, burnt out, frustrated with your low-fee clients, wishing you could charge more, but you’re worried no one will come.
Then I ask my favorite question of all. Take a moment to answer it for yourself. Don’t worry, no one will hear you, it’s between you, your computer and…well, maybe that harsh superego sitting there on your shoulder.
If I could give you 10 $180 clients right now, would you take them?
Well, would you?
The fact is, even though we say we offer a sliding scale to “give back,” the reality is, we offer a sliding scale because we’re afraid – afraid to take a look at how much money we need to live a rich life (whatever that means for you) and then charge that fee.
I whole-heartedly believe in keeping one or two sliding scale spots open in your practice if you want.
But, in reality, having a couple of sliding scale spot is a luxury.
It is what you do once you are paying off all your bills, putting money towards your retirement, taking your friends out to dinner, investing in your kiddo’s college education and making regular trips up to see the folks.
It doesn’t make sense to offer a sliding scale or, more likely, to have the majority of your practice made up of sliding scale clients, when you feel like you are drowning, overwhelmed, stressed about money, worried about whether you can even pay your bills.
When I asked Miranda Kelly, the other half of the glorious Zynnyme duo to contribute to this article. She was eager to debunk the myth that we must only contribute to society by lowering our fees. She said,
“Your fee is set so you can be a sustainable, impactful business. When your business thrives you are truly able to give back to your community which is the opposite of limiting who and how you help. There are many ways to give back beyond the sliding scale model without sacrificing the survival of your practice.”
By encouraging our therapists to start with a sliding scale we’ve gotten this backwards. It makes more sense to run your practice like the Virgin America song says, “Put your mask on first before you offer assistance.”
(I literally had to pause the writing of this article to go watch the Virgin America safety video. Again.)
Check out what the amazing Barbara Sheehan-Zeidler, LPC with Creative and Caring Counseling in Littleton, Colorado had to say about finding a way to give back that also fell in line with her value about maintaining her own financial well-being,
“I came to a place of peace around this topic by volunteering with Mental Health America Colorado and offering two pro bono sessions per week and doing community outreach via free public speaking engagements on topics related to mental health. In this way, I am able to have the lifestyle I want for my family and I, while honoring my heart and values of giving back.”
Build up your practice with clients that can financially support your business first. In order for you to create a private practice that will thrive in the long run, it is imperative that your emotional, physical and financial needs are provided for.
Make a list of all the ways you can give back that do not compromise your well-being. Here are a few to get you started:
- Volunteer as a Big Brother or a Big Sister.
- Offer to teach a workshop for graduate students.
- Organize a monthly trash pick-up with your friends and colleagues.
- Walk dogs at the local animal shelter
- Send care packages to college youth who have aged out of the foster care system
Myth #5: I can’t charge more than my consultant (supervisor, therapist…)
Let’s all pretend we’re five years old for a second and ask ourselves “Why.” [go to 1:07]
Why can’t you charge more than your supervisor or consultant or even your own therapist? And why to that answer? And to the next?
What happens when you imagine setting your fees equal to or above your respected mentors?
It’s like this old scene where Bart (yes, that’s right, I went there) is haunted, only rather than creepy old ladies, you’ve got your supervisors, beloved professors – all kinds of internal figures – whirling around your head, demanding, “Who do you think you are?”
In reality, who the fuck gets to tell you what you get to charge?
The answer… well, no one.
It’s your business! And, despite the voices in your head, if your respected elders are worth their salt, then in real life they will be proud of you for taking care of yourself.
If not, then likely they’ve got a bit of envy going on and, though that’s hard to see, it’s better to recognize this kind of dynamic sooner rather than later.
I’m always surprised to see people who have been in the field for twenty years who are still charging pretty low fees. But really, it’s none of my business. I don’t know much at all about the reality of their situation.
- Maybe they come from wealth and do therapy for professional esteem, rather than as a source of primary income.
- Maybe they have conflicts about setting their fees based on their own difficult relationship with money.
- Maybe they slipped on a banana peel while wearing a bathrobe and..wait, what?
People set their fees based for all kinds of whacky, unknown reasons. It does not behoove you to set your fee based on the fees of others – yes, this even includes very idealized others.
Sure, it will be hard to set a fee equal to or (heaven forbid) higher than your respected advisor.
Yes it will bring up all kinds of internalized conflicts about surpassing your parents, taking responsibility, moving forward as an adult in the world (*gulp*).
And, yes, it is necessary for you find ways to play out your psychic conflicts outside of your primary source of income, like, I don’t know – in your own therapy.
Sit down and figure out your fee based on your rent, your grocery bill, your dreams, your costs of living. Get anxious just thinking about it? You don’t have to do it alone. Check out the Therapist’s Guide to Setting Fees (Guilt Free). I’ll walk you through it, step-by-bloody-step.e.
Myth #6: I should set my fee based on what I “deserve.”
The idea that your personal worth should be the metric by which you set your fee is a very slippery slope, indeed. You will be heading into a dark tunnel of Trump-ish proportions if you imagine that your fee should be tied to your value as a human being.
Because, that would mean that men are more valuable than women, white folk are more valuable than black folk, and Switzerland is more valuable than Greece.
The fact is, you can’t set your fee based on some ambiguous sense of self worth. At the end of the day, it’s just not good business practice.
So…one way to set your fee that can give us a more “objective” viewpoint is to set our fees based on…well, our current and projected expenses.
“HUH, Tiffany?! Setting my fees based on my…income needs?!”
I know, sounds totally random, right? But really, your business is there to support your quality of life, so outside of all the conflicts you have about good and bad, right or wrong, rich and poor, you’ve actually got to pay your bills, along with all the costs necessary to be a quality therapist (things like, physical health, emotional well-being and ongoing training).
You can keep all of those internal conflicts. Shoot, they make for an interesting character. But play them out in therapy, rather than in your business.
Sit down with pen & paper and write down your monthly expenses and projected expens – okay, okay. I know. BOE-RING.
So, if you haven’t already, sign up to download the worksheet. Yeah, yeah. I’m driving this home, but if you can’t do it alone, why not get some help?
Myth #7: No one will pay my full fee
This is an easy one to debunk with this little fact.
Fact: Yes. They will.
HA! I crack myself up.
But really. They will.
Don’t take my word for it. There are people out there who really value the work we do and they are willing to pay for it because they see the benefits. In response to my survey about being in therapy, one person responded:
“It’s still hugely expensive in the context of my budget, but I’ve realized it’s just worth it. I once stopped seeing [my therapist] for a bit in order to try to find someone cheaper, and I tried out a couple other therapists, but we just didn’t work well together and I didn’t want to keep parading all my vulnerabilities to tons more people in order to find someone. I simply had to recognize that the fit matters tremendously, and the work we do together is worth it, even if it creates financial pressure.”
Much of our disbelief about the potential of people paying our full fee arises from our own difficulty imagining what it would be like to pay that much for therapy.
You guessed it – projection!
A lot of us therapists have gotten so used to working for next to nothing during internships – barely scraping by, forced to choose between a cappuccino or lunch, and relying on our own therapists to slide their fee for us – that we forget that there is an entire range of the population who chose a different path.
Let me give you an example.
I just randomly checked out the salary for a “technical employee” at SalesForce and saw that the average salary was about $120,000 per year. I happen to live in a tech city, so there are a lot of young rapscallions who make this kind of money. That means that, each month, this person – let’s call her Sally – is taking home about $6,461 per month after taxes. This means that, unlike you, Sally is not being forced to choose between things like paying for therapy or paying for rent. She is likely choosing between paying for therapy and paying for that really cute new pair of shoes. Well, really, just one shoe because Sally has expensive taste. But she’ll make sure to get the pair even though it’s double your session fee.
There are a whole lot of Sally’s all over the country who have plenty of disposable income. Just because they are not in your friend circles (which are composed largely of therapists and starving artists) does not mean she is not everywhere, all around you, desperately wishing she could put her money towards something that will actually improve her life in a way that lasts long beyond that pair of designer pumps.
Just in case you struggle to imagine that there are enough individuals out there who are willing to pay full fee for therapy… check out therapists like Lindsay and Jodie and Ryan. They’ve set fees commensurate with the standard of living…and they’ve successfully found an entire practice worth of clients who are eager to pay those fees.
Find other therapists who do charge their full fee and find the clients who can pay for these fees, who are able to both thrive professionally, while also giving back.
I know I talked about this earlier in the article, but I cannot stress enough how important it is to find people who are already doing what you strive to do. Study them, interview them, write them thank-you cards for inspiring you, ask them how they did it!
Nothing is more motivating than talking with kind people who are making it happen, who believe that you, too, can join the financially successful therapist club.
Myth #8: I should set my fees based on what I feel I can ask for
I hear this one a lot. Therapists come up with a random fee – usually about $150 – that they “feel” they can ask for, just based on, well…just that.
I can weigh in personally on this one. When I was deciding to set my full fee upon getting licensed, I planned on stating the requisite $150. I felt this was a fee I could easily get behind. Then, I had a flash in my head about charging more and I was filled with panic.
I could NEVER charge something like…gulp… $180. And that number began kicking itself around in my brain for the mere fact that it was terrifying.
Then I decided to give myself a challenge. I decided to charge $180 per session because of the fact that the only thing keeping me from doing so was, well…fear.
I tended to live my life such that a feeling like fear was a good enough answer for why I wouldn’t take certain risks. I don’t mean risks like hanging around in dark alleys waiting to comprehend bad guys. I mean risks that would only serve to benefit me and my practice, but that just scared the bejeesus out of me.
I justified this fear as a concrete, reasonable fact.
I realized that if I really wanted to move forward in life, I’d have to find something beyond terror to keep me from activities that would lead to growth.
In the beginning, I attempted to justify my less than $180 fee idea with reasons like “assessing the market,” basing my fees on supervisor’s fees and the sanctimonious, yet vague declaration, “SOCIAL JUSTICE”…but behind it all, was really just fear.
So, I said, “fuck it!” and tried something new.
The fact is, money anxiety doesn’t go away. In my survey research, 70% of therapists reported feeling “anxiety, guilt and conflict” when thinking about money.
Not surprisingly, the percentage of therapists who were in their first two years of working in a private practice setting were more likely to experience anxiety and guilt when thinking about money matters, with about 77% saying “yes” to money anxiety.
But even of those clinicians who have had over eight years of experience, 59% still reported that they had feelings of anxiety and guilt when it comes to thinking about money.
This means that if you’re waiting for your anxiety about your money to decrease, waiting for the moment when you “feel” ready to charge your full fee, you’ll have a long wait ahead of you.
You would be wise to figure out your fee based on your financial needs and then work with your therapist or honest colleagues or successful mentors to start charging your full fee sooner rather than later. Yes, even before you feel comfortable charging it.
Take time to acknowledge your fears about charging the fee that you need to in order to have the life of your dreams. Recognize the feelings of inferiority, doubt, terror, guilt. If you’re really into these little fear buddies, make them a little bed, feed them kernels of frozen corn, kiss them sweetly.
BUT DON’T LET THEM KEEP YOU FROM SETTING YOUR FEES.
Determine your fee using the worksheet and video guide and then charge those fees.e.
Don’t have it yet? Get it.
Myth #9: If my fees are low, I’m bad. I should be mightily castigated. Hourly
As you’re reading this article, it is hiiiighly possible that you’re beating yourself up for not having summoned the courage or pizazz or whatever you imagine it is one needs to:
1) Know what fees you should be charging based on your financial needs and then
2) Charge those fees.
I’m going to step out of my role of shaming, ball-buster (or vag-buster as the case may be) and give you this little nugget: Be kind to yourself.
Really, despite my no-nonsense, shit talking style, the only way any of this can really work is if you’re kind and patient with your delicate little heart.
This stuff isn’t easy.
If it were, you’d have done it a long time ago. You’d be some private practice wunderkind, like this adorable knucklehead.
I greatly admire the therapist podcast aficionado, Melvin Varghese – creator of the top-rated podcast Selling the Couch. I was surprised and relieved to hear that even Melvin struggles with anxiety with reconciling our desire to help people and our need to get paid for our expertise. After reading this article, Melvin wanted to share this with us:
“Many healers (myself included) believe that we’re “just nice people.” The thought of being a caring soul AND charging what we’re worth doesn’t seem to line up despite our years of highly specialized training. But our abilities are not the norm; the world would be a much better place if they were. Our work as healers is vital to this hurting world. Our work matters.”
We all do our best at the pace that we can. One of the reasons that I love writing for therapists is because we all came from some kind of struggle. We’re all working to level up, change, grow, make a difference and help people in the ways that we so desperately wished someone had been there to help us.
So, cut yourself some slack from the you-bashing.
Rather than criticizing yourself, just do the thing – fill out the form, figure out your fee, and then charge it.
If you’re struggling to take action, reach out! Talk to a friend, a colleague, a mentor – even me.
You don’t have to be alone with this stuff.
Myth #10: If my fee is high, it limits who I can work with
Actually, quite the opposite is true!
What really limits who you can work with is… burnout!
If you’re stretched to your max, trying to see 30 hours of low-fee clients, barely able to pay your bills, much less having money or energy for your loans or spin class or little Jimmy’s first grade knickers or little Jimmy himself (!), then you’re surely not doing your best work as a therapist.
By having a primarily low-fee practice that leaves you struggling to make ends meet, you’re actually perpetuating a system in which those who are at the bottom of the economic barrel get bottom-of-the-barrel treatment.
Painful, but true.
Check it out, if you have a high fee that allows you to pay for the trainings, personal therapy, organic carrots, awesome consultation, trips to the hot springs and all the other things you need in order to show up as your best therapist self…then you will have more than enough energy, time, and financial well being to really serve those who fall into your population of passion.
Though it feels counterintuitive, what really limits who you can work with are your own feelings of stress, overwhelm, anxiety and sense of lack. By setting yourself up with a stable financial foundation, you will have more capacity to serve whomever you want, not less.
Remember, you must start with step one (self-care and financial stability) before you get to step eight (giving back with a fully bursting heart).
The Facts About Fee-Setting
- One of the most thrilling things about private practice is that there is no limit to what you can do!
- You get to choose what hours you want to work. Seriously! You get to work whenever you want!
[And I don’t want to hear anything like, “Nuh uh, Tiffany. I can’t work at 2am!” YES YOU CAN. And I bet you’d discover awesome niche around swing shifters, insomniacs and new parents.]
- You get to choose what you earn.
There is no conceivable cap on your earnings beyond the cap you place on yourself.
- You get to choose to work with whomever you want.
Really. Is it possible to work with underprivileged youth and make $200,000?
Sounds ridiculous, right?!
But, guess what, you are your own boss, so if you can conceive of how to do this… then yes. There is no one to fire you or demote you or give you a harsh talking to. Well, besides yourself.
Check out some of these amazing clinicians who have broadened their practice beyond the fee. They have found ways to bring in a basic income that is not reliant on fee-for-service clients, thus freeing them up to make more expansive decisions about the kinds of fees they accept in their private practice without compromising their financial wellbeing.
Miranda and Kelly are two amazing clinicians who have created increased their financial foundation by creating an online Private Practice Boot Camp that helps therapists up their private practice game. They have also created the Most Awesome Conference in collaboration with some other brilliant therapists in order to give back, while also creating a stable financial foundation.
Therapist Development Center.Com
A lot of you have heard of Amanda Rowan, LCSW. She created online training programs to help therapists pass their licensing exams. What you probably haven’t considered is that she is a clinician who made the choice to create an additional income stream that could take some of the economic pressure off of her private practice, thus freeing her up to take on low-fee clients, if she so chooses, without making sacrifices to her bottom line.
Perhaps you’ve heard of Melvin Varghese – an early career psychologist turned podcaster who busted onto the scene with over 65,000 downloads in less than year! Melvin is another amazing example of what we can do as clinicians if we allow ourselves to expand beyond the fee for service model. Melvin has created an online podcasting workshop and membership community, both of which provide freedom and flexibility in terms of his finances. I don’t think Melvin has yet to open his practice, but when he does, he will certainly be starting with a HUGE referral network and plenty of options about his fee range, because he’s already done the work up front to establish a solid financial foundation.
The Next Step
Okay, guys, I know this article was long, but here’s what you got:
- You’ve learned to tell the difference between myths and fact when setting your fees.
- You can now recognize when your fears are getting in the way of your professional success.
- You have some solutions that can help you take action even when you’re afraid.
If you’re having a hard time setting fees based on objective reality, then definitely download the “Fun with Fee’s worksheet.
In it, I’ll walk you step-by-step through:
- Setting your Fee based on your current expenses
- Knowing what you need to charge in order to have the lifestyle that you dream about
- Figuring out how to set your fees so that you can keep the sliding scale clients you already have without compromising your professional and personal goals
If you happen to be one of those people who has a pretty good idea about what you need to charge, but you still find yourself stuck, sign up and stayed tuned.
I’ll be sending you a video course that will knock your socks off.
And you know what, it’s all free! WHY? Because I have set up my practice so that I can give back. Cool, huh?
Set Your Fee
Every potential client price shops and wants to use their insurance. The wealthy and the gov’t employees with great insurance seem to be the most miserly of all, even about $13 co-pays! I learned this working for a busy and bustling private practice where i earned $30 per 45 minute session and made nothing for no-shows and cancellations. While i don’t accept insurance in my practice (and don’t have clients anymore — all my clients, most of whom never paid full fee, have left, citing money troubles — and their salaries far exceed anything i have ever made as a social worker), i also don’t personally know ANY therapists who are thriving without accepting insurance. Who are they? Where are they? They certainly aren’t here in my area of NJ. Yet people who balk at paying for psychotherapy will gladly pay hundreds to psychics and charlatans and “life coaches.” BTW all your links are to things that are discontinued. I am burnt as hell and want out of social work. It’s all hustle for 40+ hours a week & lots of pressure for a minimum of 30 billable half hour sessions — HALF HOUR –! even when working for someone else and no REAL money. All these employers want workhorses who are responsible for getting those 30 billable half hour sessions per week. That is insanely poor practice! I’m well into middle age with no retirement in sight because i didn’t just buckle down and get a gov’t job when i was young. So is this for real, or a way to get $$ off of desperate therapists who are piss poor & burnt beyond recognition?
Hey PissPoor! I’m loving that you’re leaving so many comments. Thank you for letting me know about those broken links. I’ll fix them asap.
NOW! as for your question about whether anyone in the WORLD will actually pay for psychotherapy out of pocket, I definitely recommend you check out this new podcast The Money Sessions. I think you’re about to have your mind BLOWN. ==> http://leaninmakebank.com/category/podcast-the-money-sessions/
I am currently a LLMFT and was leery about starting my own private practice this early in the game but I was encouraged by my supervisor and my passion/ vision was driving me to get started. I’m not sure if I’m crazy or just driven to get started but I’m working my butt off to grow my practice. Setting fees is a difficult conversation but you broke it down in a version that makes sense and speaks truth.
HA! It’s certainly not crazy to start your own practice and work your butt off to make it happen. In fact, it could be the sanest move you make! I’m so glad the article was helpful and I’m stoked that you’re getting started on this journey. Huzzah, Siedah!
I am just starting my own practice after more than a decade of working for others. I am nervous about it as I am not sure I will have enough clients and if I am going to have a stable job. On so many sites, people claim that they just started their practice and suddenly had a full caseload and a noticeable change in income as well as their happiness with their employment. It really isn’t that clear if this happens and, if so, how this happens. Any ideas about it ? How true is it ?
Congratulations on starting your practice. What an exciting journey. It is definitely possible to build a thriving and profitable practice in 3-6 months. “Easy” – I’m not sure as there are a lot of *emotional* and *behavioral* growing pains associated with building a business, but in terms of tactical strategy – yeah! Attracting clients who are willing and eager to pay your full fee merely involves a series of steps.
The first and most important piece – find and INVEST in someone who has a proven track record of having built a practice themselves and who has successfully taught others to do it. I definitely recommend checking out Allison Puryear’s Abundance Party and Melissa Lawton’s coaching programs if you want to DIY it. . There are a ton of people out there who help with this who are really good!
If you want to hire out the marketing, check out Becky DeGrossa over at CounselWise or John Clarke’s team over at Unconditional Media!
You got this!
Compared to other professions, psychotherapit get paid too much! Engineers, lawyers, accountants and professors do an enormous amount of work outside that billing hour. Most professions have an up front cost to get work in the bidding process, syllabus, briefs, etc .I see therapists lining clients one after the other with no breaks between, meaning no processing between. With back to back clients, therapists are doing no prep before nor remarks afterwards. Therapists take days off between work days and many cosequetive week in a row off to “clear” their psyche or mind. Many professionals do not have that luxery; putting in 65+ hours a week with a vacation, one week, once every four years. I find therapist cannot remember from one session to another with clients. Justification for pay due to schooling is not feasible either. School is expensive no matter what field. Self promoting not based on experience is self defeating to both clients and ultimately psychotherapists. Architect and engineers must work 4 to 5 years under a professional, after getting their highest degress, before beginning to test for professional status. Experience is again required to obtain professional recommendation. Get your rates aligned so real people can get the help they need!!!
F. Golding are u kidding? Therapists do all sorts of ancillary work outside of the actual session, particularly those like me who work in community mental health centers. None of that is billable and employers are loath to pay more than $30 per hour, usually less. Because that and the enormous amount of State required paperwork aren’t billable, the employer insists on stacking the clients into half hour sessions one after the other leaving no time for that required paperwork or any of the other ancillary work. All the other professions u mention make way more right out of school than i have ever made. Please get your facts straight.
Not to mention there often is no time for lunch or a bathroom break and therapists often wind up doing that paperwork after hours and on weekends.
I remember those days when I worked in community mental health. Ay yi YI – a struggle. Let me ask you this, PissPoor, if you *could* design your professional life to be exactly what you wanted, what would that look like?
I know this was years ago and you probably won’t see this, but this is so wrong. I work for a group practice right now. Last year I worked at least 60 hours a week and I made about $32,000 before taxes and about $22,400 after. I work at least an hour out of session per client–most often more. I prepare for every client (if I have clients “back to back” then I prepare for multiple clients before I see the first–also even with back to back there should be at least 5 minutes in between because sessions are generally 53-55 minutes), I have notes, emails, phone calls, I consult with the other care team members for my clients, I talk to parents, I find resources and other helpful things for my clients, I have to deal with billing and talking to insurance, I consult with other mental health professionals, etc. My costs. At this point I take insurance–that means that sometimes that is $60 dollars for a session. My work place takes half. So that’s 30. Let’s split that in half with the work I do outside of session, so $15. Then we take expenses into account (fidgets, books, continuing education, computer, hipaa compliant phone and email, ehr, etc)–that ends up being a good 25-30%–so we’ll be generous, say 25% and get down to 11.50. Then we have to take taxes, because as a contracted worker I pay personal taxes *and* the taxes for the business side of things. That’s about 30%. So then we’re down to $8.05 an hour. And no, I don’t get health insurance, vacation, sick pay, etc. So try to factor all of that in, too. I have a lot of health concerns and, for example, spent a month in the hospital after a major emergency surgery this year (yes, with no health insurance or sick pay. I did have to work some during that time, but only work that wasn’t billable…so only unpaid work). Do I only get $60 for each of my clients? No, but it’s not far off.
I DO still see this post.
Thank you for sharing your experience.
I’d love to know more about where this article didn’t resonate with your experience. We’re big on engaged dialogue.
Also, check out our podcast, The Money Sessions, to hear even more nuanced conversation.
[…] went a little something like this: You, the therapist in private practice, get yer hands on my 10 Myths of Therapists Believe Around Setting Their Fees article. It knocks your socks off. You excitedly download the Fun with Fees worksheet and use it to […]
Tried getting the doc but it won’t send it to me. Is there another way to recieved it?
Uh oh! What happened when you tried, Eric? I’ll follow up via email.
This is an amazing read for anyone starting out, I am from India and we have a loose therapy structure here but same doubts as a therapist. Thank you so much for writing this and coming up with a guide and worksheets.
[…] five minutes to fill out the Fun with Fees Worksheet and get a realistic sense of how much it actually costs to achieve the standard of living that you […]
I love this post and have recommended it to colleagues, even if they aren’t thinking about money quite yet. I wanted to quickly share a lightbulb moment that I had recently…. In my former life I was a massage therapist and it occurred to me the other day that I was earning (20 years ago) the same for giving a 50-minute massage that I am currently getting reimbursed for now (after years and years and years of training) for a 50-minute talk therapy session (thanks insurance). I was in school for 9 months to be a massage therapist, enough said. Anyway, your post helped kick this little revelation up and I am so appreciative! I am feeling even more energized to get paid what I believe my services are worth.
Oh my GOSH! YES, Alexis!! I am so glad you shared this. It is remarkable to think about how we therapists undervalue ourselves. Professionals who have spent MUCH less time and money in training and gaining experience often charge 2, 3 or 4x’s as much as we do. It’s not that humans in the world don’t value talk therapy, it’s that we often don’t then invest in learning how to speak to our potential clients to communicate that value – ie, marketing! I LOVE that you had this revelation and I love Love LOVE that you’re sharing this article. Thank you!!
If you have no good friends to talk too then sure pay someone $250 buy a good friend to bear your soul too so they can laugh with their “colleagues”
Therapists! Here’s an example of one way people out in the world who are not familiar with therapy think about it. Have you ever gotten comments like this? How do you talk about the benefits of therapy for folks who imagine it’s the same as having a good friend?
Tiffany!!! This is nothing short of life-changing for me!! I literally copy-pasted huge chunks of this into my journal, going, “get out of my head!”. I am now off to do the worksheet.
I’m only about 8 months into my practice, and the phone hasn’t been ringing because I haven’t done a lot of networking, marketing, etc. Your video course as well as all the other AWESOME stuff you’ve been so gracious to share with the world (like this article!!) has inspired me and I am off to get a LOT more done for my practice. You rock, THANK YOU!!!!!!
You ROCK MY WORLD!! Thank YOU, Vanessa. I am THRILLED to see that you’re taking your practice to the next level. I cannot WAIT to hear what is coming down the pike for you. I see some winning on your horizon. Fuck YEAH!
I am a behavior analyst who dreams of opening up my own practice in the future. I truly appreciate all of the information provided here on this blog.
Morales! It is AWESOME to hear from you. I LOVE your dreams. I hope we can make that future happen sooner rather than later. 🙂
[…] 10 Myths Therapists Have About Setting Their Fees […]
My experience with this would blow your mind. In a good way. My practice is about to hit 7 figures. Everyone told me it could not happen. Never been on any insurance panels. Determined to help people and be fairly compensated for years of school and training.
So glad you are doing this. I’m so tired of the pervasive belief we are supposed to be poor.
Kim – you have ABSOLUTELY blown my mind. Oh, I’ll be emailing you. Believe YOU ME.
Thank you so much! I’ve been all around this issue getting nowhere! I have volunteered so much in the past years since I earned my MA in 1994 that I don’t feel the need to give back right now, but I did need the kick in the butt to step up and take responsibility for my income.
Allison – YES!! This is awesome! Man, oh man. If your hourly rate is $150 and you’ve volunteered 15,000 hours over the past 20 years, you’re basically at a $3oo,ooo volunteer surplus. Feel free to get an extra $300,000 in your savings account before you hit the volunteer train again. 🙂
[…] You may have all kinds of reasons to take clients for less than your full fee – all of which are addressed in this article. […]
I Believe! I believe! I Believe!
I am surrounded by naysayers, skeptics and those who are “concerned” that I am limiting myself.
I just started my PP January 1st after two years of 2 different indentured servitude internships with low salaries and ridiculous % splits.
Many of my counselor & social worker friends are well meaning but not helpful when advising me that I must get on panels.
I joined a FB page for people sharing info about credential ing. Every time I read something, I feel anxious and wonder if some of these pros are addicted to the martyrdom of begging insurance companies to be paid for work they already did. No thanks.
Your words and how you use your words really resonate with me- so thank you! I am hiding that aforementioned blog and want to use my screen time on the like minded and affirming resources that you shared.
Alli, sooo… I’m getting the sense that you… believe.
Would it be accurate to make that leap?
HA! Yes – YES! I’m so glad, Alli! There ARE so many therapists out there who are doing amazing work, charging good fees, giving back to the community AND living a life of passion, security and joy. I LOVE your enthusiasm and I have no doubt your practice is going to go swimmingly. Keep spreading the word! It’s so important that newbies (and oldbies, alike, I suppose) know that there are therapists like you out in the world. You just made my morning 🙂
Please stop yelling at me. I have a hard time with these articles that insist I must be afraid and anxious in all these different ways if I disagree. I read them anyway to glean what I can as I start and grow my private practice. And I do learn something. But the tone is so off-putting! My greatest concern is that, in proposing a “me first” attitude, the potential for elitism is never mentioned. Just the insistence that the reader is burned out, afraid of money, and weak-willed. I understand the tone is supposed to be humorous and it still leaves me feeling assaulted.
Papillon – I yell! I yell! What can I do?! I get excited.
Thanks for bringing up the potential for elitism. I know that suggesting that you sign up for my 3-part course would be the most EGREGIOUS thing I could possibly do. That said, I suggest you sign up for my 3-part course. Heh heh. I address the ideas of elitism there and how we use it to… Hey! You’re trying to get me to tell you what it’s about! Don’t scam.
I’m glad you’re here. Stick around 🙂
You took the words out of my mouth. Background for context purposes….I earned a PhD. after first participating in a PsyD program, which didn’t address my research needs as originally indicated. I earned my LCSW-R years prior. I have worked in the field for roughly 22 years in various settings. I have had a private practice for a decade. I also teach on an adjunct basis for cumulatively nearing 10 years. I am also a licensed real estate agent on the side for investment purposes. I’m beginning my 40s with plenty of time on the clock to enjoy my remaining professional and personal life. I work in NY, specifically lower Westchester County. I have always been an insurance based provider (a few out of pocket only) for primarily ethical reasons and the fact that the accessibility to clients is so high that I can afford to pursue work with those who interest me most, professionally speaking. I have done my own billing the entire time as I happen to love numbers and after speaking with countless colleagues, I wasn’t ready to lose between 10-30% of my income because of mismanaged claims and even fraudulent behavior on the part of the bookkeeper. I’m content with the latter arrangement. I have considered transitioning to entirely out of pocket because of the more recent “doctor shopping” approach I am observing with my clients and general sense of disregard (by some not all) for policies which include full payment for cancellations in less than 24 hrs. I have always been weary to work with out of pocket patients where I practice since the ones I have now from privileged circumstances are becoming less tolerable to me due to their lack of ability to discern between a genuine problem vs inconvenience, annoyance, or irritation. For example, receiving $10k instead of $15k as a X-mas gift because your father needed the difference to put towards healthcare is not an actual problem, losing your 41 y/o mother to COVID is while having no living parents at 20 y/o. I prefer strongly to work with the latter who utilize insurance. I don’t foresee a realistic way around the problem I’ve observed for years and I’m turned off to make the transition knowing what it will likely look like. I do; however believe based on my educational attainments, experience, and area of specialty that I deserve a stronger salary. I am able to maintain a nice lifestyle vis-à-vis insurance, i.e. I don’t own a yacht but I do own 2 luxury vehicles “for fun” since I love cars. I’m genuinely uncertain how to best proceed to receive what I do believe I’ve earned financially while also avoiding the elitist attitude you point out. It is entirely off putting when I speak with professionals who say, “if they don’t like XYZ, they are welcome to find someone else.” We did agree to work with people with mental illness in a helping profession, correct? Whose needs are we meeting then? Again, I live in one of the wealthiest areas in the country so I am thankful for what I have and I question is my colleague with a masters education and 10 years of experience, entitled to $350/45 minutes of time simply because she feels she’s worth it?!
Nice article, and you are funny. I just started my PP, but I meditated on fee for a little while. At the beginning it was (gulp) 180, and now I’m getting more and more comfortable with it. Waiting for my clients to start calling.
YAAAAAAY!!! Dalila – good for you!! Believing is the first thing and it sounds like you’ve got that part down. Let the waiting begin!
(but in the meantime, take some action…what’s your next step?!)
Dalila! Somehow your comment eluded me for 5 months, but I’ve finally discovered it. CONGRATULATIONS!!! You’re doing it! I think the hardest part is not letting our fear dictate our actions and it seems as though you’ve marshaled the resources to stick with your fee despite your initial anxiety. Given that it’s now 5 months later, I would bet you feel MUCH more comfortable with $180. Am I right?!
Thank u so much! This was just what I needed to hear. I started my practice in October, 2015 and my caseload is now down to 10 clients per week. I’m basically freaking out! Many told me to get on an insurance panel and I almost did but chose not to. But it’s been very hard and I’ve been riddled with fear. I’m looking forward to completing my worksheet and talking to my colleagues I know who have a successful and thriving full fee practice. I really can’t thank you enough!!!!
You’re welcome!!! You, Jena, are what keeps me going 🙂
Stick to your guns, set your course and keep going. step. by step. by step.
I think the most important thing is to know, really know viscerally, what you are doing it all for and it will only be a matter of time before your business (and life!) starts falling in line with what you want. Trust me. I’m going through it right now and it is WILD.
Glad I found your blog Tiffany as I am just about to start thinking of what I want from my private practice after I graduate.
Awesome Muuka!! Shoot me an email and let me know what you’re thinking about. I’d love to hear what your DREEeeeeEEAAAm practice looks like!
The 82 percent trust thing is that from an article?
Hey Jens – it’s from a survey I put out! Here’s a link so you can see the questions (and take it if you want!): https://docs.google.com/forms/d/1JLRD6PcWHo4FrD835GyRhdXsCdIDNferjmGqQmB4hok/viewform?usp=send_form
…and HI 🙂
Great stuff, Tiff! Thanks for the kick in the ass.
Bill – I’ll kick your ass anytime. Just say the word.