Admitting you’re in private practice and burnt out is difficult.
What I found even harder was figuring out what to do about it. I had a caseload of 41+ clients in my “successful” therapy business. It was too much for me and I knew it needed to change. I needed to see less clients to honor my mental, emotional, and physical needs.
After much inner searching, research, consulting, tears, therapy, journaling… you name it… I decided to restructure my private practice. I knew I was the only one who could attend to me and take care of me. I was responsible for myself.
I started by looking at how much money I needed to survive and pay for things I wanted in my life (like saving for sick days, vacation, retirement, etc.). I then discerned how many clients would be a healthy amount for me in a week. I learned this approach from Tiffany McClain and I joined her paid program to help therapists address their money mindsets and implement fee raises in their practices ethically. Through her program, my conversations with other therapists, and my own discernment, I knew my new fee needed to be $200/50 min.
At the time, my fee ranged from $35-$150. I had a mix of fees because I had some people at my original fee of $75/50 min, some on sliding scale, and then varying levels of fees because I slowly raised my fee to $150 over the year. On average, my fee was $84/50 min.
It was May 2021 and I decided that come August 2021, I would have a flat fee of $200/50 min for everyone.
There were many ways I could have raised my fee: slowly increasing it 5% each month, only raising my fee for specific clients, only raising my fee for new clients, etc.
I chose to put my new fee into effect for everyone at the same time for multiple reasons:
I had 41+ clients on my caseload. It was far too many. I needed to see less clients. I didn’t want to slowly raise my fee and retain all of my clients. I wanted to cap my caseload at 15. For that, I knew it was better to state my new fee.
I wanted to be fair, equitable, and ethical with everyone. With my previous fee structure, my sliding scale was based on an honor system. If people requested a sliding scale fee, I took them at their word. Over time, I realized that everyone has a unique relationship to money. We all have beliefs that influence how we feel about money and what we “deserve” when it comes to support. For example, I had a full-fee client take on extra shifts so that she could pay for therapy. I also had a sliding scale client who took multiple vacations throughout the year, but insisted she could only pay $35 per session. These examples are not to shame people. These examples are to show that I don’t always get the full story as a therapist. For me to sit in judgment of who gets to stay at a sliding scale and who will move up to my new fee felt far too complicated and unfair. I decided to treat everyone equally across the board.
As an autistic person, my brain can easily ruminate and fixate. I knew that I would handle all of the changes the best if I did them consistently across the board at the same time with the same timeline. I know some therapists who choose to talk to clients at different periods of the year about fee raises depending on the client’s situation. I knew I didn’t want to juggle 41+ different plans in my head. That was too much and it’d take up too much brain space
I knew what it was like to have people at varying fees. It was a lot to keep track of. I wanted to simplify my system and have everyone at the same fee.
I wanted my new fee to go into effect with the new changes to my business policies. That involved my new schedule availability, no cancellation policy, and weekly meetings requirement. I wanted my clients to be able to commit to my new fees AND these new policies/schedule.
I was burnt out. I knew if I continued to offer a range of fees, that meant I would have to see more clients to have my financial needs met. I did not want to be a burnt out, resentful, or depleted therapist. I wanted to show up excited, energized, and prepared for the work. I knew that meant having a smaller caseload.
I wanted to live what I taught my clients - honor your needs.
All of my above points took a lot of internal wrestling. I talked in depth with my own therapist. In fact, I even hired an additional therapist during that period who had more experience with helping people examine their relationship with money. I quickly learned that money will bring up EVERYTHING. I had to work through a lot of my own beliefs.
Was I abandoning my clients?
Was I being unfair to my clients?
Was I a bad person for putting my needs above theirs?
Was I no longer “helping” if I wasn’t offering a sliding scale?
Could I be a good person if I wasn’t serving in some way?
Why was lowering my therapy fee my primary way of measuring “helping”?
I also had to face a lot of the contradictions within me. I did a lot of soul searching. I had a lot of conversations with myself, my therapists, my supervisors, and other colleagues.
In short, I made the best choices I absolutely could. And regardless of that - it still had an impact on my clients. It still meant their therapy fee was going up and they had to make tough choices. I don’t deny that reality.
I chose to be fully present during those moments. To help clients dig into what was coming up. I was amazed by how much it deepened our therapeutic work. How much came to the light that I didn’t know was there:
One sliding scale client told me she did have the money and decided to pay my full fee
One client was excited to possibly do EMDR with another therapist
One client confessed that she felt she needed more therapy than what we were doing (we were seeing each other every other week) and so we found her a weekly therapist at a fee she could afford
One client shared she had been wanting to raise fees in her own business but didn’t know how and was grateful to have a model by watching me raise my fee.
It was a full range of responses. Some clients didn’t bat an eye. Some took time to process. Some were excited to pay me more. Some were upset. Some decided to work with other therapists. Some were able to take deep looks at their own relationship with money.
As I got real about my needs, so did clients. We had deep conversations about what they really needed.
For example, I had one client who was willing to continue at my full fee. However, I used our fee talk to also explore the progress she was making in therapy. That discussion led to us deciding it was time for her to try another therapist who offered a different therapy modality that might be a better fit for her.
I had some clients who were willing to pay my fee, but said they would have to reduce to meeting monthly. We talked at length about their therapy needs and how monthly didn’t really provide the frequency they needed. We also talked about how choosing to go down to monthly mirrored how they often sacrificed their own needs. We found them therapists who could meet with them regularly at a fee they could afford.
And herein lies the truth: I am not the only therapist who can help.
There are many, many therapists. Once I was clear on what I needed for my private practice, I was clear about what I could and could not offer. I am one person - I am not a group practice, agency, or a non-profit that can use government funds or grants. I do not have the same resources.
Thus, if a potential client comes to me and is upset that I am not affordable for them, I can remind myself that I cannot meet everyone’s needs. I am one person. Even if I only charged $1, I cannot provide therapy to the thousands that need it.
It’s now been over a year since I raised my fee. My practice has continued to evolve. I found I work best with longer sessions, so I now charge $300/80 min. This also lets me see even less clients. I’ve also found that having longer sessions has far less energetic impact than seeing an additional client in one day.
As I’ve honored my needs, I’ve also seen my energy dramatically shift. It’s enabled me to flourish in my personal life, and I joyfully fill my time writing essays like this one and contributing in a myriad of other ways to my community.
Which brings me to my final point. In our field, a sliding scale is often seen as the only way to give back and be accessible to people. As I’ve maintained a full fee practice, I’ve realized there are many, many ways I can contribute to my community outside of a sliding scale. I think I am far more of an asset to my community as a rest, energized, resourced, happy human than I was a burnout therapist offering a sliding scale.
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