The $12,000 Mistake Many Therapists Make

Ending sessions on time or charging more for extended sessions not only models good boundaries, it's good for your business.

What's the big deal about giving a few extra minutes to your clients? After all, we are in this field to help others and we are generous souls by nature, right? Yes, we are. However, an on-going pattern of giving away a few minutes each session adds up over a year's time.

Let's say you see 10 clients for 50 minute sessions per week= 500 minutes. If you go over 10 minutes with each client you're doing 600 minutes of therapy and only being paid for 500 minutes. That means you're giving away 100 minutes of therapy every week. After one year of giving away 100 minutes every week you are giving away 5200 minutes of free therapy. 5200 minutes is the equivalent of 104 free 50 minute sessions every year. If you charge $115 per session your practice is giving away $11, 960 of free therapy a year!

In addition to thousands of dollars of lost income, therapists who have a habit of giving away their time carry the stress of running late for other sessions, not taking adequate time for self-care, and falling behind on clinical notes and other administrative tasks. These chronic patterns may ironically lead to you being a less effective therapist with a less successful practice.

Now, just to be clear, I am all for pro bono work. The problem with this kind of "pro bono" work is that therapists don't realize they're giving it away and clients often don't realize they are being given a gift of therapist's time. Clients may come to expect 60-minute sessions because therapists have taught them that this is the norm and may then feel ripped-off when their therapist decides to start setting firmer boundaries.

Setting firm boundaries with session ending times, and charging for additional time allows you to consciously take on pro-bono clients, because you have more time, energy, and resources to offer free services. If you struggle to end sessions on time, here are a few suggestions to help you.

Suggestions for setting boundaries with session length:

1. Set the expectations from the very first session. It's a lot easier to set the norm of ending sessions on time, than to bring it up later in the course of therapy.
2. Keep your agreement. In your initial consent for treatment paperwork be explicit about how you will handle longer sessions. Let the client know that if they need more time they will have to pay more. If I am in a session and it seems like the client would like to go longer, and I have the flexibility of giving additional time, I might say something like, "Our session is just about over. It seems there's more here to work on. I have an additional 15 available today, would you like to keep going with session even if it adds additional cost?"  Since I charge $150 per 45-50min session. If a session goes 15 minutes over I charge an additional 1/3 of the session fee.
3. Recommend scheduling longer or more frequent sessions. For clients who seem to have difficulty processing their issues and containing their affect in a 45-50 minute session, schedule longer sessions (75 or 100 minute sessions), or offer to see them an additional session per week.
4. Start wrapping up 10-15 minutes before end of session. Give them explicit verbal cues like, "We have about 15 minutes left in the session. Let me tell you what I've heard today..." Physical cues like sitting up straight in your chair or standing up when the session is over may help you send a congruent message that the session is over.

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Pause Before Posting About Work On Personal Social Media Pages (part 1)

We all need to vent about a hard day at work, but clinicians should think twice before posting on personal social network pages.

Guest post by Kimberly Sandstrom, MFTI

Have you ever have a long day at the office and wanted to vent your frustration to someone? Me too! We are containers of all sorts of confidential information and sometimes our containers get full, or we get triggered by something that happened during the day. It’s hard to hold it all in at times—especially when it touches or triggers some reaction in us. Yet, we are called to an oath of confidentiality, and sensitivity to our client’s information. For most, venting to a trusted colleague or a relaxation activity can be enough. Yet, some therapists use their personal social media accounts to release stress about their clients. Can’t believe clinicians do this? Read on.

As therapists, we reach in, listen, validate our client’s pain and help them make sense of it so that they can reflect, respond, and repair the distance in their relationships. It can be emotionally draining work. And we need ways to work out our stress. But are personal social media accounts the place to do this? Probably not.

Yet, some therapists post things their clients did or said that made them laugh or made them upset.  Yes, you read that right. I’ve seen complaints about cancellations, clients not following treatment plans, and negligent parents. Then there are the posts intended to be funny—pictures of notes clients left for them (yes, I have seen this), pictures of children in the local paper they treat (this too!). Friends comment back “lol” or similar funny retorts, and then everyone gets a good laugh.

My heart drops whenever I read these posts.

What about all the people in their friendship circle who are in therapy or contemplating therapy? Do they wonder if their own therapist is posting something they said? I know I would.

We have such a wonderful opportunity to promote a positive image o

f ourselves and our therapeutic community and to cultivate confidence in the therapy process (see Julie Hanks' article on using social media in practice). We also have an opportunity to foster community with our public who often need courage just to pick up the phone and call us for support. Posting about clients negatively undermines these opportunities!

The good news is that therapists who post in a negative or comical fashion about their clients are definitely in the minority. And, given that I have seen some of these posts myself online from people I know, I take the view that their posts are not meant to be harmful but meant to release steam from a difficult day, or to draw others in as a way to cope with the “compassion fatigue” often experienced in this line of work. While the person posting does not intend harm, ultimately, in a round-about-way, they can elicit harm. How do we address this problem as we experience stress burnout and how do we address this with our therapeutic community?

Next time, I will provide tips on how to create self-awareness of our personal postings about our work, promote a positive image of therapy, and how to approach colleagues who may not be aware of how their posts about clients impact our wonderful therapeutic community.

Kimberly Sandstrom is a Marriage & Family Therapist Intern and Relationship Educator, Supervised by Kathryn de Bruin, LMFT, working in private practice in San Diego, CA. Married for 24 years, she and her husband are raising three daughters, two of whom are now adults.  She works with couples, and families to create emotionally safe and enduring connections in their most cherished relationships.