Dollars & Sense

Clinical Issues with Money (for therapists)

Posted Jan 02, 2015

For clinicians, many may struggle in private-practice because of the quandary they face regarding charging clients for work they see as a service to the community. Therapists as a whole go into this business not for money but for improving the welfare of individuals, families, and the community at large. Part of this is my own journey in wanting to work with multicultural clients, specifically Asian-American and African-American clients since that is the world I grew up in. However, in the transition from community mental health and school-based agencies to private-practice, I had to eventually work through my own issues with money (i.e. charging clients for therapy). Questions related to fees, late charges, NSF checks and everything that comes with running a business crashed head-on with my idealistic world of doing therapy as a means of "giving back to the world". I had to wrestle and reconcile with a broad range of money-related issues and come up with a fee that I felt was not only ethical as a therapist but also viable as a businessperson.

Part of this process is learning how to draw boundaries for yourself, so clients can learn through their relationship with you what healthy financial boundaries look like. These issues crop up when clients don't pay on time, ask for a "free pass" for late cancellations, have checks that bounce, ask to pay at later dates, and a plethora of other payment issues that come up. If you as a therapist, do not have a policy in place for these issues then you need to first get one. Secondarily, you need to process why it's difficult drawing boundaries with clients when it comes to money. Do feelings of guilt, care-taking, or desire to please override other choices? Do you find it difficult to require clients to pay late-charges or NSF fees for bounced checks? Do you shudder just reading this blog and my insistence on being comfortable with money?

When I think about this topic, I'm also reminded of my reluctance early on to ask couples about their sex lives. I would tell myself, "Why talk about that since they're not addressing it?" But through time, I learned if I wanted to be a better couples counselor, I had to become more comfortable talking about sex with them. In the same vein, if you want to be a better therapist, you have to become comfortable with money on your end of the therapeutic relationship so you can better serve your clients.