do you pay your T to consult with other T's?

I'm looking for some opinions or experiences. I received my last therapy bill and discovered that my T charged me for his conversation with a psych dr (at his regular rate). I attended a trauma assessment clinic and the dr suggested my T attend a few supervision sessions. When my T and I discussed it he didn't tell me that he would be charging me for the supervision or that he was charging me for the time he had spent talking to this dr and discussing my case. I left him a message telling him I was upset about him not discussing it with me and he told me he regretted not discussing it with me first. So we will probably discuss it further and my session tomorrow and I am wondering what other people's experience with consultation or supervision has been.

On one occasion I went with regular-T to a super-T. I paid super-T but not regular-T. But regular-T didn't pay super-T so I guess it all works out.

I've never been in this circumstance, but I would imagine it comes down to paying for time. The time was spent on your behalf and was substantial--and it sounds like at your request--so I think you would be expected to pay for the time. It of course would have been better for the arrangement to have been clarified beforehand.

I go see consulting therapists all the time and pay them. I have never tried taking the therapist I see regularly.

I would agree with this. You've received a valuable service from your t and thus I think you should pay for his time. Otherwise, you would be benefiting from something that you haven't paid for. However, I also think you have a legitimate beef with your T that he didn't tell you that he would charge you for this. That was a mistake on his part, but I don't think that the remedy is to not pay him. He's acknowledged the mistake and apologized for it. Personally, even if he suggested I not pay for it, I would be uncomfortable accepting this for free just because he neglected to inform me about the payment. Although it's probably never reasonable to make assumptions, he probably thought that you would know that he would charge you for this service.

I think he should have agreed this in advance.

My T goes to supervision (accredited Ts in the UK have to be in regular supervision) and pays for it himself, but that's a regular thing and not appointments for a specific case.

Can you afford to pay?

How much time and money are we talking? If it is for 10 minutes of consultation, that feels a little petty to me. If T spent a whole hour, that is more justifiable (although he absolutely should have cleared it with you first.)

EJ

Thank you for letting me know your opinion.

I did pay my T and would never expect of insist that he spend time that he wasn't being paid for doing something for me. The confusion arose because he didn't discuss it with me before billing me and there are some complicating issues. For example he has consulted with two other T's in the past and not charged me for those consults (although I have no idea how long those conversations lasted). Also this will be a fairly substantial amount of time if I okay the supervision. The initial consult (and what I was billed) was 30 minutes but we had discussed him having 1 hour sessions with the doctor and the number wasn't decided so not telling me about his fee could result in quite a large fee if I was paying his hourly rate and the doctor's hourly rate.

I pay for my therapy completely out of pocket and it costs me approximately $1250/month (2 sessions/week) which is a huge expense for my family of 5. It is worth it but I need to be prepared for the fees because adding another $300 or so per hour of supervision would be costly. It was also a lot more difficult because between the consult phone call and my bill be prepared my husband received notice at his job and I spent a session telling my T how worried I was that he might not be able to find a new job and that I would probably need to decrease the number of sessions I attended to prepare for that.

The session with my T went well. I paid the bill first and then discussed it with him. He apologized for not discussing it with me and said it was his standard practice but he might not have charged in the past if they were short phone calls. He also told me that he thought he would charge me his fee and he would pay the doctor's fee himself but he was willing to discuss it. I told him I was okay with whatever fee he decided on but I wanted to be informed of it in advance as well as being informed on how many sessions he would be attending. I okay three initially but after that I might reconsider the supervision or need to skip some sessions myself in order to keep my therapy costs steady.

I hope it goes well for you. I personally believe the therapist should pay for his own supervision, not the client.

As far as I know it is standard for the therapist to pay the supervisor; but it is also common for the client to pay the therapist if it is the client requesting the supervisory sessions. So it's a pass through cost, and while it's not costing the therapist in $, it is a time commitment, so some wouldn't agree to it.

I did not read this as the client having requested it.

This made me think the client initiated it--

I attended a trauma assessment clinic and the dr suggested my T attend a few supervision sessions.

But if not, then it would totally be the therapist's responsibility and decision whether to seek supervision and the client shouldn't be charged.

Yes I did request the assessment. Over the 4.5 years I have been seeing him this is the 5th time I've consulted other therapists and the second time that he has consulted with those therapists. He didn't charge me the first time and I know it was a single phone call (I don't know how long the call took). I've had a lot of negative transference with T (but I have it was everybody in my life) and he has always been completely understanding and accepting of my choices in consulting other professionals (which is part of his job but I know a lot of T's aren't able to do it). I appreciate his willingness to attend supervision with a T that I basically picked for him and I'm willing to pay him as long as I am not surprised by any charges.

Your approach makes sense to me. The "supervision" (which might more accurately be labeled as "consultation") is for your benefit and at your request. I think that more traditional supervision is for the benefit of the T for all of his or her clients, not just one client. If it were the later, it would be appropriate for your T to pay.

My T and MC have consulted each other and neither charged me.

I've always had people consult with each other (individual T's with group T's with dietitians with psychiatric nurse practioners with doctors), even repeatedly, and no one ever charged me. I agree that payment should have been discussed ahead of time.

I don't think he should have charged you. A T's professional development is his own responsibility and a cost of doing business that should be built into his operating expenses. Many Ts have ongoing supervision and I have never heard of a T charging a client separately for this expense. Different professions handle this kind of thing differently. For example, my lawyer usually charged me for any time she spent doing tasks related to her work for me, even a 5 minute phone call. That is the fee structure model of lawyers and a convention in their profession. However, therapists generally don't follow that model, especially when it is supervision, which many therapists have. I work at a mental health clinic and when the Ts get supervision, the clients are not billed for this. There are certain things they can get reimbursed for outside of face-to-face client time, but supervision is not one of them. There is no CPT code for that.

In any case, I think your T should have told you up front that if he were going to get supervision, he would charge it to you. Then you would have had the opportunity to decline. His supervision on trauma treatment for your case will benefit him in future trauma cases too, so I do see it as part of the cost of professional development, which professionals usually pay for themselves, or their employer pays for.

I don't think I would. I pay them for a set of skills. If they need top consult with someone else (and I imagine most professionals consult with others on occasion) that is to help them with their professional development and they pay for it (or whatever arrangements they have worked out for the consultations. I think all therapists should be in regular supervision/consultation on general principles.

I like to pretend that my fee pays for my T's supervision and my session is free...