Raising Your Fees Could Make You a Better Clinician

Contrary to the subtle & not-so-subtle messages you got in grad school, having people pay real money for the services you provide doesn’t make you an awful person. In fact, it may make you more effective. I recently raised my fee to $150 per session. It had been $125 per session for 4 years and it felt like time for a raise. Plus I’ve been elbow deep in my own money work and decided to practice what I preach. I had the response you might also have when you raise your rates: fear that no one will pay it, concern that my colleagues would think I was full of it, relief that I could take on fewer clients and maintain my income or keep the same number of clients and take more vacations. I also had a reaction that I had forgotten about when I gave myself a raise 4 years ago- I wanted to up my game. Something about getting paid a lot of money makes me want to over-deliver. I don’t want my clients to question whether or not that was money well spent. I want them to leave feeling like they are working with the best therapist they’ve ever seen. Now, for me over-delivering doesn’t mean emailing back and forth at 9pm on a Saturday. It means maintaining great boundaries so I can model that for my clients. Over-delivering also doesn’t mean spending every spare moment in consultation or continuing ed, though it does make me more selective when choosing where to consult and learn. Over-delivering actually means being better to myself. It means spending some of that extra cash on self care or vacations so I’m not burned out. It means taking some time before each session to get grounded and present so I can do my best work. It means prioritizing sleep instead of playing around on the internet too late at night. It means saying no when I’m full and sending referrals to other therapists I know do great work. There is money out there. There are people willing to pay good money for great services. There are also people who truly can’t afford $XXX per session and that doesn’t mean you shouldn’t serve them. You can charge $XXX for private pay and still take insurance, but only if you don’t get resentful. You can charge $XXX and have sliding scale, but only if you don’t get resentful. A lot of people say that people who pay more are more invested than people who use insurance or pay a sliding scale fee, but I disagree. Sure, it’s true sometimes, but some people spend $150 with the same ease that I spend $3 because they’re that wealthy. It doesn’t necessarily mean they have skin in the game. Conversely, one of my hardest working clients right now is a sliding scale client who makes $50/week happen to come and see me. I don’t mind the $100/session difference because she is invested in healing and growing and she truly inspires me. In my experience, there are no truisms based on clients’ hard work and money. However, there are truisms based on your hard work and money. If you feel like you aren’t getting paid what you’re worth, it doesn’t feel as gut-wrenching to dial it in. If you’re charging a lot, you’re more likely to be on point. If you’re selective in who you take on for sliding scale, you are able to weed out the people who can afford full fee but don’t want to financially prioritize therapy. Then you don’t get pissed off when they come in with a $300 purse or details about a fabulous vacation. A question that often comes up is whether or not to raise fees with current clients. Do I go to the clients currently paying $125 and tell them my fee is now $150? My often controversial answer is no and here’s why: you have developed a relationship with someone who has shared her/his vulnerabilities with you. You are connected and there is attachment. Even though you likely try to minimize the sense of hierarchy, it is still present. For me, it feels predatory to renege on your financial agreement and the unspoken social contract. There will be another post going more in depth about this, but I want to mention that this does not mean that if you get off insurance panels, you just need to charge your client the copay amount. Having an intermediary like managed care in the mix is a different scenario altogether. So, what happened to referrals when I raised my fee? They actually increased! There was a confounding variable though in that I re-branded my website and updated my website copy at the same time. My guess is that by charging a little bit more and having a better web presence, people saw me as more valuable. Try this: if you were in the market for a therapist and one therapist charged $60/session and another charged $150/session, which would you assume was more competent? So, that’s why I encourage you to raise your prices if you’ve been thinking about it (or to think about raising them if you haven’t). Work your way out of any scarcity that may be nagging at you. Your turn: Email me with your fee concerns. What do you want to charge? What are you afraid will happen if you set your fee that high? Or, do you feel like you’re low-balling yourself? Feel free to forward this or any of my newsletters on to friends and colleagues. :)Allison Puryear is an LCSW with a nearly diagnosable obsession with business development. She has started practices in three different states and wants you to know that building a private practice is shockingly doable when you have a plan and support. After retiring her individual consultation services, she opened the Abundance Party, where you can get practice-building help for the cost of a copay. You can download a free private practice checklist to make sure you have your ducks in a row, get weekly private practice tips, listen to the podcast, hop into the free Facebook Group.  Allison is all about helping you gain the confidence and tools you need to succeed.


1 comment

Allison Puryear

Coaches often charge more than therapists, so I'd play with what you consider "reasonable." I'd make sure you feel solid with your coaching skills (since it is a different skill set and not "therapy lite" as some might think). Make sure you have great supervision or consultation in case you get stuck and then sit with some different numbers. Choose what feels both exciting and scary to you and what your ideal clients can make work.
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