I suppose we are all hearing about the economy from at least some of our clients. In one of our groups recently, up came the topic of priorities. The topic of fees and money in our work is so central and worthy, and one that is (oh, forgive me) rich with possibilities for understanding much about the client, how they communicate, what they need and fear and how they deal with change. But of the many, many facets to the discussion of money and therapy, the subject of how we therapists view therapy was pretty fascinating.
Is therapy a luxury? Is it a necessity? Who decides this and how? Some of you tell me that you feel guilty charging your fee when people are having a difficult time. And some of you tell me you have difficulty paying your fee to your own therapist.
Should we help clients to come and stay? Is that too sales-y? Do we slide our fee? (Does the massage therapist?) Do we really believe in what we do? Is it possible that coming to therapy actually helps people prosper? And make more money? Why are we hesitant to conduct business as usual?
I am not at all saying that we should encourage folks to come to treatment that they cannot afford. But I am asking us to consider what afford means. What is our work worth to us and why? And what is it worth to them?
I think that these are things that can be discussed in session. I have seen many solutions. Some people have to come less often, some have to take a break for a while. Some of you have reduced your fees when the need was clear, and with the understanding that when things get better the fee will be returned to it's regular status.
There are many possible answers, but I don't think we can get to right ones, or the highlight the choices without some good discussion about our own ideas. What does it mean to us to lower a fee or change a schedule? What message are we sending? In some cases, we may be sending out the idea that things are indeed pretty bad, and they won't get better. It's an emotional message, not a verbal one, when we agree to a fee reduction or frequency change.
Sometimes it's a message of despair, not of understanding and support. Sometimes it may signal that we don't value the work, or value the client, when we lower the fee. Not always, we can't be sure unless we really talk it. We can't be sure what message we are sending to the client about their worth, their potential. Or our interest in working with them. We can't be sure what message we are sending to ourselves. And sometimes lower fees leave us resenting the client. Also not good for the treatment.
Lots of therapists have the idea that they are being supportive, or practical, loving even. And it may be so. Just not so fast I think. Our relationships with clients are important. Our time with them is sacrosanct. Not to be dramatic, but we work hard, and with concentrated effort and dedicated time. We are not (well, I don't think so) the mani or the pedi that could be done at home.
And what about our fears? Of losing clients, of financial insecurity. It's difficult enough to have your own business, and have your paycheck change from week to week. To have to bring in business on top of doing good work. How much do we know about our own fears and the effect they have on our decision making when it comes to fees? Do we think we must slide to keep business?
I think that we all prosper when we give ourselves permission to really talk out our ideas to a good ear, and to study what's operating underneath. We do not have to act quickly. I think sometimes we want to resolve things fast. It's hard to stay with uncertainty, uneasy feelings. We so humanly go for the good feeling, but I think we miss out on a lot of good information when we do this. Not to mention the opportunity to model patience, curiousity, tolerance for bearing some discomfort, and the value of talking, consulting and understanding something more fully. Even in our business, I think we sometimes forget we can benfit from studying even, maybe especially, the basics!
So, to know where we are coming from, and to unpack what's influencing our choices, when we are working toward the best idea in difficult times. And to take a look at our own ideas about therapy, and about our own therapy, and about what we consider valuable and priority and worth it's weight. It's key, I think for our own good care and toward the well being of the client, the work, and even the economy.
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4 comments:
Good grief.
It's not so complicated. When people are making more money, they should pay more. When they're making less, they should pay less. It doesn't take a weatherman to know which way this wind blows, now. The Fed just cut interest rates to nearly zero percent. We've chosen a helping profession. It's our responsibility to suck it up and help our clients. Fine. We'll go on vacation to Florida this year instead of to Bali or Hawaii.
Sheesh. In times like these, lowering a fee for a client who is hurting financially devalues nothing, and is a huge caring gift. Not lowering it is cruel and selfish and bad modeling behavior.
Maybe we all need to spend more time in churches and synagogues instead of with our IRA statements.
It's not something I ever really thought about. When I switched counselors about 2 months ago (for someone who specialized in the things I needed) we discussed her fees. I knew that I was going to need to be seen every week, and at her rate I just wasn't going to be able to do that. We discussed what I was previously charged, and she agreed to see me at that price, which was a bit more than 40% less than her normal rate. I could have managed a bit more than my previous fees, but with her generosity and acceptance of my situation, I feel so much more willing to go weekly, if not two times a week when needed because I know that she gave me the ability to have that choice. That being said, I think as our relationship furthers I will ask her about re-evaluating our fee. She does great work and I definitely do not want to take advantage of that generosity.
Lisa Marie,
My point exactly, is that there is value to the discussion. Afterall, why do people go to therapy? To learn about themselves, what they want, what is in the way of getting it. Perhaps to feel better, to get over hurts and hurdles. Well, many reasons.
And what is the fee for? I mean, what exactly do we charge for? Our time, our analytic ear, our guidance, our expertise? Depends who you ask.
We don't negotiate fees with the grocery store, or cable company, or the gas station.
Most doctors and dentists don't negotiate either. Though a friend of mine who is struggling financially told me that her doctor told her to keep her copay, (not pay it). My friend felt very loved by this.
And a lot of lawyers I know do pro bono work, or barter. Or maybe it should be as anonymous above suggests, like taxes. The more you make, the more you pay.
I think many therapists try to make treatment available and manageable for clients as long as they themselves can afford to.
Point is, that money has a lot of meaning, and I think that when we don't take at least a few minutes to be curious about what the meaning is to us, then we may be missing out on some good work.
Melissa
Actually, we do negotiate fees with those who provide personal services to us, and whom we are paying for their expertise. Tennis teachers. Carpenters. Plumbers. French instructors. Personal trainers. And, I would think, those doctors and dentists that do not accept insurance. Isn't the parallel of psychotherapist to these sorts of professionals, instead of to someone whose business is to sell gasoline, beer, or even clothes at the Syms bash?
As a client, if I had a financial windfall, I'd offer to pay all these professionals more. If a setback, in order to continue with them, less. I hope you would, too. Especially when the relationship itself has such great meaning, and assumes its own currency.
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