To Slide or Not to Slide, That is the Question

Maria Gray, LMFT, NMP

During this time of year, I start to prepare my financial data for my accountant. I review my earnings for the last year, and I consider my goals for the new year. This “financial housekeeping”. helps me determine how many sliding scale spots I can offer in my practice. Our business is unique in that many therapists are willing to adjust their fees. Most of the healthcare practitioners I know do not offer sliding scale rates to their clients.

When I started my private practice, I was an intern. I offered most of my prospective clients a sliding scale; this helped me build my practice. As my practice grew, I had to make decisions about if/when I could continue to adjust my rate. The decision to slide for me is not just about my finances, it’s also an intuitive decision based on what I am feeling when I talk with a new client on the phone. I might choose to slide if I am receiving a referral from a colleague I know well, or am interested in getting to know. I have a soft spot for students and interns; we all remember how challenging that time was. There are certain times of day where I do not offer a sliding scale, specifically evening appointments and early mornings.

Here are some of the questions you might ask yourself prior to deciding whether to adjust your fee:

1. What are your financial goals for this year?
a. How much do you want to earn?
b. Do you have any student loan or other debt to pay off?

2. Is this referral from another clinician who you are building a relationship
with? Could taking this client lead to additional referrals?

3. Is this client presenting with symptoms you are comfortable working
with, or does it seem like this client may be more challenging and
require lots of interaction between sessions?

4. How many low fee clients do you have in your practice?

5. How many sliding scale clients do you have in your practice?

6. When was the last time you raised your fees?


Maria Gray, LMFT, NMP is a psychotherapist in private practice with offices in West LA and Larchmont. Maria specializes in trauma and addiction. To learn more about Maria’s practice see Maria’s next marketing workshop, Everything You Ever Wanted To Know About Building A Profitable Private Practice But Were Afraid To Ask, is scheduled for Saturday, February 25th.  To register, go to