To Charge or Not to Charge, That is the Question

QUESTION:

Often I have people who complain of financial difficulty and want me to lower my fees.  I have a difficult time knowing what to do about this.  I don’t want to stop someone from benefiting from my services, yet I don’t want to be used in some way by people who really could afford me.  What is your experience with this, and your advice?

ANSWER:

I struggle at times with this question myself.  Mainly, I put it back into the lap of the caller with a suggestion they save up for my first session, because of the amount of extra work I put into preparing for them such as setting up the file, giving them a free CD, etc., and then to come to our session with their model of what they can afford to pay for their following sessions, or some other way they can participate. If the person has a skill I can use, I take that into consideration for bartering possibilities.  If a person cannot do at least that much, then you can expect they will not be a dependable client, later.

I keep open and continue to struggle with decisions about this, even after all these years, for these reasons:

(1) When I was extremely ill--on death's ground, I was working with an international organization where I got my room and board and $100 stipend for the entire month for everything else in my life.  Needless to say, I took advantage of low-priced medical clinics for many years in my life. Unable to get help from any of these doctors, I was introduced to natural medicines and special healing practices, which, at that time, were not covered by insurance companies.  It was only through the generosity of a healer and the persistence of my husband that I received much needed help for very little to nothing in the way of money. This was due to the fact that this healer (also an acupuncturist), who later became my mentor, sensed that I had some kind of destiny as a healer myself, and considered me to be part of her "tithe”.  Also, my naturopathic doctor, who required full payment, was lenient in allowing time for the money to be raised and arrive for my weekly sessions.

(2)  My first and one of my finest office assistants was on welfare when she came to me for help.  She paid me full price for her first sessions, and then began to work in my office on a barter system.  Once her sessions were done she continued to be my office assistant, and was a great one, because she had experienced so positively what we were "advertising."

More often than not, however, I’ve experienced negative results from offering discounts, sliding scale, etc. These have included other counselors to whom I’ve given courtesy discounts who continually changed their appointments to suit their own schedules, did last-minute cancellations or didn’t show up; a desperately depressed woman living on the streets who needed me urgently, whom I agreed could come in at the end of the day for free, who didn’t bother to show up; and a school teacher to whom I not only gave a discount but was willing to waive payment until the next visit who didn’t show up for her appointment, never returned my call or e-mail, and never did pay me.  There are other such stories throughout the 26 years I’ve been doing this work.

Here's what I’ve come to feel:

(1) You are worth something in your practice and should charge for it on the basis of your amount of experience and training.  The charges should be in keeping with your geography and other similar therapists.
(2) People need to feel like they have some commitment of some kind, even if they can't afford much, thus they should pay something commensurate with their income.  This has to do with human pride.
(3) People who talk "poor" aren't always poor. (Check the car in which they arrived.)
(4) Every therapist should be aware of others in the community who can offer services at a greatly reduced price, or sliding scale. This allows you to offer referrals of those who can better meet their needs. In my “tickler” file I have a list of such professionals. I also have a list of those who handle insurance.  A person should not be left without resources after calling you.
(5)  If a therapist is in a situation where there are quite a number of people who need services for less, then it is within one’s power to set aside special times of the week or month for sessions that require less money. Another idea is to do half sessions rather than whole ones, for less money.
(6) Keep in mind other ways a client can pay, such as trading services (make sure they are worth it) - painting a room or house, gardening, doing clerical work, answering your phone, running errands, cooking meals, exchanging some service they are involved in such as salon work, etc.

Once in a great while, you'll run across someone who is very desirous of their own healing, but just doesn’t have the resources --That's when your own heart needs to reign over your pocket.  Only you can make that decision; each person is a unique case.