The Bottom Line

The Bottom Line

A Fee Policy Can Clarify the Therapeutic Relationship

By Lynne Stevens

November/December 1998

Money is an underdiscussed topic in graduate programs, supervision and peer groups, yet every therapist I know has felt the awkwardness of seeming mercenary when insisting to a client who has fallen behind that he or she needs to pay. Unfortunately, most therapists were never coached about how to reconcile the closeness of the therapeutic encounter with the fact that therapy is also a business. When I first started out, I made the mistake of letting my caretaker impulse overcome me and charging a certain client who was in crisis a lower fee for several sessions. When she didn't pay even that fee and later let it drop that she had gone on an extravagant vacation, I felt like a fool. It has taken me years to understand that therapy is not separate from the exchange of money. I am in this profession because I care and have skills and knowledge that can help, and I also need to make a living.

These days, I run into the problem of clients who don't pay far less frequently than I used to. I attribute this to two changes I've made. The first was convening a peer group to discuss money issues. We examined our family values and messages about both the importance of money and the secrecy that often surrounds money matters, while also looking at the impact of social messages about gender and earning potential. When I heard everyone's war stories about clients who owed hundreds of dollars or terminated therapy without paying, I realized that my discomfort with money wasn't a…

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