With ex-T and ex-MC, they had a receptionist who handled payment before the session. All of my p-docs have been the same way (though after the session). So that's what I was used to. My T is in solo practice without office staff, so I have to pay him directly at the end of session. I use a credit card (partly so I can get a little cash back), so I have to stand there while he runs it, then gives me the slip to sign. It made me feel uncomfortable at first. Now I generally sort of chat with him (usually about light stuff) during it to make it feel less like a financial transaction. I am glad we shake hands after though, because that brings it back to more personal (even though I know some people see hand-shaking as more business-like). Still, it can be a bit jarring if it's been a really emotional session or if he said something that hurt me. I've contemplated asking if I could pay at the beginning instead, but not sure if that would be even more awkward. I am wondering if he could just keep a credit card on file, and he could bill me later, or, since I see him twice a week, I could just pay him at the second session or something. Or perhaps I could just start going the check route (though I have to submit claims to get partial reimbursement from insurance, and that can take up to 2 months--at least lately--so the credit card at least pushes the actual payment back to closer to when we're reimbursed).