The Money Talk: A Guide for Therapists in Private Practice

Lisa Marie Bobby:

Today, we’re talking about a topic that many therapists find deeply uncomfortable, and it’s not sex. It’s actually money. Specifically talking about money and fees with clients. This can be a really common pain point in my experience, especially. especially for therapists transitioning out of an agency or medical model setting into a private practice.

But I think it can be hard for a lot of us. Let’s get real. And if the thought of talking about fees or unpaid sessions or late cancellation policies and how you’re going to uphold that. If that idea makes you feel kind of squirmy on the inside, you are not alone. I have struggled with this too, transparently, but today we’re going to be discussing not just what to do with this, but really like doing a dive into the root causes of this discomfort and discussing some ways of handling these conversations.

With confidence and clarity, and I hope that by the end of today’s show, you’ll have a new understanding for what is going on with some of these things, specifically what’s going on with you as it relates to some of these things, but also that you have a little toolkit of, okay, here’s how I’m going to handle this going forward.

So, um, to, to dive in, I, I am Dr. Lisa Marie Bobby, I’m your host of the Love, Happiness and Success for Therapists podcast. And every week, you know, I’m talking about things that are struggles for us as therapists in this challenging profession. Um, my role, I’m the founder of Growing Self Counseling and Coaching, which has grown over the last, gosh, I don’t know, even 10 years into, uh, pretty robust group private practice.

We have about 60 clinicians running around here these days. And one of the things that I’ve been doing more and more of is, you know, thinking about how do we teach and help and support and, and mentor and just kind of love and take care of clinicians so that they can love and take care of their clients and be really not just caring, but also helpful and effective for clients.

But so that their needs are also met. I believe that clinicians, the therapists like us deserve to be happy and healthy and get their emotional needs met, but also experience success and satisfaction and dare say prosperity. in this career. And so a lot of what I do day to day is like, how do we take care of therapists and advocate for them and champion for them?

Um, and one of the things that I have spent a fair amount of time doing is working with clinicians and coaching therapists on our team around their own values and feelings or baggage and stuff. issues around money specifically, because there can be these really big barriers that therapists don’t even realize they are holding onto that can create a lot of problems for them, particularly when it comes to success and prosperity.

in private practice or in the profession in general. And you know, what I’m doing with this podcast is really just kind of broadcasting a lot of the stuff that we’re doing internally at Growing Self, you know, in hopes that it’s connecting with you. If you’re not plugged into, um, you know, a group private practice or an organization that really has That, that growth culture or that community support baked in, like I know, and you know, that you need it.

We all need it. So, you know, that, that’s what this podcast is all about. And that, that’s really, I think why today’s topic feels so salient and important for me, because when we as professionals or personally are carrying Discomfort around money and talking about money and having relationships that are transactional with people that we care about.

Um, again, it can create these obstacles to. the kind of professional experience that we would like to have. So that’s, that’s where we’re going today. And I’ll just, I’ll preface this, you know, in the introduction, I mentioned that in my experience, I have found this to be very frequently true with clinicians who are moving from an agency setting or a clinic setting.

Kind of setting, particularly one that is based on the medical model. So, you know, insurance pays for the treatment of psychiatric conditions, kind of deal people, therapists coming out of those environments, um, into private practice, either a solo private practice or truly even a highly supported group, private practice, like growing self, um, struggle.

With this, they can feel very, very uncomfortable talking with their clients about money or communicating the value of their services. And, um, this is also something I think that that surprises. a lot of clinicians because, you know, it’s, it’s really common if you’re in a community mental health center in an agency to think about, you know, private practice would be so much better, right?

Uh, and in some ways, you know, it certainly can be in terms of the, well, theoretically, the freedom. I have not personally met a small business owner who, um, Would describe their experiences being free and typically small business owners have have exponentially increased their workload because of the realities of trying to run a business, but sorry, I’ll save that for our next therapy sessions.

My my own stuff. However, uh, one of the things that is very, very challenging for people coming into any kind of private practice environment is experiencing the fact that in an agency setting, clients aren’t choosing you. They are not selecting you and they are also not paying for your services.

Somebody else is paying for it. It could be Medicaid, it could be insurance, but that is a very different dynamic than a client who has lots of different choices and who could work with anybody. Why should they choose you specifically? That’s hurdle number one. And then also, they have to pay you directly for it.

And so managing that, talking about your rates, collecting for your services. I mean, you know, if some like magic health insurance system is paying for that, clients aren’t paying the bill. So they’re not like, wait, how much was that? Or, Uh, what do you mean? I have a fee for standing you up for the session, right?

That’s like just simply not part of the experience at all. And talking about money with clients for a client who is paying you well out of pocket is a totally different animal. And so, you know, that, that can be a reason why some. clinicians do some soul searching around how do I really feel about having to market myself, having to sell myself, having to communicate my value with confidence, having to, you know, um, set boundaries and have expectations around what my services are worth and that people are going to pay for those.

Like some clinicians are like, I don’t, I don’t want to do any of that like ever. And that That is enough of a hassle and enough of like a business mentality that they’re like, yeah, that’s, that’s really not who I am or what I want to do. So I think I am actually going to stay in an agency environment or in a clinic setting because that is more congruent with who I am and what I want to be spending my time thinking about and doing.

So. That’s a totally fair and valid decision. And I just wanted to say that out loud because, again, therapists do not see that one coming until they start doing it, and they’re like, Oh, this whole thing energetically is like really different in private practice. Yes, it is. So, If you have heard this and you’re still like, no, I still want to be in a private practice environment.

Let’s crack into some of the other things that can make talking about money with confidence and empowerment feel really hard. And also, you know, some things to, To do about this, um, in my experience as a clinical supervisor, as a mentor, as a business owner, and I have also experienced this personally is that sometimes our own feelings of guilt or self worth issues can be at the heart of feeling uncomfortable talking about money.

So, um, Are we charging too much? Am I good enough to warrant what I’m asking people to pay? Would I pay this much to talk to me? Um, are my clients really benefiting from this? And those are valid questions. Therapy, especially traditional talk therapy, um, non directive, person centered, growth oriented talk therapy, like, it can be quite vague and fuzzy.

It can be difficult, I think, sometimes for clients, and legitimately so, to be like, where is this taking me? Right? Like how is talking about this, like getting me to where I want to go, totally valid actually. But also if you as a therapist are like, yeah, where, how is this benefiting you? I mean, like really, cause, um, I think I’m fun to talk to, but that’s not why we’re here and you’re paying me to help you get results and have transformation in your life.

Is that happening? Right? Right? Right. And so if we as therapists are not fully sold on our own services and the benefit that people are getting from this, it can be really easy for us to second guess our worth, um, or feel guilty about charging what we charge. And I also think that, well, that’s something that needs to be.

In our awareness and maybe managed, I think that there’s also a lot of value and embracing those dark emotions to say, am I really creating value for my clients? How do I know that I’m creating value for my clients? Because if I’m going to be charging this much, I sure as heck better be. Right. So don’t throw that baby out with the bathwater.

I think that that can be an important moment of soul searching. And I will share that that is actually one of the big reasons that I personally made the decision to transition in my career from identifying as a therapist. So a psychologist, a marriage and family therapist. That was one of the big drivers for me of getting involved with coaching psychology in a coaching mindset.

It is much more centered around outcomes, goals. Yeah. Where is this going in a way that, um, can feel much less well defined in therapy. Now I will say clinical mental health treatment. You are coming in with major depressive disorder, and we are here to help you feel better and reduce your symptoms. That is a very clear cut path.

And so I think that clinical mental health has a, uh, much more clearly defined trajectory. So what I’m talking about that can feel vague is, um, you know, therapy that isn’t clinical mental health, but it’s also not coaching. Can, like, what’s the why, right? So anyway, um, coaching is, is what helped me pull that together and not saying that you need to become a certified coach, although that’s certainly an option, but to be thinking about how do I know that this is valuable to people and, and solving that.

And this also goes into another reason why it can be very hard for clinicians to talk about money, which is this subterranean imposter syndrome that we may or may not be fully aware that we’re holding onto. And I will say that many clinicians, especially either people new to private practice or earlier career clinicians.

are often grappling with a pretty bad case of imposter syndrome. You know, that, that nagging feeling of not being good enough. Do I really know what I’m doing? Um, you know, it’s, am I deserving of these kinds of rates? Right. And have that little voice in your mind that says, well, I don’t know. Are you like, again, I think, I think it is appropriate for all of us to be operating with humility.

Like, you know what, if I am going to be charging 150 an hour, I need to be doing a good job. And so, you know, bringing in that energy to our sessions, but also at the same time, you know, not going too far on the other side of this, we’re experiencing shame or really like, you know, I’m a self esteem. Um, to be able to value our own expertise, to be able to trust the fact that we do know what we’re doing, um, you know, we, we need to fight back against that imposter syndrome narrative, particularly if it’s making it hard for us to do what we need to do as, um, business owners in private practice.

Another self of therapist issue that is very common that many of us deal with, and I know that I have noticed this in myself from time to time. This is kind of a tendency towards conflict avoidance and a desire to be a peacemaker in relationships. You know, I’m a marriage and family therapist. That’s kind of what I do, right?

Making the peace, but, um, we can’t be conflict avoidant. So for example, uh, you know, I might have a 24 hour cancellation policy, meaning that if you cancel a session with me outside of, you know, a true emergency or being sick or something like that, um, You know, in my paperwork, it says that I am going to charge you for that session anyway.

And, um, I could absolutely do that. But, you know, there’s this, this other part that the conflict avoidant part is like, well, maybe I should just let it go. I don’t want them to be upset with me. Let’s not make a big deal out of it. What if they get mad at me? What if it ruptures our relationship? Right. And, um, I think to a degree, we do actually need to be sensitive to the relationship.

I have charged clients for a missed session. It has created a rupture that we never recovered from. And so I regretted doing that because it torpedoed a relationship that otherwise could have had a long future, right? So we need to make some decisions like how. important is the money to me versus I happen to know that this person is very fragile right now.

They are going to take this personally. They are going to actually get angry and it will disrupt the course of our relationship together. So I need to be making clinically appropriate decisions around sometimes when, um, to hold boundaries and when to not hold boundaries. So I think that it is okay to do this.

However, You know, something that I, that we need to be aware of is that if it’s actually not based on sound clinical decision making, but rather our own desire to for peacemaking and conflict avoidance, you know, that’s something that we need to be aware of. So, and I think the way we crack into this is if it’s a pattern for you.

So I think also conflict avoidance can show up in many other aspects. of our therapeutic role with clients, so not challenging people on things that, you know, our job is actually to challenge them on something to consider, but certainly, uh, around, you know, setting limits, having conversations about money, um, challenging clients around money.

So like, for example, we’ll just tell you, I will still actually offer sliding scale rates because I want to offer sliding scale rates to, um, make working with me affordable for people because, you know, there’s a lot of, uh, financial privilege. I think that can go along, uh, with working with, uh, uh, private practice therapist.

That’s just real. So anyway, this is an important value of mine. So for me, I’m not, I’m not in this for the money, right? I do sliding scale rates and have, I will never forget a client that I was working with. Um, I offered her sliding scale rates and she filled out the form based on her current level of, of income.

And over the course of our conversations, I came to learn that she was very, very wealthy, like generational wealth, inheritances, um, one of the pain points that we were talking about during our conversation was, uh, anxiety that she was experiencing about the vacation home that she was purchasing and like kind of which one to go with.

And I was thinking, Oh my gosh. And so. You know, that was something that I then had to confront because I had offered her very low sliding scale rates. And Then learned that she was quite wealthy. I mean, exponentially more wealthy than I was and, and having to confront that and say, you know, what, what’s going on with that?

And so I had to work through my own conflict avoidant tendencies to do that. Cause there was a big part of me that was like, Oh, just, you know, whatever. It’s fine. I’m sure she had her reasons. Let it go. But also that, um, wealth and money and financial status and identity pieces related to that were actually a very big deal for this client.

And we’re showing up in some unhelpful ways in a number of different relationships in her life, including the relationship that she was having with me. So I had my stuff to manage and in doing that opened the door to what turned into very productive and important conversation with this client about her relationship to money and wealth and how that showed up in her relationships with other people.

So, anyway, it’s a growth opportunity for, for a lot of us to go there, but the rewards can be more than just financial. I guess that’s what I’m trying to say. Um, yet another reason that can make it very difficult for therapists to discuss their fees confidently, um, in private practice are sometimes, you know, very legitimate concerns about needing to fill their practice, especially for solo private practitioners.

And let’s face it. I mean, Yeah. Yeah. We are in a highly competitive industry. There are so many therapists and they all are, you know, kind of oftentimes wanting to work with the same kinds of clients and offer the same kinds of services. And I know there are also a lot of people who want therapy and coaching, but, um, especially in this day and age with the rise of AI and with.

Big corporate organizations, you know, you have better help and you have talk space. I mean, what is simply true is that there are much cheaper, faster options for clients to connect with than either of us. And this is only going to grow with the rise of AI assisted therapy. I mean, somebody downloading an app on their phone costs seven bucks a month.

They can talk to their therapist as much as they want, like, you know, and so I think that this industry is changing really rapidly and every private practitioner is. Already feeling the squeeze of this. So one of the things that, that some people consider is like, okay, well, how, how do I reduce my rates?

Um, because that would help me keep my calendar full. And while that is certainly a strategy, so negotiating downwards and especially if you know, you’re new to private practice, it can be one way to connect with more people than you would have otherwise, but I think also, um, To be aware of what is the message that this is sending about me and the value of my services Is is this what i’m worth?

Do I believe that this is worth more? If so, how do I have those kinds of conversations with my clients where I help them understand what this is actually worth to them? And that can be a smart investment for you as you You’re, um, developing a private practice. So that’s just something that I wanted to throw out there.

Um, and particularly if you feel that. People are saying over and over again, I just, I can’t afford this. I, this isn’t worth it, you know, to be reflecting on that and, and doing some thinking around what is the disconnect? Why, um, am I having trouble in helping prospective clients understand the value of my services or is the way that I am operating or the outcomes that I’m getting people, you know, does, does it actually need.

to be different in order for me to be able to do the kind of work that I would like to do. Do I need to do some continuing education around ways of operating as a therapist that can help me be more effective? Is it again going and exploring coaching credentialing so that I have a more. Clear path to help clients understand.

If you work with me, here’s what we’re going to be working on changing for you. Here’s how, here’s what you can expect. And again, that’s a different culture. It’s a different ideology. It’s a different way of communicating our value. But, but, um, for me, certainly it’s been very effective. Additionally, we need to address yet another obstacle that is probably the biggest one for many of us when it comes to money and talking about money and our relationship with money and talking about clients about money, which is our own cultural and family influences.

Um, money is nothing. It is literally not even a thing. It is a symbol. It is a, you know, something that we have all collectively decided is a stand in for value of some kind or another, right? It is most basic form. It is a means of exchange. And we all come from family of origin systems and cultures that had different ways of understanding and relating to money, finances, and wealth.

Um, and some families such as my own, I mean, we didn’t talk about money at all. It was a taboo subject, which then led me to grow into an adult that felt very uncomfortable talking about money at all. All right, especially when it comes to relationships, like, you know, if we’re going to go out to dinner, like, I would rather just pay for the whole thing than have a conversation with somebody about, like, negotiating how we split the tab, like, because.

it makes me uncomfortable to do that. So that’s something that I’ve had to work through. And so, um, if you grew up in a culture where money was bad, or people with money were bad people, or people who were taking money from others, so business owners, landlords were some kind of like evil entity, right, that there wasn’t a, uh, Earning mentality.

There was a taking mentality, you know, cast them in the role of the villain. Subconsciously, you are going to feel like a villain when you are now in this role trying to negotiate rates or collect with clients, be like, hey, you haven’t paid me for a few sessions. You’re, you’re, you’re, you’re. Tab is growing.

What’s up with that? How do we handle this? You know, that it’s going to show up. Um, and certainly too, there can be other pieces of this. I mean, I’ve also met clinicians who have made mistakes and that they have prioritized money and how much money they’re getting and whether or not they’re getting paid and you know, how fast they’re getting paid have absolutely indexed that.

over how their clients are feeling. Um, the quality of the relationship they have with their client and it has been to their detriment. So clients are like, Oh, this doesn’t feel good to me. And they nope on out of here, which then creates a situation where this therapist who cares a lot about money and getting paid every dime they should be paid are really struggling to create successful and prosperous outcomes.

Transcribed in private practice because they’re alienating people left and right. So there’s a lot to unpack here and it can go in a lot of different directions. So it’s, it’s really figuring out what do I want my identity to be? Uh, what do I need to work on related to my relationship with money and finances?

How does this show up in the space between me and other people? Uh, and this really requires a lot of deep personal work. I mean, this is worth talking through with a mentor therapist consultation group, um, because there’s, there’s big stuff here. And I think especially to one of the things that is almost unique in our profession, when it comes to the intersection with finances is that we are having relationships.

With people and talking about money can be very uncomfortable for us. When we also have genuine love and care for the clients that we are in a relationship with. And I know that this is not a personal relationship, but as a professional relationship, but it is also a real one. And I mean, you like me probably care very much about your clients personally.

And so. It’s, it’s not a conscious thing. I think it’s a subconscious thing, you know, to be paid to have a caring relationship with another human that can feel weird, you know, that can feel kind of squirmy. And I think that that also just needs to be acknowledged. One of the ways that I’ve come to understand this, that has been really, really helpful for me is that.

This is absolutely a real relationship. There is real love. There is real care. There’s kindness and generosity and all the things. And in my relationship with clients, it is a one way relationship. I am here for them, not the other way around. They’re not asking me how I’m feeling. They’re not taking care of me.

It doesn’t matter how I’m doing or what I feel like talking about. here for them. And because of that, the money that they pay me, it closes the loop. It’s an energy exchange. That’s really all it is. And so when I’m able to kind of go into that place, it’s an energy exchange. Um, That’s what works for me. I would love to hear about the mindsets and the ideas that have worked for you around this issue professionally.

Share this in the comments of this post on my website. You can go to growingself. com forward slash therapist, find this podcast post, jump into the comment section. Also connect with me on the socials. You can track down growing self on Facebook, Instagram, also connect with me, Dr. Lisa Marie Bobby on LinkedIn.

And it’s, you know, I, I would. Honestly, be personally very curious to hear about the mindsets or thoughts that have helped you be in a place of not just peace, but also empowerment. Like, yeah, I have the right to be paid for this. Like, what is the mindset? Particularly when it comes to relationships with people that you love and that you are also paid for.

So when we started this conversation, I also promised you some strategies. We all love a good strategy. I just shared you one of mine that, that. does help around the energy exchange mindset, but here are a few others. Um, one of the strategies that I think is most important is to be reminding myself, ourselves, that our services are really valuable, right?

That our skills, our training, our insight, the fact that we can help create genuinely positive outcomes, uh, for our clients are really important. inherently valuable. I think that if we do not believe in the value of our services, it can be very difficult to communicate that value to others. I will also share that practice makes perfect, especially if you have like cringy little feelings talking about money to Practice out loud, even doing role playing conversations with a colleague, with your consultation group of Jane.

Um, I noticed that you canceled our session, you know, an hour before and said that you were kind of just, busy and didn’t feel like coming today. And I need to remind you that I have a 24 hour cancellation policy, which requires me to charge you for today’s session, whether or not you attend, like, you know, if, if saying those words out loud is challenging, which I think it really is for all of us practice that with a person, talk to a mirror, journal it, talk to it with your consultation group, because the more that you practice, the more natural and confident, um, you’ll be when these.

conversations need to happen. And then furthermore, I think one strategy is to just get in the habit of communicating really, really clearly, being upfront and clear about your fees from the get go, you know, including your rates and intake paperwork and also on your website. I mean, I, I put rates on my website so that if somebody is like really gonna have a problem with what we charge here, They will, uh, self select themselves to a different situation because that would honestly be a better fit for them, but just to have a lot of transparency and around that.

And then too, uh, I think that being consistent with policies, things like 24 hour cancellation policies or no show policies is, is really helpful. Um, I think that. I am a flexible thinker. It is difficult for me to go into like a black and white mindset. So I think because of that reason, I will always have a little bit of a well, but, you know, let’s think about the circumstances here because that’s just how I operate.

And I feel good about that. However, I think I also need to have a pretty clear and consistent policy for if this, then that. So barring the kind of circumstance, it’s going to make me slow down and want to do something differently. Here’s what I do, because then. Um, it is easier for me to enforce things like unpaid sessions or cancellation policies.

I think it makes me feel more professional. It makes me, it makes it easier for me just to communicate policies and a matter of fact way. It helps me set kind of clear boundaries with my clients. And, um, I think that it makes me feel like. I’m not doing something wrong. I think in the past, if when I was much more flexible and more like person by person, case by case basis about how I was going to do things, I would always feel guilty if I enforced this with like one person and not another.

So now I have a policy. This is what I do and also don’t want to. Um, be so rule bound and focused on policy that I am following the policy, but making the wrong decision for a specific client. So, because you know, we’re not, we’re not making widgets here. We’re dealing with humans and relationships and we can’t take that away.

So then very lastly, and I don’t know if this is so much a strategy, but, um, definitely do want this to be one of the takeaways from today’s episode is staying with your feelings, exploring them, you know, digging into your own stuff related to money, anxiety. Why do I feel angry about this? Why do I feel resentful about this?

Why is this hard for me? Um, what are the patterns that I’m noticing in my relationships with clients related to money and do some digging, do some journaling, talk to your mentor, talk to your supervisor, talk to your consultation group because understanding the root cause of these things doesn’t just help you be more effective as a therapist related to this.

It really, it helps you grow as a person too, because the work that you do here is also going to benefit you. Personally, I can’t imagine that you have weird hangups with money that only show up in your relationships with your clients. I know that that certainly wasn’t true for me. I mean, money is everywhere and my hangups with money show up literally everywhere.

So this is just, this is our work. Okay, so I hope that these ideas have been helpful for you today. Um, we talked about underlying issues. We talked about strategies for managing some of this and, and I will say, um, just other ways, other things to think about that, that we did kind of touch on. Um, if you really don’t want to be a business owner and get very serious about profit and loss statements and marketing and like sales, all this, and you want to be in a private practice, I would really consider looking for a group private practice that you can align yourself with because it can take away some of this stress and make it easier for you just to do the work that you want to do.

Um, a good. solid values based group private practice, like growing self, right? We’ll have established systems and structures for client billing. There’s support that takes some of the pressure for that off of you. So I think that that can be really helpful. And certainly you don’t have to manage other aspects of that.

that will, um, require all of your time that aren’t involved in providing services. So there’s that piece, but also to explore coaching as a confidence booster, especially if this is something that is new to you. Again, you know, me becoming credentialed as a coach really shift my perspective on the value of my services and help me be able to, I think, deliver value in a much more tangible way.

Um, Um, so I’m a huge fan of coaching psychology. I’m a certified coach. And that is also why I developed a, uh, a coaching certification program through growing self, which is developed by therapists for therapists to teach licensed, experienced, qualified therapists. It’s the art and science of coaching psychology to be able to, um, confidently incorporate these strategies into their practice, um, for their benefit.

It makes it, I think, much easier to be successful in private practice as a therapist who coaches. rather than as a therapist who has a clinical mental background, but doesn’t really want to do clinical mental health that much anymore. Like if you’re operating, especially in a growth space with high functioning clients, coaching is really the way to go.

So, um, if you’re interested in learning more about the growing space, Self coaching certification program. Come to growing self. com forward slash therapists. And there you will find all kinds of free resources and podcasts and articles and self assessments and stuff that I’ve made for you. But you’ll also find more information about our coaching certification program and you can, um, enroll.

And I want to also offer you a 10 percent discount listeners of love, happiness, and success for therapists. Can use L H S F T as the promo code to get 10 percent off our coaching certification programs. And you’re welcome to share that with your friends too. All right. Thank you for spending this time with me today.

Good conversation. And I’ll be back in touch with you next week with more love, happiness and success for therapists. Take care.