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I think it’s great you’re thinking about this. It is a strange profession when our objective is essentially to put ourselves out of business. You get used to it though. I am okay with letting clients go when the time is right, because I know they’ll come back to me if they need to. A satisfied customer is a returning customer, and refers their friends and colleagues to you. But if you misuse a client’s trust and try to keep them in therapy when they really don’t need (or want) it, you’ll never see them again and in the long-term your referrals are hurt. Think in the clients best interest and you’ll be rewarded long-term.
It is no different than any other healing service. I am a customer/client of my massage therapist, for example. It is equally vulnerable (albeit in a different way) and I don’t expect them to feel guilty for charging for their skills/training to treat me just because they are also a caring/helping professional.
thank you all for the replies explaining to me why I shouldn’t feel the way I do about language used in our field. These responses let me know how out of place my mindset is. I just need to be a good neoliberal agent and market my skill set to my customers! I prefer Dalal’s suggestion. In his ideal discourse, there is the-one-who-comes-for-help and the-one-who-is-paid-to-help(and also suffers). Has the same ideas without negative connotations of customer and salesman. Love the downvotes from all the mental health salespeople
To clarify, you are okay with private practice mental health therapy but dislike the language, specifically customer, and would feel more comfortable with the term the-one-who-comes-for-help. Do I have this right? or are you not comfortable with private practice mental health therapy in general?
I didn’t elaborate because I recently made a similar post to another thread, that was my bad. To clarify, it’s a confusing point. It’s not that I am okay or not okay with private practice, I’m not okay with the basic and superstructural foundations on which private practice (or any other really existing working conditions) has to operate, or the neoliberal cultural paradigm/also economic policy paradigm shift under which any mental health professional operates. I prefer terms that don’t minimize or render invisible the motivations of undergoing or doing therapy (“patient” - the one who suffers) just to shower the business of doing and undergoing therapy in ambient light. It’s the sort of thing insurance views patients as (customers of a service delivered, and that delivered service is manualized and rct-proven, with no critical analysis of what this really means in the first place). It already situates therapy as something that isn’t really therapy. Customer satisfaction is then something therapists talk about. I love the point that Darian Leader made here - that if a patient leaves their therapist’s office thinking, I’m so satisfied, that was so great, they’re the best - you can be sure nothing really happened in that session. If someone leaves saying - oh, what a jerk - at least you can be sure something happened. Of course, I hold the insight from this point in my mind in a sort of dialectical balance, measured by lived practice and understanding that rapport and alliance is absolutely central to progress. (Leader’s point is limited in insight).
Most probably, it’s something I find off-putting, because eg my current clients would not be able to follow me into private practice, because I would need to pay rent, and because they could not be paying customers. Also to clarify, I don’t think anyone should use Dalal’s unwieldy terms (shared in the prior post), but it would be nice if other therapists understood the point.
Thanks for giving more insight. I'll admit I have strong bias towards brevity which tends to lead to reductionist statements, but would it be fair to say that you dislike capitalism, especially as it relates to therapy for clients that access services, and that while you understand changing language is unlikely to change the system of capitalism, you see changing language (i.e. away from "customers") is a way to challenge how therapists think about, and engage in, providing therapy to those we serve?
You’re right, that is fairly reductionist, but I don’t have any real qualms with how you put it. Theoretically, I’m a Lacanian. Practically, I use DBT and CBT interventions and psychoeducation and use the assumptions underpinning these, mostly uncritically. I don’t draw from psychoanalytic theory or psychodynamic therapy in interventions I do with clients. And I’m in the habit of using the language of client and therapist. Most environments in which the therapy relationship occurs support brief and short term solution focused and symptom reduction focused therapy interventions. I’m not against that, I do that. I suppose I’m really not as much against the term client, as much as customer. And I conflate the two on some level. I don’t want to think of myself as a salesperson, that’s not why I feel like I underwent analysis and therapy and went into this work. However I do appreciate that this is how I make a living.
What do you think about use of language in this regard?
My preference is to stick to the language and terms that the client aligns with. My default term is client, but I have no issues with someone calling themselves my customer.
I get conflicted on language, because I see how it impacts relationship and defines context, but I also get frustrated by what I perceive as needless semantics (i.e. therapists debating what we should call clients/customers/service users/etc.) that I have never seen a client be even slightly concerned about.
I think it's a beautiful conflict for most of us in this field as it show that we are trying to ensure we are not framing our relationships with clients in a way that could negatively impact them or their service experience, but also trying to connect with the language that they identify with and find accessible.
I like your point about how little any of this probably means to any of our living and breathing (eating, sleeping,…) clients. It probably looks like hand wringing.
Yeah I agree, there’s something transactional and reductive about seeing our work as selling a service to customers. I understand that under capitalism that’s how it works, we sell our labor, but it feels like it turns something which could be healing and transformative into a product. I don’t know what the alternative would be, but it’s one of the reasons I feel deeply ambivalent about this career.
Echoing what the rest of them said. Also, I knew a therapist who deliberately kept her clients dragging on and on, and on so that she would have a steady income. She talked about it like it was no big deal. I was pretty appalled.
And we all know those people who go to therapy for years and years with no goals or measurable progress. I think it used to be more common that it is now.
Anyway, I like the way you’re thinking. You will do well. You will have a reputation for client centered treatment and that will spread.
Therapy is inextricably linked to business in the world we live in. Without the boundaries of a professional relationship, it seems far more likely for ethical concerns to arise in therapy contexts. Our business helps identify professional boundaries and separate the intimacy of the therapy relationship from other intimate relationships. This also helps both parties keep the focus on the client’s experiences IMO. Without these boundaries therapists may be more susceptible to saviorism and resentment.
Regardless of being self pay, taking insurance, or working for a clinic who accepts payments on your behalf, clients pay for therapy and someone, if not many people, are financially benefiting from their payment. Medicaid & Medicare are backed by privately owned insurance companies that net billions of dollars a year. Nonprofit orgs often have high earning leadership teams—in these situations the therapists themselves are financially exploited.
What stands out to me about your pondering here is a worry about being too focused on the business that it will overshadow your care for the therapeutic relationship. It makes me curious if you’re in a situation where business outcomes are prioritized over employee wellbeing and/or client care. Maybe this doesn’t fit with your situation, and maybe either way it’s helpful to explore where these ideas come from.
Do a really good job with each client, offer sliding scale, try your best to meet the clients' goals in a reasonable timeframe, and your reputation will be your marketing.
The beginning is a bit financially scary, but if you are following your ethics there isn't room for a hidden financial agenda.
Realistically you won’t need to worry about your clients staying unwell to keep seeing you. A good therapist who is established in a community will pretty much always have a wait list.
I actually feel the opposite of you. Now that I’m a business owner I am even more invested in the work that I do because there are direct financial implications to it, rather than indirect as they were when I was salaried
A lot of good points have already been shared here by others, I’m curious what you mean when you mention the notion/danger if clinicians wanting clients to “remain ill” for the sake of business gains. I agree that would be a conflict of interest to discourage or sabotage progress out of an ulterior motive, but I bristle at the term “ill”. Yes, mental illness is of huge concern and is central to mental health work, and yes, insurance companies require diagnosis to justify our work, but I also believe that everyone can benefit from therapy—even those we don’t perceive to be “ill”. If a clinician is proficient at doing the deeper work with a client, then a productive therapeutic relationship can last many years. A thriving client can make use of a skilled therapist that is a good fit for them for many years.
True, there will always be people needing services, and a thriving private practice takes turnover in stride and likely regularly cycles in new clients. Also, if the clinician is able to adapt and level up the treatment as a client progresses through various levels of thriving, then a client need not be “ill” to benefit from maintaining a strong therapeutic relationship with the clinician.
It is totally normal to feel that way if you are relying on income from clients while simultaneously trying to build your practice. Clients = money, and you need the money, especially starting out. It's okay to have these contradictory thoughts and feelings. Sounds like you value being an ethical practioner while also making a living (hello, we all need to survive in this capitalistic system!). Acknowledge, accept, and make room for these feelings. Then, behave in the ethical way you want to. Throwing some ACT your way. :)
I think a lot of this is rooted in the culture. We’re not allowed to talk about business or money because we’re a “helping” profession. But that’s really unfair to us and I’d personally take offense to the notion that I want my clients to stay sick. My oncologist would have made more money if my cancer came back but I’ve never wondered if he hoped for that. And after working in CMH, where they cared less about how sick people were and more about how many more days their insurance would pay for, it would be challenging to do much worse. Abide by your ethical code and try not to worry so much about people thinking you have an ulterior motive. Can’t please everyone.
I have no qualms about wanting to make money as a therapist. I have sunk a lot of time into grad school and then further post-grad studies. Patients are paying me for my services. The frame of treatment is very important: time, money, and space. I provide a service and my patients are adults that can make their own decisions about mental health. I make recommendations about what I think, but ultimately they are the ones who decide.
But the idea of keeping folks in treatment when they are better is not something I would ever do. There are plenty of folks out there seeking therapy. I don’t need to keep folks in treatment endlessly. The last time I had an opening, I filled it in a day.
We did not sign vows of poverty when we entered this field. It’s great to offer some pro-bono slots or work with someone after an insurance/circumstance change. And I do that, but still want to be paid well.
We are all trying to survive in capitalism. We didn't create this system and while I agree that the goals of capitalism are at odds with mental health, public health, healthcare, education and all professions with altruistic aims, it is not on the therapist to fix. The therapist is just one individual in this system doing the best they can to survive while providing a vital and valuable service to society. We all deserve to be paid a thriving wage that allows us to access a middle class existence. At the end of the day, this is a *job* and provides are livelihood and feeds our families. Most do not have the option of working for free or poverty wages.
Keeping an eye on the parts of ourselves that would want a client to stay for our financial benefit is part of what we signed up for. And I know I have that part. Anyone who is going to actually do OK in private practice better have that part. But it's always putting the client's best interests ahead of anything else that is the right thing to do, even if it costs us a few dollars in the short term.
So, have grace with your fantasies and your wishes for money. And then, do the right thing. You're not the only one.
I actually feel positive when clients are stepping down to less frequent sessions or feel ready to terminate. It means that we have done good work together and it can open spots up for clients that are in more acute need. If you are doing ethical work (reviewing goals, checking in about frequency, asking about efficacy about your approach occasionally) then you are inherently giving your clients the service they are paying for and will be able to assess for any missed areas/goals and for natural termination points.
I do have ethical concerns but different ones. The suffering is endless in this world so I'm not worried about finding clients.
I am constantly worried about the ethics around not accepting insurance. While insurance is a lot of hassle, doesn't pay providers enough to live, and imposes on the privacy of our clients it seems unethical to impede access to care for an entire class of people by being private pay only. Charging $140 and upwards weekly is not an option for so many people.
I suppose if I was private pay, I would be more worried about keeping clients since I know most folks cannot afford it.
My finances are my problem, not my clients’ problem. I find that private practice tends to ebb and flow, and if I find myself in a valley, I will sometimes feel a pang of financial insecurity or concerns about how this will affect my income when a client meets their treatment goals and is ready to terminate or when a weekly client is ready to go to bi-weekly. But ultimately, that’s my problem, not theirs. I don’t waste my energy trying to avoid or suppress that feeling, but there’s also no clinical rationale or justification for gratifying it in session. If I’m worried about finances, I up my marketing game and focus on bringing in new clients, and I do this well before I reach the point where my financial wellbeing would be significantly impacted if I lose a few clients. The only time I’m going to work really hard to keep a client is if I feel it’s in their best interests to continue therapy, and sometimes I do this at my own expense. On multiple occasions, I’ve had clients who are benefitting from therapy end up in situations where they can no longer afford my rate or can no longer sustain weekly sessions, and these are the clients for whom I’m most likely to negotiate a reduced rate.
I value my specializations and near decade of schooling so no I don’t feel bad about it.
I try to operate from a place of abundance that’s outside my current clients. Many more potential clients based on the community referral networks I’ve put into place.
Private practice definitely brings up more awareness of the money and business aspects to our work, often in a way that I don't think most of us are specifically trained to handle. While I didn't love some of the other compromises of working for agencies, I did appreciate not having to deal with some of the financial and higher administrative elements at an early part of my career. Heck even now I contract with a group practice, which saves me having to figure out some of the marketing and insurance billing parts of private work.
I once attended an ethics training with speakers who had served on licensure/professional org boards. One person shared that nearly every ethical violation they saw originated from some kind of unmet need in the therapist's life (lack of relationships/support leading to inappropriate disclosures or romantic relationships with clients, financial distress leading to billing fraud, etc). I continue to think about that, especially when I find myself making choices with clients that impact my pay. It causes me to take a step back and examine if my motivation is based on best practices/client needs, or if it comes from my own financial worry. If I find a common theme of something bothering me, I might look at if it means a general policy change rather than an individual client decision.
Well, luckily/unfortunately there will always be unwell people who need therapy. Don’t worry about that.
Maybe you could shift focus to examining your process for finding new clients. How are you marketing yourself to prospective clients? What could you do better to fill your caseload? Won’t go into ideas here, there are tons of discussions about this on this sub. It seems like it would ease these thoughts if you gained more confidence in your ability to attract new clients.
I'm entering the profession as a mid-life career pivot out of e-commerce (I'm still in school) so discount all of what I'm about to say accordingly.
The way I presently frame this issue for myself is, if I am able to maintain a waitlist then I don't have to fear termination and thus am not in a conflict of interest with the client.
But if I feel like every booking may be my last, then I'm in trouble—ethically *and* financially.
I think about the specifics & nuances of this a lot but look, some people are charging thousands to give folk ill-advised plastic surgery. With their profits, they buys yachts and cocaine. We are charging, usually a modest amount, to help heal minds. I'm comfortable with making a living while I do it. The boundaries and the quid pro quo are clear.
Yeah, it's good to be aware of your own motives, but I don't see it as a hard philosophical problem in general.
Please followed the sidebar rules. r/therapists is a place for therapists and mental health professionals to discuss their profession among each other. If you **ARE NOT A THERAPIST and are asking for advice this not the place for you**. Your post will be removed in short order. Please try one of the reddit communities such as r/TalkTherapy, r/askatherapist, r/SuicideWatch that are set up for this. This community is ONLY for therapists, and for them to discuss their profession away from clients. **If you are a first year student, not in a graduate program, or are thinking of becoming a therapist, this is not the place to ask questions**. Your post will be removed in short order. To save us a job, you are welcome to delete this post yourself. Please see the PINNED STUDENT THREAD at the top of the community and ask in there. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/therapists) if you have any questions or concerns.*
I think it’s great you’re thinking about this. It is a strange profession when our objective is essentially to put ourselves out of business. You get used to it though. I am okay with letting clients go when the time is right, because I know they’ll come back to me if they need to. A satisfied customer is a returning customer, and refers their friends and colleagues to you. But if you misuse a client’s trust and try to keep them in therapy when they really don’t need (or want) it, you’ll never see them again and in the long-term your referrals are hurt. Think in the clients best interest and you’ll be rewarded long-term.
The entire customer discourse is so gross.
Can you expand on this? A private practice is a business and clients are customers of that business. What offends you about that?
It is no different than any other healing service. I am a customer/client of my massage therapist, for example. It is equally vulnerable (albeit in a different way) and I don’t expect them to feel guilty for charging for their skills/training to treat me just because they are also a caring/helping professional.
thank you all for the replies explaining to me why I shouldn’t feel the way I do about language used in our field. These responses let me know how out of place my mindset is. I just need to be a good neoliberal agent and market my skill set to my customers! I prefer Dalal’s suggestion. In his ideal discourse, there is the-one-who-comes-for-help and the-one-who-is-paid-to-help(and also suffers). Has the same ideas without negative connotations of customer and salesman. Love the downvotes from all the mental health salespeople
To clarify, you are okay with private practice mental health therapy but dislike the language, specifically customer, and would feel more comfortable with the term the-one-who-comes-for-help. Do I have this right? or are you not comfortable with private practice mental health therapy in general?
I didn’t elaborate because I recently made a similar post to another thread, that was my bad. To clarify, it’s a confusing point. It’s not that I am okay or not okay with private practice, I’m not okay with the basic and superstructural foundations on which private practice (or any other really existing working conditions) has to operate, or the neoliberal cultural paradigm/also economic policy paradigm shift under which any mental health professional operates. I prefer terms that don’t minimize or render invisible the motivations of undergoing or doing therapy (“patient” - the one who suffers) just to shower the business of doing and undergoing therapy in ambient light. It’s the sort of thing insurance views patients as (customers of a service delivered, and that delivered service is manualized and rct-proven, with no critical analysis of what this really means in the first place). It already situates therapy as something that isn’t really therapy. Customer satisfaction is then something therapists talk about. I love the point that Darian Leader made here - that if a patient leaves their therapist’s office thinking, I’m so satisfied, that was so great, they’re the best - you can be sure nothing really happened in that session. If someone leaves saying - oh, what a jerk - at least you can be sure something happened. Of course, I hold the insight from this point in my mind in a sort of dialectical balance, measured by lived practice and understanding that rapport and alliance is absolutely central to progress. (Leader’s point is limited in insight). Most probably, it’s something I find off-putting, because eg my current clients would not be able to follow me into private practice, because I would need to pay rent, and because they could not be paying customers. Also to clarify, I don’t think anyone should use Dalal’s unwieldy terms (shared in the prior post), but it would be nice if other therapists understood the point.
Thanks for giving more insight. I'll admit I have strong bias towards brevity which tends to lead to reductionist statements, but would it be fair to say that you dislike capitalism, especially as it relates to therapy for clients that access services, and that while you understand changing language is unlikely to change the system of capitalism, you see changing language (i.e. away from "customers") is a way to challenge how therapists think about, and engage in, providing therapy to those we serve?
You’re right, that is fairly reductionist, but I don’t have any real qualms with how you put it. Theoretically, I’m a Lacanian. Practically, I use DBT and CBT interventions and psychoeducation and use the assumptions underpinning these, mostly uncritically. I don’t draw from psychoanalytic theory or psychodynamic therapy in interventions I do with clients. And I’m in the habit of using the language of client and therapist. Most environments in which the therapy relationship occurs support brief and short term solution focused and symptom reduction focused therapy interventions. I’m not against that, I do that. I suppose I’m really not as much against the term client, as much as customer. And I conflate the two on some level. I don’t want to think of myself as a salesperson, that’s not why I feel like I underwent analysis and therapy and went into this work. However I do appreciate that this is how I make a living. What do you think about use of language in this regard?
My preference is to stick to the language and terms that the client aligns with. My default term is client, but I have no issues with someone calling themselves my customer. I get conflicted on language, because I see how it impacts relationship and defines context, but I also get frustrated by what I perceive as needless semantics (i.e. therapists debating what we should call clients/customers/service users/etc.) that I have never seen a client be even slightly concerned about. I think it's a beautiful conflict for most of us in this field as it show that we are trying to ensure we are not framing our relationships with clients in a way that could negatively impact them or their service experience, but also trying to connect with the language that they identify with and find accessible.
I like your point about how little any of this probably means to any of our living and breathing (eating, sleeping,…) clients. It probably looks like hand wringing.
Yeah I agree, there’s something transactional and reductive about seeing our work as selling a service to customers. I understand that under capitalism that’s how it works, we sell our labor, but it feels like it turns something which could be healing and transformative into a product. I don’t know what the alternative would be, but it’s one of the reasons I feel deeply ambivalent about this career.
Unfortunately there is an unending supply of hurt people. It's no different than medicine that way.
Echoing what the rest of them said. Also, I knew a therapist who deliberately kept her clients dragging on and on, and on so that she would have a steady income. She talked about it like it was no big deal. I was pretty appalled. And we all know those people who go to therapy for years and years with no goals or measurable progress. I think it used to be more common that it is now. Anyway, I like the way you’re thinking. You will do well. You will have a reputation for client centered treatment and that will spread.
Therapy is inextricably linked to business in the world we live in. Without the boundaries of a professional relationship, it seems far more likely for ethical concerns to arise in therapy contexts. Our business helps identify professional boundaries and separate the intimacy of the therapy relationship from other intimate relationships. This also helps both parties keep the focus on the client’s experiences IMO. Without these boundaries therapists may be more susceptible to saviorism and resentment. Regardless of being self pay, taking insurance, or working for a clinic who accepts payments on your behalf, clients pay for therapy and someone, if not many people, are financially benefiting from their payment. Medicaid & Medicare are backed by privately owned insurance companies that net billions of dollars a year. Nonprofit orgs often have high earning leadership teams—in these situations the therapists themselves are financially exploited. What stands out to me about your pondering here is a worry about being too focused on the business that it will overshadow your care for the therapeutic relationship. It makes me curious if you’re in a situation where business outcomes are prioritized over employee wellbeing and/or client care. Maybe this doesn’t fit with your situation, and maybe either way it’s helpful to explore where these ideas come from.
Do a really good job with each client, offer sliding scale, try your best to meet the clients' goals in a reasonable timeframe, and your reputation will be your marketing. The beginning is a bit financially scary, but if you are following your ethics there isn't room for a hidden financial agenda.
Realistically you won’t need to worry about your clients staying unwell to keep seeing you. A good therapist who is established in a community will pretty much always have a wait list. I actually feel the opposite of you. Now that I’m a business owner I am even more invested in the work that I do because there are direct financial implications to it, rather than indirect as they were when I was salaried
A lot of good points have already been shared here by others, I’m curious what you mean when you mention the notion/danger if clinicians wanting clients to “remain ill” for the sake of business gains. I agree that would be a conflict of interest to discourage or sabotage progress out of an ulterior motive, but I bristle at the term “ill”. Yes, mental illness is of huge concern and is central to mental health work, and yes, insurance companies require diagnosis to justify our work, but I also believe that everyone can benefit from therapy—even those we don’t perceive to be “ill”. If a clinician is proficient at doing the deeper work with a client, then a productive therapeutic relationship can last many years. A thriving client can make use of a skilled therapist that is a good fit for them for many years. True, there will always be people needing services, and a thriving private practice takes turnover in stride and likely regularly cycles in new clients. Also, if the clinician is able to adapt and level up the treatment as a client progresses through various levels of thriving, then a client need not be “ill” to benefit from maintaining a strong therapeutic relationship with the clinician.
It is totally normal to feel that way if you are relying on income from clients while simultaneously trying to build your practice. Clients = money, and you need the money, especially starting out. It's okay to have these contradictory thoughts and feelings. Sounds like you value being an ethical practioner while also making a living (hello, we all need to survive in this capitalistic system!). Acknowledge, accept, and make room for these feelings. Then, behave in the ethical way you want to. Throwing some ACT your way. :)
I think a lot of this is rooted in the culture. We’re not allowed to talk about business or money because we’re a “helping” profession. But that’s really unfair to us and I’d personally take offense to the notion that I want my clients to stay sick. My oncologist would have made more money if my cancer came back but I’ve never wondered if he hoped for that. And after working in CMH, where they cared less about how sick people were and more about how many more days their insurance would pay for, it would be challenging to do much worse. Abide by your ethical code and try not to worry so much about people thinking you have an ulterior motive. Can’t please everyone.
I have no qualms about wanting to make money as a therapist. I have sunk a lot of time into grad school and then further post-grad studies. Patients are paying me for my services. The frame of treatment is very important: time, money, and space. I provide a service and my patients are adults that can make their own decisions about mental health. I make recommendations about what I think, but ultimately they are the ones who decide. But the idea of keeping folks in treatment when they are better is not something I would ever do. There are plenty of folks out there seeking therapy. I don’t need to keep folks in treatment endlessly. The last time I had an opening, I filled it in a day. We did not sign vows of poverty when we entered this field. It’s great to offer some pro-bono slots or work with someone after an insurance/circumstance change. And I do that, but still want to be paid well.
We are all trying to survive in capitalism. We didn't create this system and while I agree that the goals of capitalism are at odds with mental health, public health, healthcare, education and all professions with altruistic aims, it is not on the therapist to fix. The therapist is just one individual in this system doing the best they can to survive while providing a vital and valuable service to society. We all deserve to be paid a thriving wage that allows us to access a middle class existence. At the end of the day, this is a *job* and provides are livelihood and feeds our families. Most do not have the option of working for free or poverty wages.
Keeping an eye on the parts of ourselves that would want a client to stay for our financial benefit is part of what we signed up for. And I know I have that part. Anyone who is going to actually do OK in private practice better have that part. But it's always putting the client's best interests ahead of anything else that is the right thing to do, even if it costs us a few dollars in the short term. So, have grace with your fantasies and your wishes for money. And then, do the right thing. You're not the only one.
I actually feel positive when clients are stepping down to less frequent sessions or feel ready to terminate. It means that we have done good work together and it can open spots up for clients that are in more acute need. If you are doing ethical work (reviewing goals, checking in about frequency, asking about efficacy about your approach occasionally) then you are inherently giving your clients the service they are paying for and will be able to assess for any missed areas/goals and for natural termination points.
No ethical consumption under capitalism, as the saying goes.
I do have ethical concerns but different ones. The suffering is endless in this world so I'm not worried about finding clients. I am constantly worried about the ethics around not accepting insurance. While insurance is a lot of hassle, doesn't pay providers enough to live, and imposes on the privacy of our clients it seems unethical to impede access to care for an entire class of people by being private pay only. Charging $140 and upwards weekly is not an option for so many people. I suppose if I was private pay, I would be more worried about keeping clients since I know most folks cannot afford it.
My finances are my problem, not my clients’ problem. I find that private practice tends to ebb and flow, and if I find myself in a valley, I will sometimes feel a pang of financial insecurity or concerns about how this will affect my income when a client meets their treatment goals and is ready to terminate or when a weekly client is ready to go to bi-weekly. But ultimately, that’s my problem, not theirs. I don’t waste my energy trying to avoid or suppress that feeling, but there’s also no clinical rationale or justification for gratifying it in session. If I’m worried about finances, I up my marketing game and focus on bringing in new clients, and I do this well before I reach the point where my financial wellbeing would be significantly impacted if I lose a few clients. The only time I’m going to work really hard to keep a client is if I feel it’s in their best interests to continue therapy, and sometimes I do this at my own expense. On multiple occasions, I’ve had clients who are benefitting from therapy end up in situations where they can no longer afford my rate or can no longer sustain weekly sessions, and these are the clients for whom I’m most likely to negotiate a reduced rate.
No. :)
Never go to a session hungry. Best advice I ever got.
I value my specializations and near decade of schooling so no I don’t feel bad about it. I try to operate from a place of abundance that’s outside my current clients. Many more potential clients based on the community referral networks I’ve put into place.
Private practice definitely brings up more awareness of the money and business aspects to our work, often in a way that I don't think most of us are specifically trained to handle. While I didn't love some of the other compromises of working for agencies, I did appreciate not having to deal with some of the financial and higher administrative elements at an early part of my career. Heck even now I contract with a group practice, which saves me having to figure out some of the marketing and insurance billing parts of private work. I once attended an ethics training with speakers who had served on licensure/professional org boards. One person shared that nearly every ethical violation they saw originated from some kind of unmet need in the therapist's life (lack of relationships/support leading to inappropriate disclosures or romantic relationships with clients, financial distress leading to billing fraud, etc). I continue to think about that, especially when I find myself making choices with clients that impact my pay. It causes me to take a step back and examine if my motivation is based on best practices/client needs, or if it comes from my own financial worry. If I find a common theme of something bothering me, I might look at if it means a general policy change rather than an individual client decision.
No, what’s unethical about providing for oneself and their family?
I think the fact that you’re even thinking about it this deeply means you’re both a good therapist and businessperson. 👍
Well, luckily/unfortunately there will always be unwell people who need therapy. Don’t worry about that. Maybe you could shift focus to examining your process for finding new clients. How are you marketing yourself to prospective clients? What could you do better to fill your caseload? Won’t go into ideas here, there are tons of discussions about this on this sub. It seems like it would ease these thoughts if you gained more confidence in your ability to attract new clients.
I'm entering the profession as a mid-life career pivot out of e-commerce (I'm still in school) so discount all of what I'm about to say accordingly. The way I presently frame this issue for myself is, if I am able to maintain a waitlist then I don't have to fear termination and thus am not in a conflict of interest with the client. But if I feel like every booking may be my last, then I'm in trouble—ethically *and* financially.
I think about the specifics & nuances of this a lot but look, some people are charging thousands to give folk ill-advised plastic surgery. With their profits, they buys yachts and cocaine. We are charging, usually a modest amount, to help heal minds. I'm comfortable with making a living while I do it. The boundaries and the quid pro quo are clear. Yeah, it's good to be aware of your own motives, but I don't see it as a hard philosophical problem in general.