I have never met an accountant that had trouble setting their fees. Or for that matter, a hairdresser, plumber, physician or lawyer. Have you?

However, I have spent countless consultation hours discussing the relationship to money. And this is what I have to say about it. Work this out first before you open the doors. It is the number one source of angst and frustration for the beginning therapist and I have seen it continue through years of practice. Before I tell you how to make and collect money, let’s talk about how to get yourself out of the way.

Since the business of therapy is based on the premise of helping and relationships rather than fixing pipes, adding highlights or drafting a will, we constantly second guess the actual value of what we do. It is usually a seamless part of who we are and how we operate in the world. Our interventions and observations are often, obvious to us and therefore, flow with ease. Most psychotherapists I know have been “helping” a long time. Whether it’s their role in the family, the third grade class or a group of friends; they are “it”–the one that is called when the event occurs, the cousin ends up in rehab or the break-up is interfering with work. Sound familiar? And of course, you help. Time and time again. Because you can, and it’s as natural as taking a breath.

Well, here’s a newsflash for you. It’s a finely honed skillset with boundaries and intricacies as important as the legal document, medical exam or yes, the mixing of the color for the highlights. So own it. And until you are completely comfortable asking for the check at the end of the session, practice, discuss and self-talk your way to confidence. Because if you are not comfortable with your value, neither is your client. And who can blame them? And now, let’s make and collect some money.

  1. As you set the appointment, be sure to have your talking points ready. It goes like this: What you do, how much it costs and where and when. Put it out there. Sam, I practice cognitive behavioral therapy, which is…. and my fees are $125.00 an hour payable with cash, check or credit card at the end of the session. My office…
  2. On your informed consent page, be sure to highlight two things. The fees for your time and the cancellation policy. Adding a space for an initial is a nice way to reinforce this policy. However, the very best way to reinforce this is to go over the form at the top of the first session BEFORE you do anything else. That way, there is no question about the amount due, when, in what form, and what happens if there is an untimely cancellation.
  3. At the end of the session, have a receipt ready. There are easy templates available from any of the bookkeeping systems you use. If you are using a generic form or our Practice Smart Forms, have a bunch copied with your pertinent information. Fill in the diagnosis code and amount due and have them handy. Say, “Do you need a receipt for payment, today?” and hand over the receipt as you receive the check or credit card.
  4. Never let a session end without asking for payment. And, if the session is running over or the checkbook is forgotten; have a business card ready. That way, you can hand over the card with a cheery, “No problem–drop it in the mail before our next session.” Or–have a credit card on file so you can bill the client easily.

So, 4 easy steps to yes, making money. Unless, you have consented to a payment plan or a third party payment, NEVER go more than 1 session without payment. Why? You are telegraphing your self-worth. And the client will undoubtedly agree with whatever boundary you permit. Even the lowest of sliding scales has an explicit agreement of amount and date due. You wouldn’t think of making an appointment with your dentist or lawyer, spending an hour of their time receiving services and not paying, would you? Then extend the same courtesy and respect to yourself. And, if this is difficult in any way, remind yourself that you can do it for free anytime you want–there’s a neighbor, friend or relative that will be grateful for your time and compassion.