Los Angeles Chapter  California Association of Marriage and Family Therapists

Los Angeles Chapter — CAMFT

Editor's Note

11/30/2019 10:00 PM | Mike Johnsen (Administrator)

Lynne Azpeitia, LMFT
Voices Editor

Getting Paid: Talking About Sliding Scale Pricing The Words You Use Do Make a Difference

How much do you charge? What’s your sliding scale? Is that the lowest you charge?

How much can you slide? How low can you go?

If you dread hearing these questions you are not alone.

While questions about a lower price or a sliding scale used to be asked from time to time, therapists are reporting that now they are asked these questions all the time—from just about everyone who calls.

What’s problematic about this?

Well, before this recent phenomenon started, sliding scale requests came from just a few—usually those with a low income or reduced ability to pay, a financial hardship or significant unexpected expense. Now a majority of those asking for lower or sliding scale pricing more often have adequate resources, income, and an ability to pay. What’s a therapist to do?

Offering lower pricing to clients truly in financial need who require mental health services, is a time-honored tradition in the practice of therapy. Sliding scale and other types of price adjustments were instituted to make therapy services available to those whose economic circumstances didn’t allow payment for the full cost of services. Having these accommodations available allows therapists, at their own discretion, to adjust the amount a client pays and can manage on a regular basis

Like most therapists in the mental health profession, I believe in, and support, making affordable therapy available to people who don’t have much money and those experiencing a financial hardship. Clinicians, who are committed to this, routinely offer those in need a variety of options that allow them to afford and pay for needed mental health treatment. Many therapists also work with certain clients on a case-by-case basis to offer specialized arrangements based on their particular needs and circumstances.

Some of the options private practitioners use to make therapy affordable to clients in financial need are: pricing based on income; lower pricing; a percentage or number of lower priced client spaces; an allotted length of time or number of sessions of lowered pricing for a certain number of clients; flexible scheduling (three sessions per month, every other week, etc.); charging less for shorter sessions; payment plans; pro bono sessions for a client or two; charging less for sessions during slow periods of the day; special arrangements based on special circumstances; a limited number of reduced-price scholarships; sliding scale; etc.

With so many callers asking about the lowest prices they have, now therapists feel even more to reduce prices because

  • They want to help people get the care they need
  • They’re sensitive to the underlying assumption that clients expect the therapist to take care of them by lowering the therapy session price upon request
  • They don’t want to come across greedy, in it for the money or with a “the meter’s always running” mentality
  • They fear that if they don’t accept low prices they won’t have any clients or be able to fill their practices

While clinicians believe it’s important to offer sliding scale pricing only when a client is genuinely in financial need, unfortunately, when repeatedly asked about sliding scale or lower pricing, many end up undercharging, letting clients determine the fee, maxing out the number of low-cost clients their practices can accommodate, cutting prices below the minimum amount needed to keep their practice open, and feeling resentful or taken advantage of by clients they gave a lower price to and then discovered were spending large amounts on luxuries (new, high priced cars, jewelry, vacations, designer clothing; dining at pricey restaurants, etc.) after they’d claimed they couldn’t afford to pay for therapy and needed a lower session price.

Sliding scale, special arrangements, and lower prices upon request were never meant to be offered as options to those who had resources, could afford to pay the full price, and who, for other reasons, don’t want to or think they should. It’s also not financially feasible for any private practitioner who wants to remain in business, to give a discount to every single client who wants to pay the lowest possible price for therapy—after all we need to keep our practices up and running, be able to cover practice and professional expenses, and support ourselves and our household.

Responding to callers and clients who are asking, but don’t really need or qualify for a lower therapy rate, is a very different type of conversation than the one clinicians trained for and are familiar with—people who genuinely have, a financial need. As therapists, our task is to find the right balance of how, and how much, we can adjust session prices, for which clients, and how many—and not go out of business. In the current climate, navigating talking about prices with these clients takes more specialized skills and requires a totally different mindset, approach, and vocabulary.

So, what’s the best way to respond to a caller or current client who wants a price accommodation but doesn’t need one?

Money Talk: Words & Phrases to Consider

Let’s look at some of the words that can make a difference when a clinician talks, writes, or communicates about money matters involving sliding scale and adjusted pricing for those with limited income—and how and why these words can affect the amount a person is willing to consider or pay for therapy services.

This information applies equally to phone calls, face-to-face conversations in real time or virtually, emails, texts, social media postings, and what’s printed in marketing materials or written on a website. Yes, each of these words and phrases can have a direct effect on the perceived value of the services a therapist provides and the amount clients are willing to pay for the clinical services you provide.

As you read the following information, be sure to remember:

  • Only do and say things that fit for you, your clients, and your practice—and always within legal and ethical guidelines.
  • You can ignore everything written in this article and still be successful. Discover what works for you, your clients, and the practice setting you work in.
  • These suggestions are meant for use with clients who aren’t low income and don’t have a financial need since most therapists are aren’t having much difficulty with fee conversations with clients who can’t pay for therapy without an adjusted price.

Now about that vocabulary . . .

As noted in Getting Paid: Talking Fees, Pricing, Prices The Words You Use to Talk to Clients About Money Matters in Therapy Do Make a Difference, using fee, full fee, my, my fee, etc., currently seem to signal to those seeking therapy that any stated rate for clinical services is just a starting point. It’s automatically assumed therapists are open to requests and negotiating lower prices. You’ll notice that the words listed aren’t used in this article—that’s why. To review alternate wording, click the link. Using some of these suggested words may eliminate a client who doesn’t need a sliding scale asking you about one.

1.     Low, lowest, lower . . . Reduce, reduced . . . Discount, discounted . . .

Lowest price/prices/rates/amounts . . . reduced price/prices/pricing/rates/amounts . . . discounted price/prices/pricing/rates/amounts

Are the people who call us about our services seeking therapy or shopping for therapy?

In today’s world using any of the words listed seems to put people on the “I’m shopping” channel. Not exactly the best channel to be on to seek professional help for mental health issues or work, family and relationship problems, self-regulation skills, healing past traumas, addiction, recovery, anger management, parenting skills, growth, etc. It’s sometimes very easy for people to get mixed up about what type of professional help they need and what that costs.

Are people looking for a professional who’s trained and skilled in helping clients like them with their presenting issues? Or are they looking for the lowest possible price for counseling? How much is it necessary to pay? What difference does the price make? These are all important questions for therapists to address when clients call about therapy and cost is discussed.

As mental health professionals who are highly skilled and experienced, we don’t want to add to any confusion, so it’s important we’re aware of the words we use when we talk or write about the price for therapy services so we don’t inadvertently encourage clients to shift into a shopping for the lowest price mindset or turn into a “therapy price shopper.”

Clinical services are valuable and worth paying for since stopping unhealthy behaviors, learning new skills, and how to take better care of yourself can save both money and time as well as help you take advantage of opportunities that make your life better. How much does therapy save when you don’t get divorced, lose your job, get a DUI or???? When you compare the cost and benefit from what you receive then the price may seem worth paying—even if you must rearrange your budget, put it on a credit card, arrange a family loan or payment plan, etc.

Unless therapists are specializing in clients who only want to pay low, reduced or discounted prices for therapy services, in general, it’s best for those in private practice to use other words and not any variation of “low, reduce, discount” when referring to or stating pricing for therapy services.

2.     Sliding Scale

When in conversation or writing, substituting one of the following words in place of “sliding scale,” price . . . rate . . . amount . . . pricing . . . cost . . . charge . . . along with adjust, adjusted, alternate, alternative, affordable, special, economy, helps clients understand, and cognitively register, that this isn’t the type of pricing range where a therapist will, upon request, “slide” all the way to zero, or some other very low price.

Adjusted price . . . economy rate . . . special pricing . . . cost adjustment . . . more affordable amount

Using this wording usually results in fewer requests and conversations from those not truly in financial need. With these words people, usually don’t just automatically try to negotiate to make a stated price lower.

Let’s look at this from another perspective . . . When you go to a doctor, attorney, dentist or other professional, do they use the term, sliding scale? Most likely these professionals use words like adjustment, introductory, limited time or another pricing term. Clients are familiar with this wording. and when it’s used, don’t automatically assume that the price stated is open for negotiation to a lower one. Nor do they experience these definitive words as an invitation to ask for a discount or adjustment to a much lower number.

Now’s a good time to take a moment to think about and consider the words you are using with the people who call or clients who want to change the amount they pay, what you’ve read about this, and what your colleagues are saying about handling these things and if, and how, it’s working for them, and for you.

That’s enough for today on talking sliding scale pricing and getting paid. I hope you’ve found it useful to understand how the wording you use to talk about sliding scale pricing can increase or decrease the money you earn in your practice. See for yourself how the words you use can make a difference.

The next article, the fifth in the Getting Paid Series, covers sliding scale, part 2—specific suggestions about how to introduce and talk about your sliding scale, adjusted pricing and specialized alternatives.

Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples, and Gifted, Talented, and Creative people across the lifespan. Lynne’s been doing business and clinical practice coaching with mental health professionals for more than 15 years, helping develop successful careers and practices. For more about services, training or the monthly LA Practice Development Lunch, visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com.

Getting Paid: Talking About Sliding Scale Pricing—The Words You Use Do Make a Difference is the fourth article of the Getting Paid: Talking with Clients About Money Matters Series:

  1. Talking with Clients About the Price & Value of Therapy 

2.   Talking Fees, Pricing, Prices—The Words You Use to Talk to Clients About Money Matters Do Make a Difference

3.    Talking Pricing, Services, Rates—The Words You Use to Talk with Clients About Your Services and Rates Make a Difference 

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