In this part of the framework and guidelines for starting therapy, I will discuss some of the logistics and rationale for fees and payment. This part is a bit more technical, but remains rooted in specific values concerning therapy and the therapy process. There is a whole other aspect to fees and payment that surrounds the meanings that they carry, but that is a topic for another time.

I determine my standard fee based on a fair market rate for a licensed psychologists in my geographical area and near my level of experience. This set fee amount requires no negotiation, regardless of frequency or circumstances. I occasionally raise this fee based on various factors, such as increases in cost of living and doing business, as well becoming a more experienced therapist as years go by. Whenever there is a standard fee change, I will give you notice of this at least one month ahead of time, if not more.

What about those who legitimately cannot afford to be in weekly therapy at this standard fee? I understand that there are many individuals for whom weekly therapy at the standard fee is simply not possible, or may cause excessive hardship, so I offer discounts for certain weekly time slots. I have tried many different configurations of fee and frequency over the years, and found that mutual agreement on a fee that allows sustainable weekly sessions is of paramount importance for successful work. Therefore, discounted rates are for a weekly standing appointment, and are charged as a flat monthly amount rather than a per session fee. I do not have an official sliding fee scale (which would place you at a specific fee based on specific income), but leave all discounts up to the unique circumstances of each person. A rule of thumb, however, is that if your household income is below $6400 per month and you feel that paying the standard rate for weekly appointments is not plausible, we should discuss an alternative arrangement. If you are earning more than this, let’s talk about the other financial or personal circumstances that make the standard fee implausible for you, and decide whether a discount is appropriate. Other factors may be unique expenses, dependents, unemployment, or the like.

I also often discount for regularly scheduled multiple sessions per week. Even for those who can afford the standard fee for weekly sessions, multiple sessions every week may not be financially viable. Therefore, if you’d like to move to a two or three session per week schedule, we can adjust to a weekly or monthly fee that discounts the additional sessions. One of my primary professional values is the capacity for deeper work together, and if you’d like to pursue this, I am open to discussion about how to make it workable.

After our fee is set, how do we manage payments? My policy is to collect payment at the “time of service.” This helps prevent you from building a debt and me from having to collect on debts. It also brings payment into the “here and now” rather than putting it off in the distance where we don’t have to think or talk about it. We can do payment per appointment or per month. If you are paying per appointment, we will handle payment at the beginning of each session. That way, payment does not interrupt us at the end of a session or lead to going over our time (time spent on payment is part of the 45-50 minutes, not extra time added on). If you are paying with a debit/credit/HSA card or mobile payment, I can take all major credit cards. The card must be present, I do not store cards on file or do remote card number entry. If you pay with cash or check, just set it on the table or hand it to me when you come in*. I may be a bit of a dinosaur in our digital world, but I prefer check payments, as they do not bring the processing fees and the sharing of the transaction with a third party into our relationship. If you are not already at a flat monthly rate, I recommend paying for sessions monthly if you are able, typically on the first session of the month. This is especially helpful for card payment because then we only spend time running a card once per month.

You may have deduced by now that my practice is “fee for service.” That is, I am not currently on insurance panels and do not bill insurance. The reasons for this are explained in my FAQ. If your insurance will reimburse you or apply your payments towards your deductible, I can provide you a superbill with the required codes on it (usually at the end of each month or quarterly). If you’d like a superbill, let me know and we can talk about the pros and cons of sending this documentation to a third party and the potential addition of a psychiatric diagnosis to your health record.

As you may have read in the disclosure and consent forms, I have a policy regarding charges for late cancellations or missed appointments. For those at the standard fee, sessions canceled with at least 24 hours notice are not charged. However, within the framework of weekly sessions in a depth psychotherapy approach, a pattern of cancellations becomes a topic for gaining understanding and insight into your feelings about the work we are doing, or more broadly, the underlying patterns or feelings that lead to the cancellations. For appointments cancelled with less than 24 hours notice, I may charge for the session unless the schedule permits us to reschedule later that week. Fee setting and payment can be fraught with anxiety and avoidance (from either of us)! It is really important for us to have a frank discussion about money matters. Your feelings and associations to fee and payment are important parts of exploring and understanding, so I encourage you to bring them up when they come to mind.

*Another COVID caution - we are avoiding direct item contact and keeping distance, so I am discouraging everyone from directly handing me payment. Cash or check is now set for me to pick up after the session to be handled with appropriate cautions. I also have contactless credit card payment set up.