How can I feel confident to charge my worth as a therapist?

I spoke recently about how to feel confident to charge your worth, a question submitted by one of my facebook group members.

Charging your worth is important because you have worked hard to become a therapist and there are business costs associated with running a private practice. In order to have a reasonable living that allows you to be remunerated for your study and ongoing education and your business costs, it means you need to charge a fee that reflects your worth.

When you don’t charge your worth, it often leads to seeing large number of clients in order to make a reasonable living. This, in turn, increases the chances you’ll become resentful or worse burn out and not have longevity in a career that you’ve worked hard to achieve.

It’s about mindset and values.

In order to address charging your worth, you must understand the importance of knowing what your confidence mindset about your worth is and your values about health care are and how they interact.

What is a good enough mindset issue?

For some therapists, working in low fee settings helps them to feel comfortable because they don’t think they’re are good enough to earn the kind of fees that are charged in an industry fee standard private practice. The idea of doing so makes them feel nervous, so they avoid this discomfort by working for less than what they are worth. This is a mindset issue. It is crucial to address any “good enough“and money mindset issues you have if you want to have a long-lasting career in private practice.

What is a values based issue?

For others, they work for low-fee because of their values around healthcare. If you believe that health care should be free, you may choose to charge no more than the rebatable amount. Or if you have a value about making health care as accessible as possible you may choose to have a sliding scale or other options to make access possible for all, knowing that this fee isn’t really what your time is worth.

If you have a strong value about seeing the most vulnerable clients, those with unstable housing and regular crises, you will be unable to charge your worth as a therapist in \ a private practice setting. These clients cannot pay the fees we need to charge to have a reasonable standard of living that reflects our education and ongoing professional requirements and the cost of running a business.

The long term impact of low fee work – you matter too.

I respect that people need to live according to their values. However I would encourage you also to consider the impact working for low fee will have on your health in the long term, particularly if you are in private practice. For some people, I think it is worth thinking about transferring back into government-funded services if this is the kind of work they want to do. Not only will you be adequately financially rewarded for your work, but a team structure is available to help deal with the typically chaotic nature of these types of cleints.

I am also of the view that if you start to feel resentful about the fee you are accepting, it is time to reconsider whether your values are working for you.

My story with mindset, values and fees.

In my own experience, I found offering a mixed billing practice difficult to manage. I originally decided to offer mixed billing to help make psychological care accessible. I would regularly found that supposedly low-income clients who could not afford to pay my full fee were spending much more elsewhere on non-essentials. Once I became aware of this, I would become resentful and would find it hard to work with the client with the same genuine passion.

I also found that for people who were not being charged any gap fee, I encountered three problems. The problem of choosing not to spend money on therapy whilst still spending on other things still occurred but also I would find therapy was often not valued and there were increased no-shows and cancels.

My mixed billing practice meant I had to deal with more cancels, drop outs and lose income all at the same time. It was hard not to feel resentful.

But most importantly, I noticed that many of these people were not in a stable enough place to get value out of therapy. They valued my time and experience but their life was so full of chaos or they couldn’t afford to get to the appointment even if it was free. These people need community agencies and public health services with social housing, food and financial counselling. They didn’t need therapy nearly as much as those things.

And so in order to continue to live my value of accessible psychological care, the decision I made was that it was better to refer these clients to a service that is better able to meet their needs. Rather than pretend that therapy was going to be the answer to their complex social problems, I now refer them to an appropriate agency.

It’s not access if you can’t afford to even make it to your appointment.

As I often say, it’s not really “access” if you can’t even afford the petrol money to get your appointment. Also dropping out of therapy for these reasons increases a person’s sense of failure and if this can be prevented by sending them to the right place to start with, then that is a good thing. As a result, I no longer offer different fee scales based on income.

If you are struggling to charge what you are worth because you don’t think you’re good enough, that needs to be addressed through mentoring and supervision. Because feeling confident to charge what you are worth will help you to keep doing what you love for longer.

But if you are struggling to charge what you are worth because of your healthcare values, you need to decide whether the cost to you is worth it. Do you need to rework your values, like I did? Or do you need to work for an agency who allows you to serve vulnerable people for free and still be paid enough to earn a reasonable living (this will not be a private practice).

It’s not ok to be asked to work for a pay cut just because you serve people.

Finally, I would like to point out that every day in Australia, health professionals are being asked to take a pay-cut. To see people for less of a fee than what they are worth.

Imagine if you will, a salaried worker being told that today they would be paid less because a client the company was taking on didn’t want to or couldn’t pay the usual rate. Or that just for this hour, they would earn 50% of their rate. Imagine a manager saying: “Sorry Karen, yes your super contribution will be affected as well.”

This would not be considered acceptable and it wouldn’t happen.

And yet, I repeat, every day in Australia health professionals are asked to accept a fee that is up to 50% less than what they are worth. As if that is ok because we care and we serve.

We do care and we do serve, but in order to do this work over the long haul and be healthy, we also need to charge our worth.

PS: Need help to identify the mindset and values issues that stop you charging your worth? Join the waitlist for my course Thriving Therapist Formula here or book a coaching consult with me here.

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