Food prices go up, gas goes up, your utility bills go up, your insurance premiums go up, your office rent goes up, as well as taxes, and, well, pretty much everything else related to your cost of living goes up, but how easily do you ask for a raise when you are in private practice or self-employed?
In the same vein, as Art Psychotherapists: What is your Worth?, this blog post addresses a professional practice question asked by many art therapists: “I have not increased my rate for service and supervision for years, however I am conflicted with how to handle a substantial increase. I would like to be at double what I am asking her now because my fee is so low. How do I raise my rates?”
Here is the simple answer: You decide what your new rate* is going to be and pick a date at least six weeks in advance to implement it. Send a written letter to all of your clients or supervisees informing them what your new rate will be and when it will become effective. If you do not see your clients weekly, send this letter by mail so enough time is given to prepare and adjust for this change. I believe it is best to give current clients the letter at the beginning of a session, rather than the end in order to give ample time to discuss this change, if need be. If you have a waiting room, you may wish to post such changes as announcement in a visible place including your stated new fees. By posting this in the waiting room, it gives your clients a little time to digest this information before entering into the therapy space and before being notified directly by you. Bottom line, you must inform your clients what your regular rate is and let it be known before the first session, preferably in writing (perhaps in your Consent to Treatment Form) and anytime thereafter.
Here is where it gets a little more complicated: You cannot have different rates for the same service for different clients. This would be akin to employers offering different rates to employees of similar background, training, or expertise based on an arbitrary determinate, which is considered discriminatory and creates a lot of animosity in the workplace if (and most likely, when) salaries are leaked. This is why employers offer a salary range for certain positions based on education and expertise, even if they don’t always disclose it. So if you offer a sliding scale to clients based on financial need you will have to determine how you will assess that need. Will you take their word that they have the need because they said so? If so, consider, how will you may feel when they buy a new car, get their nails done weekly, or take a lavish vacation? In order to determine need will you ask for a monthly budget to assess their income and expenditures; request a copy of their tax return; or want to see proof of public assistance? If accepting a fee lower than your normal rate, be sure to make a notation on the receipts indicating the amount paid is a sliding scale rate based on need and is discounted from your regular rate, which is also stated on your receipt. This prevents the adjusted rate be your “new norm”. When a sliding scale fee is established, it is helpful to discuss the expectation that should their financial circumstances change (i.e., a better job, a second job, a roommate or partner that helps to share the patient’s financial burden, or a lucky windfall) that a revisiting the current sliding scale fee will be necessary.
Here are the big issues that make discussing money so difficult for therapists and clients: The financial arrangements for therapy are often related to larger issues with money and need to be addressed within the therapy. In my experience, the three largest issues when working with couples are: Children, sex, and money (not necessarily in that order). Attitudes and relationships with money can be very complex and need time for processing. For many, discussing money is a huge taboo; so struggles are kept secret. How people prioritize their spending often reveals their values. Money can be used as a means of restricting and compulsive buying, acting out, or getting even. It can symbolize love, esteem, power, security, greed, and good will. It can be used as a form of punishment and may become an instrument for some sadomasochistic behaviors. These are not the proprietary issues of clients. Therapists too must grapple with the multiple meanings and relationships they have with money, including how they ask for what they deserve and how to continue to evaluate and adjust course when needed.
When selecting a mental health provider or supervisor or setting rates as a professional, like perfume, cheap is not better. In private practice, therapists want to be reknown for their expertise (or niche), not as the “cheapest” therapist. As a clinician, undercutting yourself, your colleagues, and the mental health field only leads to an unsustainable, anxiety-filled existence and sets a poor example of self-care, advocacy of professional and self worth, and mentoring of future professionals. Managed care companies have already derogated the value placed on professional mental health services. Asking for a living wage and adjusting as needed is imperative for therapists. The monetary portion of the work allows therapists to invest in their work and focus more fully on their clients. You are the best tool, and arguably the only tool, you have in the therapeutic relationship so it makes sense to care for yourself.
Seeing sixteen – twenty clients per week is considered full-time in private practice due to all of the other administrative and business demands as well as the emotional intensity and potential hazards of the work. Seeing more clients, on a regular basis, runs the risk of eroding the quality of the therapy as well as placing the therapist at risk of developing illness (i.e., vicarious traumatization and compassion fatigue). Being able to care for oneself and family and attend trainings and retreats allows mental health workers to be in the best position to care for others. The caretaker must able to have their own needs taken care of emotionally, spiritually, and physically in order to provide the optimum service. Payment for services are just one piece in this equation.
* If you are having a difficult time naming a reasonable rate, check with your national and local professional organization for their latest salary survey. According to the DVATA’s latest survey, the average fee for private practice is $110 with the highest rates in this area $169.99 per session and groups are reported at $60.50/session. For the full report check the member’s only section of their website.
© 2014, All rights reserved, The Center for Psyche & the Arts, LLC and Michelle L. Dean, MA, ATR-BC, LPC, CGP, HLM (DVATA)
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