Do You Feel Guilty When Charging Your Clients?
With summer comes more cancellations, lighter client loads and vacations, making money tighter than usual for many private practice clinicians. During times like this, it can be even more essential to hold firm on our cancellation policy to remain financially afloat. For many therapists, but especially Highly Sensitive Therapists, charging these fees can feel very stressful.
Our sensitive systems are wired to be more empathetic and to anticipate all the possible negative consequences of our choices. Therefore when it comes to charging our clients, instead of considering our own needs, we quickly flash to worries of:
The Financial Impact on Them
Our Client Getting Angry With Us
Losing the Client
Being Perceived as Selfish for Charging for Time We Didn’t Work
Doing such emotionally healing work makes it easy to forget that we are also running a business. When a client cancels at the last minute or does not show up for their session, that is lost income for us. We typically spend that time worrying about the client if they didn’t notify us of missing their appointment or fretting over whether or not to charge our late cancellation fee. In essence, that’s not a free hour for us and takes away from seeing other clients.
I recently had a therapist reach out to me to say:
“I have the hardest time asking my clients to pay the no show fee, and think I am too empathetic.”
Other concerns I have heard therapists say:
“I feel bad for charging my client because getting sick is outside of their control.”
“I feel guilty even when the client acknowledges the cancellation fee.”
Being empathetic is a powerful clinical skill, but becomes a burden when we need to switch from clinician to business owner. Plus, an unfortunate by-product of being so attuned and perceptive to our clients is guilt which clouds our ability to make sound business decisions. This is why I have adopted the practice of holding ALL my clients to the same standard, no matter the situation. Despite the reason for cancelling or missing an appointment, I charge the full session fee, which is outlined in my consent agreement and reviewed with the client. To soften this policy, I always waive the first no-show or late cancellation fee and use this as an opportunity to review my financial policies.
This approach releases me from the difficult position of needing to judge whether or not a client has a valid reason for the cancellation. In addition, maintaining a consistent policy across the board helps reduce the decision fatigue and emotional agony Sensitive Therapists are prone to experience as deeply reflective people who want to make the perfect choice every time (again, this is how we’re wired).
As Sensitive Therapists, we have these incredible gifts of empathy, perception, intuition, creativity, presence and more, but the shadow side of these gifts is our tendency to get physically and emotionally exhausted and be more prone to overwhelm. That all boils down to us not being able to maintain case loads as high as our non-HST colleagues, making it even more essential for us to charge for our time or risk getting burned out. There are four areas where we run into the empathetic clinician vs. business owner struggle:
Charging Our Full Fee
Late Cancellation Fees
Charging for Additional Time
If you tend to work with clients long-term as I do, it’s important to have the majority of our clients pay our full fee and have a set number of sliding scale spots. Otherwise, we risk losing a significant amount of income for an extended period of time. To accommodate more low-fee slots, you can set your full fee slightly higher than you would need to otherwise. For instance, if your full fee is typically $150 and you need to see 15 clients per week at that rate: charge $180 and offer five sliding scale spots at $90 to make the same amount seeing the same amount of clients per week.
Late Cancellation Fee
Charging the late cancellation fee may be the hardest of all, mostly because clients generally have valid reasons such as an illness, a work conflict or transportation troubles. This can really pull on our heart strings, especially if we need to make our schedule changes from time to time. There are many options to make the late cancellation fee feel more palatable:
Don’t charge if the client can reschedule within the same week.
Have a partial cancellation fee for late cancellations instead of charging the full fee.
If the client is sick, offer a phone or video session instead of coming to the office.
Ever since I started using an online scheduler that sends out automatic text and email reminders (you can use your EHR or the HIPAA-compliant version of Acuity), I rarely have a client no-show. However, when it does happen, I always waive the first missed session and use that as an opportunity to review my policy.
Charging for Additional Time
When clients reach out for additional support in-between sessions or want a quick phone check-in, it can be easy to give that time away for free, but that can set a precedent with clients expecting more than we can give. In addition, that time can cut into paid client hours if we’re offering additional support to multiple clients throughout the week. I personally charge for any contact that extends beyond five minutes and have that in my consent agreement. I firmly believe that sticking to the practice of charging for our time models strong boundaries and self-worth for our clients.
Being more empathetic and perceptive gives us powerful gifts as Sensitive Therapists, but can make it extremely difficult to enforce our business policies and fees. We prioritize the needs of our clients over our own leaving us at risk for financial distress and emotional burnout. Although we are doing deep emotional healing work, we are running a business and need that business to be financially viable to continue to help people.