As Sensitive therapists in private practice, we find ourselves having to make emotionally-charged decisions around money. Every. Single. Day.
As socially conscious beings, we can’t help but want to alleviate as much suffering as possible in the world, yet we only have so many hours in the day and have to make sure that we cover our bills as well.
How can we make peace with our desire to be of service AND our need to make a living?
Often, this is where the sliding scale comes in. Our sliding scale might be tied to our social justice values, spiritual values, or religious background. Most of us have accessed sliding scale or reduced fee as clients and want to pay it forward. Others want to offer services to folks who may not be able to access their full fee.
There can be a darker side to sliding scale, though. Sometimes it can be rooted in the fear that you won’t be able to fill your practice will full-fee clients so will take whoever wants to see you. As your practice fills with folks paying half your rate, this often creates stress and resentment when you can’t meet your bottom line. Other times, sliding scale was adopted into your practice policies without you consciously choosing this was how you wanted to run your business.
Terminology Talk: Reduced Fee vs. Sliding Scale
In some states, using the term “Sliding Scale” requires that you collect financial information about your clients in order to access a certain fee. Reduced fee is exactly as it sounds, a fee that is reduced so that folks can access therapy with you.
For readability, I will use the terms interchangeably in this post. However, it’s important for you to do some research on your own to make sure that you’re using the right words.
5 Myths about Sliding Scale
Take a look at the following common myths around sliding scale. Do you find yourself believing any of them? If so, where did these beliefs come from? What emotions are attached to these myths?
Myth #1 : Every therapist must have a sliding scale option.
Fact: Therapists can choose to do their social justice/charity work outside of their business. Your business structure does not have to include sliding scale.
Myth # 2: You have to offer sliding scale to everyone who asks for it.
Fact: You are allowed to have a limited number of sliding scale spots, even if you are still building your practice!
Myth #3: You must collect financial data on your clients in order for them to access your reduced fee.
Fact: As I mentioned earlier, look into the appropriate terminology in your state/country. Collecting paystubs or tax returns can easily be a part of your practice or you can rely on the goodwill of your clients. What matters most is what feels in alignment with your business values and how you want to work with your clients.
Myth #4: Collecting financial data from your clients will save you from difficult money conversations down the road.
Fact: Oh, if only that were true! As a therapist in private practice, you must be comfortable having money conversations with all of your clients, including those on a sliding scale. If a client on your sliding scale has a significant income change (either increase or decrease), you must be comfortable talking to them about how that impacts their ability to pay.
Myth #5: You must have a single fee to offer all your reduced fee clients.
Fact: You are allowed to have a tiered system of sliding scale, meaning that you can have multiple spots at multiple prices below your standard rate. You are also allowed to have certain low-paying EAPs or private insurances panels be considered your sliding scale spots. Some folks choose to have one price for a reduced fee to keep it simple for their bookkeeping. In my practice, I have a tiered system where my reduced fee spots are staggered in amount. (You’ll see more about how this works in the script below.)
When your spots are full, provide other resources to prospective clients
- Connect with other therapists in your area. Don’t be afraid to ask what insurances they take, if they offer a sliding scale, and what their prices are. This allows you to soundly refer out when you aren’t a good fit or your sliding scale spots are full.
- Determine how you would like your reduced fee/sliding scale structured in your business. Do you want to have one single price? Would you like your EAP/Insurance/Medicaid folks to count as your sliding scale slots? Would you rather have your social justice work be done outside of your business?
- In addition to local therapists you know, compile a list of 1-2 low-cost therapy options for folks in your area. Open Path is a great referral option, including local community mental health centers or group practices.
- Make sure that you have your sliding scale options listed on your website – including if you have spots open or not. This can save both you and the client time if you don’t have spots available.
Here’s what to say when a client asks for Sliding Scale
Here are the talking points I use when talking to a client about reduced fee options. Feel free to use this script verbatim or adapt to make it your own.
Client: Hi, I’m interested in counseling with you.
You: Great! Thanks for calling. I’m happy to talk more. How did you hear about me?
Client: I found you on …. [Open Path, Psychology Today, HSP website, can’t remember…]
You: Wonderful. Before we talk about what you’d like to work on in counseling, let’s talk about some logistics. Are you hoping to use any type of insurance or Medicaid?
Client: I have [insurance type], and if I can’t use that I’m hoping to see if you have any sliding scale spots.
You: I do not accept that insurance. I’d be happy to offer you the names of some therapists I know who accept [insurance name] or talk to you about a reduced fee option. Which would you prefer?
Client: Well, I really liked what you had to say on your website, so if it’s possible to work with you, I’d like to hear about your sliding scale spots.
You: First off, my standard fee is [insert fee here]. I keep a limited number of spots of reduced fee on my caseload. I see some clients through Open Path at a rate of [insert fee here] a session. I have a variety of other reduced fee spots that range from [insert your fee range]. Let me check my spreadsheets to see which spots I have available to offer you.
Client: Ok, thanks for looking.
Therapist: So, at this time, I have a reduced fee spot for [insert fee] open. In order for therapy to be helpful, I would need to see you [insert frequency here]. How do you see that working with your current finances?
If the client says yes, then move ahead with the rest of your call to determine fit.
If the client says no, use this script below to wrap up the call.
Therapist: It’s important for you to be able to come to therapy as often as you need to get support. After we’d get off the phone, I’d like to email you a list of therapists who I personally know who take your insurance/offer sliding scale and may be able to see you at a lower rate than what I can offer. I want you to know that I can remain an option for you, should you decide that you are able to come in [insert desired frequency] at [insert rate] a session.
Client: Thank you! I’ll keep an eye out for the email and let you know.
You Got This!
By reading this article, you have already started to shift your money mindset. You are embracing your entrepreneur self. You already had all of this within you, and now you’re starting to run your business in a way that feels authentic, empowered, and true to you as a person.
This work may also result in shining a light on some areas where you still need healing around your money trauma. Money trauma has many names and manifests in many ways. Yet, there is a way to heal your money trauma and not have it impact your business negatively.
I’ve Got Your Back
This money stuff isn’t easy and it helps to have someone who knows the ropes, has been in your shoes, and can offer the combination of sound guidance and deep listening to support your money journey.
If you want continued support and cheerleading on this journey, I’d be happy to walk alongside you.
Arianna Smith | The Copy Cove 
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