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Voice of Experience: Billing guilt

By Gregory K. Moffatt February 18, 2020

I am a very poor bookkeeper. I will admit that up front. I am capable, but I just don’t enjoy managing the finances of my clinical setting. Perhaps more importantly, for many years I felt guilty about charging my private practice clients.

Therefore, I was hesitant to mention overdue balances or to expect payment from my clients at the time of service. It just felt awkward. If clients didn’t pay their bills, I often would let their accounts slide into history and eventually ended up closing their files with an amount due in the ledger.

Then one day, many years into my practice, I got some new accounting software and decided to clean up my old books. For no reason other than curiosity, I went back through all my overdue accounts and was stunned. The total owed by overdue clients was in the thousands of dollars.

Granted, this was over a long period of time — more than 10 years — but those individual accounts that I let slide had added up. I could have bought a new car with that money. Fortunately, my private practice was not my primary source of income. Otherwise, I very likely would have been operating in the red.

It is uncomfortable asking for payment, but this seems to be true only for counselors. Can you think of any other service in which the vendor is hesitant about asking for payment? I can’t. Whether they are plumbers, mechanics, dentists, morticians or babysitters, people get paid for providing a service.

Nearly all of my new counselors, interns and supervisees express some hesitation about charging clients. One experienced counselor, in fact, asked me to look over her revamped informed consent. Her fees were clearly listed.

“You aren’t charging enough,” I told her.

“Really?” she said sheepishly. “I don’t want to be greedy.”

I asked her what her time, education and experience were worth. She had two degrees, was fully licensed both as a professional counselor and as a marriage and family therapist, and had several years of practice under her belt. Yet her fees were the same as when she was still in supervision.

I asked, “Are you providing a service that has value to your clients?” Of course, she said yes.

“Then there is nothing wrong with being paid what you are worth, at least within the market standards.”

She decided to raise her rate — and she deserved the higher fees. She also saw no change in her client base. In other words, none of her clients questioned paying a rate consistent with the standard in the field. As it should be.

One of my colleagues who has run a successful private practice for many years taught me something on this topic. She had a basket in her waiting area with a sign: “Check goes in the basket before you come back” (to the therapy room).

These days, her sign probably says something like, “Payment on my cash app must come through before therapy starts.” I don’t know. But the point is that she set an expectation for payment that was reasonable and clear, and people lived up to her expectations.

Even though my informed consent said payment was due at the time of service, I wasn’t clear about what my expectations for my clients were. My practice demonstrated vague expectations, so my clients back then lived down to them.

I completely understand why we feel guilty about charging as professional counselors. After all, we are helpers, not mercenaries. But few things in life are free.

If a client balks at my fee, I’m happy to provide referrals. I’m also very generous with pro bono hours — as are most therapists. But I no longer feel any guilt about charging my clients or my supervisees. I’ve invested in my career, it costs me money to run my practice, and I’m good at what I do.

“How much is your marriage worth to you?” I asked one potential client who hesitated at starting marriage counseling. (Sometimes I asked, “How much does a divorce cost?” That usually put things in perspective.)

“I guess it is worth $150 an hour,” he said, referring to the fee his therapist was charging. And it was worth it for the therapist too. She used her expertise to help heal a damaged relationship just as a physician might use medication or surgery to help the body heal.

Regardless of whether you have a sliding scale or a fixed rate, accept third-party payments or are cash only, you are providing a service. You spent time, money and energy developing and maintaining your expertise. You deserve to be compensated.

 

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Gregory K. Moffatt is a veteran counselor of more than 30 years and the dean of the College of Social and Behavioral Sciences at Point University. His monthly Voice of Experience column for CT Online seeks to share theory, ethics and practice lessons learned from his diverse career, as well as inspiration for today’s counseling professionals, whether they are just starting out or have been practicing for many years. His experience includes three decades of work with children, trauma and abuse, as well as a variety of other experiences, including work with schools, businesses and law enforcement. Contact him at Greg.Moffatt@point.edu.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

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