Don’t Choose Your Therapy Fee with Your Eyes Closed

I’m admittedly biased when it comes to therapy fees in private practice.

It ties to my values.

I believe humans deserve places of work that nourish and energize them.

I want therapists to feel alive and excited by their businesses.

I want clients to experience effective, impactful therapy.

What does this have to do with fees?

Private practice therapists rely on fees to cover the cost of running a business and pay for their personal life. It is their income for all of the things that create a grounded, stable life: food, rent, bills, health insurance, sick days, vacations, education, retirement, and more.

Private practice therapists usually have this in the back of their mind, and then set their fees based on what they think is fair, the average fee in their area, or what they think they “should” do. Most therapists deeply want to help others and they feel they must be accessible to everyone, which often translates into low and sliding scale fees.

"Conundrum" Illustration by Jackie Schuld

As an unintended consequence, many therapists find themselves in a conundrum. They either have to increase their client hours to meet their desired income or they have to make less than what they really want.

Many therapists end up seeing 20+ hours of clients a week and depleting themselves emotionally and mentally. Other therapists simply sacrifice their long-term well-being and don’t save for retirement or an emergency savings fund.

I don’t like either of these scenarios. I don’t want therapists to sacrifice their current well-being to make a living as a therapist. I want therapists to thrive. I also want therapists to be taken care of, meaning they have financial safety nets in place when the inevitable sick day arises or when retirement comes.

I want therapists to do what we teach our clients: honor your needs.

How do we do that?

It means examining our money stories. It means looking at our relationship with money: the past, present, and future. It means being aware of the narratives that shape how we set our fees. It means identifying the cultural norms that influence how we feel about money. It means sitting down with our budgets and looking at how much we actually need and want for our lives. It means being real about the dreams for our lives and determining if we actually want to fund them or not.

It’s the work we do in therapy with our own clients - but on a topic that most therapists feel deeply conflicted about us.

Once we can really dive into money, explore, understand, and converse openly about it, we can make decisions about our fees that honor us instead of what we “should do.” From this grounded place, we can also come up with creative solutions to meet our needs and honor our values.

One therapist I know chooses to see 12 hours of clients a week at a rate that supports her.

Another therapist sees 20 clients every week, but takes the 4th week off every month.

Another therapist charges three levels of fees: supporting (for people who have extra income and can donate a portion of their fee to support others), standard rate, and supported (a sliding scale fee funded by the supporting fees).

Another therapist has the same fee for everyone, and then offers groups so she is more accessible to others.

Another therapist sees 80% of her clients at her full fee and 20% at a reduced fee.

I see all of my clients at the same rate. Instead of a sliding scale, I prefer to give back in ways that are free to the community and evolve over time. What I offer depends on my energy capacities at the time. Sometimes it is essays like this one, other times it is free art therapy activities, pro bono art therapy intensives, or volunteering with a local non profit.

I share all of these examples to free you from the idea that there is one “right” way to do it in private practice. We are all unique humans with unique needs.

What I do hope you gain from this essay is the resolve that your needs matter. Putting that into action means looking at our money stories. But it is worth it, because it leads to a more nourished, grounded, and joyful present AND future.

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