Your Money Problems Matter

Unfortunately, I have had two personal therapy experiences where I felt manipulated because I was a private pay patient. In my opinion, two different therapists preferred working with full pay clients, and they increased how often they thought I needed to be seen. (Some of you therapists may think I was in denial of how much work I needed, but I’ve already considered that.) I believe they had a conflict of interest.

Recently, I saw a client for a “booster” session where we have been extending out how often he sees me. In planning our next session, he asked my opinion on when we should meet next. I told him confidently that he seemed strong enough to extend the time out even further this time. I only considered his need and not the effect on my practice. I know he appreciated that there was not a conflict of interest.

Many positions require that job applicants go through a personal finances screening. Especially if they will be working with money or high monetary items (police working with narcotics), there are increased temptations for theft. I guess the theory is that those who have big financial issues or debt are more vulnerable to temptations. In general, when employees are underpaid, the resentments build, and thoughts of being owed can create unhealthy mindsets.

I don’t want you to compromise in your private practice on how and whom to best serve. Even though we are exploring the accounting in your practice, I ask therapists who they are serving – typical diagnoses, clients with insurance, EAPs, and how many are at less than your full rate. Why is that relevant to the books of your business? If you usually serve complex diagnoses like personality disorders, high risk individuals, psychosis, etc., I want to know how much they are investing in their self-care. If you are serving EAP clients, typically this is more crisis and short-term work. If your policies are lax on not paying full fee, how might that be affecting how you practice? I want to minimize outside influences on how you practice as a clinician.

Frequently, I get the question if personal therapy is deductible as a business expense. Personal therapy is a health or medical expense and not a business expense. If you only see private pay patients, you are asking them to invest in their mental health even though their investment is not deductible for them. If you need personal therapy, what an amazing example of role modeling by taking care of yourself. You aren’t sharing with your clients that you are in personal therapy, but walking the talk and living your values shows in many ways.

There is a funny cartoon that shows a 2-story house that is in the shape of a cat. The caption says, “If I won the lottery, I wouldn’t tell anyone, but there would be signs.” What signs do you think you give off to your clients? We teach our clients to eventually be their own therapists, to be as independent as is possible for them. When your personal financial house is in order, the way you practice is much freer of interest conflicts. I confess that my personal therapy experiences sometimes add to my distrust of people’s motives in helping me. This is one reason why I work with therapists so that your clients know you have their best interests always in the forefront of your mind.

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