During my graduate school practicum placements I never had to think about the financial aspect of seeing clients. Billing specialists took care of collections. That was their job. After graduation I worked in a private practice setting where I was required to ask clients directly for...money. It was awkward at first to have clients share their pain with me, open their hearts, and be so vulnerable, and then ask them to pay me.
Adding to my money anxiety was the fact that I was charging the same rate as my clinical supervisor and I didn't believe my services were worth it. My supervisor helped me gain confidence by explaining that clients aren't just paying for my time and skill, but they're also paying for her years of expertise. I hadn't thought about it from that perspective before.
My supervisor also helped me to view myself as a professional. Even though I wasn't licensed to practice independently I did had a graduate degree and two years of practicum, and I was licensed to practice under supervision. I had valuable experience, knowledge, skills and tools to help my clients.
Almost 10 years ago I started a solo private practice. Suddenly, I was the therapist, the receptionist, the webmaster, the marketer, and the billing specialist/collections department. I realized that I had to get even more comfortable bringing up money with clients if I was going to build a successful practice. Through the years I've become extremely comfortable addressing the financial aspect of clinical practice with clients. Here are a few things I've learned to help you get more comfortable with money in your private practice.
1) Value your expertise
Keep in mind the time, money, energy, and passion you've invested in your education and training. The more confident you feel in yourself, the easier it will be to accept client's payments and comfortably bring up money issues.
2) Think of money as energy exchange
Money can be such a loaded topic, fraught with baggage from your own upbringing. It may help to reframe money in a more emotionally neutral way, as energy. You are offering your gift of investing energy in the therapeutic experience in order to help your client, and they are offering you their energy resource called "money."
3) Ask for payment at the beginning of the session
I've found that it works best for me to bring up money related issues at the beginning of sessions before delving into deeper therapeutic issues. It's awkward to ask for money after a client shared deep pain during their session.
4) Set firm payment policies and stick to them
Clients will take your lead with money issues. Setting consistent policies regarding payment from the onset of therapy teaches your client what you expect in the therapeutic relationship. If you're anxious about asking for money, your client will feel uncomfortable too. If you're confident, they'll likely respond positively. My clinic policy is that if you are one session behind in payment your therapy is on hold until your account is up to date. Also, we charge full fee for no shows and late cancellations, even on initial sessions, unless there is an emergency.
5) Money is a clinical issue
If you have clients who resist paying you, who "forget" their checkbook, who cancel at the last minute and don't want to pay you, treat the resistance as a clinical issue. Consider how the client's money patterns are part of the larger issues brings them into therapy and address it openly in your session.
6) Write a "money script" and practice it
I've recommended to several therapists I've supervised or consulted with who feel anxiety bringing up money with clients to write down a brief script and role play. Here's an example of the phrases I use in my practice.
At the beginning of the session, before walking into my office I ask, "How would you like to pay for your session today?"
When potential clients ask, "Do you work with my insurance company?" I respond, "While we don't bill insurance directly, I'm happy to provide you with a receipt to submit for reimbursement from your insurance company. You may want to check with them and ask if you have out-of-network mental health benefits."
Do you have money anxiety? What blocks do you have when it comes to asking clients for payment? How have your overcome them? Feel free to post your thoughts and comments below.