Negotiating Sliding Scale
Curt and Katie chat about the pros and cons of sliding your fee for therapy services. We look at the theories around fee-setting, sliding fee scales, and conversations around money. We discuss what actually makes a difference in determining if clients are invested and will benefit from your services. We also dig into the laws, ethics, and practicalities if you choose to offer sliding scale in your practice.
It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.
In this episode we talk about:
Feedback from our conversation with Tiffany McLainClinical theories on how fee impacts the clinical relationshipThe different ways that people enter into therapy, different financial situations, etc.A more nuanced conversation about sliding scale feeFreud’s views on having direct conversations with clients on feeHow clinical orientation can impact how therapists view fee-settingThe idea that fee must be set at an “uncomfortable enough” that clients invest in therapyHow fee paid impacts attending the last sessionDifferent types of investments that might impact how much people benefit of treatmentPractical ways to assess what fee would be in the sweet spot for sliding scale (e.g., written out scale, financials, etc.)Do therapists show up differently for clients who pay more or less?How fees average out among larger caseloadsIncorporating outcome measures and practice-based evidence to assess whether you are showing up differently for clients who pay more or lessMythology around what we have to do and what is best to doLaws and ethics, practical considerationsUsual and Customary feesAdvertised feesPhilosophy related to how you set your feesThe impact of insurance on our profession related to sliding scaleEthical codes on fee setting related to services provided and client ability to payModels of subsidy for mental health servicesThe need for a standard justificationThe risks for insurance fraud related to fee-setting and accepting copaysThe ability to adjust usual and customary fee as needed as long as it doesn’t violate state lawWhat we have to do and what the softer, virtue ethics might recommendThe importance of accurate billing and justificationThe tension between the equity argument and the practicalities of businessAre you unfairly treating clients who are paying less?The need for pro bono work, but not sliding scale workThe need for clinician-led discussions and opt-in from the clientCheck your insurance contracts, advertise your fees correctly, written basis for a range of feesOptions for sliding scaleOther models for addressing accessHow to create a sliding scale practicallyWhy you need to identify what you need to make on average per sessionMoving your sliding scale or pro bono work outside of your practiceOur recommendations for Open Path Psychotherapy Collective and Give an Hour