How to Avoid Resenting Your Sliding Scale Fee

Most therapists went to school because they love helping people. For that reason, counselors in private practice usually offer sliding scale, or reduced fees, to a certain number of clients. We want to make sure those who truly need it are able to get therapy, even if they can’t afford our regular full fee. And we feel all warm and fuzzy inside about it, too… until we start to feel used and then resentful, that is.

That’s right, I’ve heard time and again about well-meaning therapists starting to doubt whether or not their reduced fee clients really needed the reduced fee. Or, I hear of therapists who were swayed by a client’s story of need and are now feeling a financial pinch because they couldn’t really afford to provide therapy at that rate. 

How do we reconcile this desire to provide affordable services to those who need it most with our own need to provide for our families, take a regular vacation and continue our professional growth? The answer is to create a sliding scale policy! Consider how reduced fees fit into your business plan, write it out, and stick to it. Here are three things to consider for your Reduced Fee Policy:

  1. Business Plan. I know, this is not a fun word for most counselors. However, a basic business plan is necessary for determining how many overall slots you have for clients, setting your fee, and deciding on a reduced fee or number of pro bono slots. Not sure where to start? Check out this free webinar on How to Set Fees.
  2. Time. How long will you allow clients to see you at the reduced fee? I recommend you plan to evaluate the client’s need ongoing and at certain intervals (3 months, 6 months, etc.). For example, you may decide to offer a reduced fee for a client who recently lost her job. However, will you continue the reduced fee once she starts working again? Six months after she starts working? Financial constraints are often time-limited and it’s totally appropriate to expect your clients to pay an increased or even full fee once circumstances change.
  3. Financial Criteria. What are your financial criteria for the reduced rate? Is it a scale based on income bracket? Or maybe you decide on something like a flat rate for all graduate students. Will you take people at their word or do you require some sort of proof of income? What type of proof are you comfortable asking for and how will you verify the information? Most therapists have a small business so it’s not like you’re going to do a full credit check, but you do want to know you weren’t swindled. Decide what is in your comfort zone but also what will make you feel confident you’re providing a service to someone who is truly in need. 

The last thing you want is to feel you’re being taken advantage of when you hear your client mention other costly purchases throughout your time working together. Nagging thoughts of “How did she afford that trip?” or “She told me she only makes $1000 every two weeks!” don’t need to enter your professional life and taint your view of your clients.

Consider the following scenario: A therapist friend calls you about a possible referral. He says someone called him seeking services but their need is not his specialty. He knows this is the perfect client for you and as he describes her you know it, too. You call her and hear the pain in her voice as she describes her financial situation and you are 100% confident this is a great pro bono or reduced fee client. You take her on and start doing great work together. One month later, you get another phone call from someone seeking services and she tugs at your heart strings as well, but you just don’t have the space to see her and refer out.

The last thing you want popping into your head after that phone call is doubt that your other reduced fee clients are taking up slots they may not need. You want to feel good about your work and you don’t need negativity hovering like a dark cloud over that. 

So, review your current policy and see if you’ve really considered your business plan, time, and financial criteria. Don’t have a policy yet? Now is the time to open up a blank document and get to typing! Review it with a therapist friend when you’re done to make sure you’ve considered all the possibilities. If you’re still having trouble getting started, check out my free online training- The Private Practice Paperwork Crash Course.

P.S. Notice how I keep using the term "reduced fee" over "sliding scale"... check out why in this video!