Money and Therapy Post #3

A Big Money Topic – Raising one’s fee:

Therapists out there – how often do you raise your fee? Do you raise it by the same amount each time? If you have a sliding scale, do you raise the fee differently depending on what your patient is paying you? Do you sometimes raise the fee with most but not all of your patients, or do you raise it with everyone?

Therapist/Supervisors out there: how often should one raise supervision fees? I have a supervision group that I started four years ago, June, 2008, and it still costs the same per month per person. The economy was worse then. In addition, I pay 30$ more monthly to my own much more experienced and well known supervisor for the supervision group I attend. Should I be charging the same to my supervisees as what I pay? I now have three new people in the group which consists of 6 members, so of course it is my excuse that it is not good to raise the fee when half the people in the group just joined it in part because they figured into their budget that they can afford it.

Art therapist supervisors: I have an art studio supervision format, which means a lot of art making and processing through art takes place in the group. Should I charge a separate materials fee, say every three months an extra 5$ from each group member? So far, I’ve never done that…

Since starting my private practice many years ago, I have raised my “full fee”, the regular amount I charge that very few people can afford and that one insurance company actually pays me, so I’ve raised that fee two times in about ten years! When I write that, I think, it’s time to raise my fee. However, in reality, most of my patients whose insurance does not pay me or who don’t have insurance, are stretching their budgets just to pay what they are paying me now… So I know this is not a good time to raise my fee. Another thing about this topic, it makes sense to raise one’s fee at the beginning of a new year. Somehow people are more able to accept it and it seems less random…

There is the big problem of the economy; I think I raised the fee more regularly before 2007; I don’t even remember exactly when the economy got very bad. However, it is hard these days to raise a fee that hardly anyone can afford on their own. There is also the philosophy I discussed in another post. Basically some people believe there is a fee ceiling to therapy, meaning, therapy should not cost more than about $125-$150 per session hour (50 minutes). I believe that to be true, that there is a limit to how much a session should cost. I even think a reasonable fee is probably a little lower than my “real” fee. Partly I have this “real fee” for people on the sliding scale to recognize to what extent I have “slid” down to meet them where they are at financially. I now won’t accept anyone who can’t pay at least half my regular fee. Most people would think this is too much of a sliding scale, but I remind everyone, this is New York City, meaning that, yes, I have to pay New York City rent on my studio office, but my patients are paying too much of their salaries on their own rent and other New York priced necessities like food, and don’t have much cash left over to pay for therapy.

So this post was meant to focus on fees and fee scales as well as the issues of raising fees and how often to raise them. The questions I’m trying to bring up, besides the ones I already asked are:

Therapists and patients: how do you feel about raising your fees? how do you feel when your therapist announces to you that s/he is raising his/her fee? same question for therapists in supervision with their supervisors raising fees for individual and group supervision.

Therapists and patients: do you believe that there is some kind of fee ceiling for therapy, ie. therapy just should not cost more than somewhere in the neighborhood of $125/session? That there might be a fixed value for the therapy session, especially given the unique aspect of therapy: most people see their therapist once a week, and thus pay about four sessions per month. There are no other doctors you see that often, unless you are going to physical therapy or other forms of therapy, such as yoga therapy, hypnosis, acupuncture, Reiki, etc. When I pose questions about fees I include all these forms of healers in contrast to regular physicians and medical specialists.

Most patients are quite respectful and do realize that most therapists are very dedicated and invested in their work, but they are running a business and have expenses like rent, electricity, insurance, advertising/internet marketing, and for art therapists, a lot of art supplies. In my studio I aim to have a really wide variety of materials, so I do spend quite a bit on supplies as I think it is important for patients and supervisees to see when they come in that they have a lot of creative options. I also have a sandtray and figurines for it, as well as extra sand because a lot of sand ends up on the floor. This is a special kind of sand called moon sand, which costs quite a bit, but it’s totally worth it! The subject of Sand Tray therapy with children and adults is fascinating, and I intend to write a whole post about it soon…

So yes, therapy involves an intimate form of paying money and being payed. There is a conversation at the beginning of therapy that involves fees and cancellation policies. When the sliding scale is discussed, the patient is required to actively think about his/her budget, how much s/he can afford for weekly therapy, and the patient usually takes into account what the therapist’s regular fee is, and usually wants to respect that the fee needs to somehow be reasonable for the patient and respectful of the therapist’s experience, skills and business.

In some ways, a lot of these issues are circumvented by the existence of health insurance. I do have a lot of patients who pay through insurance. However, I have a soft spot for “starving artists”, meaning actors, musicians and performers and visual artists out there who don’t have health insurance. There are also patients who have health insurance, but often the insurance won’t pay out of network or won’t pay a Licensed Creative Arts Therapist. In those cases, I know my new patient is very invested in working with me because s/he chooses to pay out of pocket, when s/he has the option of finding someone else whom the insurance would pay. In those cases, even if the person is paying on the low side, I feel very grateful for their investment in working with me in particular and that we have a strong therapeutic bond, even after just a few sessions. 

This last example shows how the fee can really express a lot. It can be the patient telling the therapist, “I really like working with you; I don’t even want to choose the economically easier option of just finding someone on my insurance and paying a low copay.” That to me is much more valuable than anyone, insurance company or person, paying me my full fee. It involves someone choosing an option that is worse for them economically because they really value the therapeutic alliance or what their gut is telling them about working with me. A lot of people can tell pretty quickly that they have a good fit or not with their new therapist, and this is one of the most fulfilling votes of confidence one can receive from a patient. Money can communicate a great deal. And money does matter. It means a lot of different things to different people, but money is about value, and how much you value the service you are seeking out and receiving…

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One thought on “Money and Therapy Post #3

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