[Kitty527]

Hi everyone!

I'm new to this site and I'm choosing to post a thread on here because something really angered me about my last therapy session. I'd like to hear feedback on this topic from other psychotherapy patients or therapists themselves because I don't really know what is "the norm" on this issue.

This is kind of a touchy subject for any of us to talk about because it deals with money and I don't know if you even deal with these sort of questions in this forum...but anyway... I've been in therapy for about two years now for anxiety and codependent related issues. My therapist is male and he and I have a very solid relationship for the most part. I go twice a week. I've been paying the same fee of 150 dollars...out of pocket...the whole time I've been his client. I've never given him any payment problems - always on time and paid in full. Needless to say, I've already paid him a great deal of money.

I usually send my checks in through mail to his office but last session I decided to bring the check in and give it to him directly...Only because I happened to have my checkbook with me and it was one day before the due date so I figured, if I'm here I might as well give it to him this way. So, he used this new occurrence as an opportunity to "raise the topic of a fee increase." He said this is the time of year he usually brings it up to clients. He said he missed the opportunity with me last year. First of all, he didn't give me ANY notice that there was even a possibility of a fee increase ever and second of all I felt like if I never handed him the check in person, he would have never brought up the issue at all. So in essence, I felt kind of punished for bringing in the check instead of sending it in the mail like I usually do. Like, the first time I actually hand him money he asks for more! lol

We talked about this fee increase for the entire 45 minute session. He told me that just because he raised the topic of a fee increase doesn't mean I HAVE to start paying more...but just the fact that he asked and in the manner in which he brought up the topic just doesn't feel right to me. Now, even if I decide not to pay more money, I think I'll always feel guilty for not paying more and that is going to put a damper on our whole therapeutic relationship.

I know that therapists have a right to raise their fees but I think there are rules about how they go about doing it and when they do it and who they ask it from. I mean he NEVER gave ANY indication from the very first session that there was even a possibility of a fee increase. I think he should have told me that this might happen right off the bat. I think I was just in shock that he actually asked me lol. Shouldn't therapists give advanced notice if they are going to increase their fees? And after two years, now he's asking me for more? Kind of seems to me that he's almost trying to push me out...or saying that I need more money from you if I'm going to put up with you for longer lol. I know that's probably not the case but the way he went about this left me feeling very betrayed.

Additionally, he pretty much told me that he does make enough money that he is not under a strain but that he's constantly trying to improve and he has costs for the office and stuff that he needs to cover. And he asked me if the current fee was a strain on me and I said that it's not really a strain but it's the largest expense that I currently have. (I'm 26 years old and I still live at home with my parents and I'm a teacher and make a decent salary) But he pretty much indicated that since it's not a "strain" for me then it would be okay to pay a little more. Just because I'm not "struggling" means he can just up his already expensive fee whenever he wants in a not -so-professional manner?

Sorry for the long post...as you can tell I'm pretty angered about this whole thing...and I promise you, I'm not quick to anger. In fact, I usually do not stand up for myself at all. But the way he handled this whole issue just doesn't seem right to me and I would like to hear what other people have to say about it. Like I said before, I really like my psychotherapist...he's never acted like this before so that's probably another reason why I'm feeling sad and shocked. Maybe he just had a bad day lol

By the way, I do plan on addressing this issue with him at our next session.

Any thoughts? Thanks!

[Willowleaf]

I noticed on web site mine had put hers up a few pounds a couple of years ago, but she still charges me same amount. I once asked her to remind me how much it was and she wasn't sure so I wonder if she keeps clients at the rate they started at. Could be a real bonus if I stay in therapy for years and years!
I understand exactly how you feel, I would have felt the same. If you hadn't handed him the check chances are nothing would have been said. Is it going up a lot? I think I would end up paying but feeling very cross about it. I understand they need to raise fees to pay their bills but like you said a period of warning would have been good. Also saying you don't have to but should if you can would make it really hard for me. Good luck with this. It will be interesting to see what others think

[wotchermuggle]

If I were in your situation, I'd be honest and say that you feel like there really isn't a "choice" because you'd feel there was this barrier between you two if you don't agree to the fee increase. I'd say that I'd probably have to cut back to one session a week to avoid the barrier.

Are your sessions $75/session?

One time I had a fee increase of $5 and I was giving a few months notice.

[tinyrabbit]

I'm sorry your T didn't mention the possibility of a fee increase from the start. Mine gave me a printed sheet with his holiday dates, cancellation policy and info about fee increases, which just says they go up once a year after the summer holiday. I'm not sure if my fee is going to go up. I'm actually a bit worried about it, but have decided to wait until he mentions it rather than bringing it up.

I totally get why you feel like maybe your T only brought it up because you came with the check. It makes sense that you're thinking: if only I hadn't done that, he would never have mentioned it. But it sounds like he was looking for an 'in' and that just happened to be his reason for bringing it up. I think he would probably have brought it up anyway.

That said, it strikes me that he's being kind of vague. So he raises the issue, but says you don't have to start paying more? I can imagine you might feel guilt-tripped. Are you supposed to offer more money?

However, I don't think he's trying to push you out. Sorry, but that's all you. He said he wanted to discuss a fee increase and you don't have to pay more. How exactly does that constitute trying to push you out? Is that an actual fact, or simply a feeling you're having?

I think he's handling this badly. He should have a clear policy that applies to everyone. Maybe that the fee goes up by x% unless you earn under a certain amount. It bothers me that he's talking about things like office costs. Obviously he has these, but the discussion should simply be about what your therapy hour costs and not all the other stuff he 'has' to pay for.

[precious things]

While a therapist has every right to change their fees, this situation would not sit well with me at all. To me, it seems like old clients should be grandfathered in and kept at the same rate while new clients can start at the new "advertised" fee. I would be upset too that an entire session of your time was spent talking about this as well.

Originally Posted by precious things

While a therapist has every right to change their fees, this situation would not sit well with me at all. To me, it seems like old clients should be grandfathered in and kept at the same rate while new clients can start at the new "advertised" fee. I would be upset too that an entire session of your time was spent talking about this as well.

Why though? For how long? I wouldn't expect my T to still be charging me what I started at 8 years ago. That would not be fair to him.

My T did have a rate increase about 4 years ago I guess. That's just the cost of doing business.

At least this T took the time to discuss the rate increase possibility with the OP. Usually fee increases show up as a sign on the wall next to check out and don't include any discussion at all.

[tinyrabbit]

I think the OP's T basically needs to grow a spine and make a policy instead of being so passive aggressive about it...

[precious things]

Originally Posted by 1914sierra

Why though? For how long? I wouldn't expect my T to still be charging me what I started at 8 years ago. That would not be fair to him.

My T did have a rate increase about 4 years ago I guess. That's just the cost of doing business.

At least this T took the time to discuss the rate increase possibility with the OP. Usually fee increases show up as a sign on the wall next to check out and don't include any discussion at all.

I totally appreciate that, though I have to wonder how many T's have clients for that many years. I suspect but don't know,that it is more often the case that T's have a lot of people start-up and quit after a session or two or over a relatively short period of time.

Originally Posted by tinyrabbit

I think the OP's T basically needs to grow a spine and make a policy instead of being so passive aggressive about it...

That I can agree with.

[wotchermuggle]

Originally Posted by tinyrabbit

I think the OP's T basically needs to grow a spine and make a policy instead of being so passive aggressive about it...

I agree.

[sunrise]

Originally Posted by Kitty527

He told me that just because he raised the topic of a fee increase doesn't mean I HAVE to start paying more...

What does this even mean? Why would he tell you he is raising his fee if he doesn't expect you to start paying more? It sounds like he handled this very awkwardly.

FWIW, my T has the policy that the fee the client pays to start with is what the client pays for the duration of therapy. So he has different clients paying different rates, depending on their start rate. That's just how he does it. So my fee has never increased over 5 years (or however long I've been seeing him). On the other hand, my daughter's T passes on rate increases to established clients. She has raised her rates twice and each time she gave 1-2 months' notice.

Kitty, how much warning do you think you need from a therapist when the fee is raised? Is one month enough? If so, perhaps you could agree to pay the new fee beginning in one month's time.

My xT had raised rates but I didn't think it was a big deal... cost of living increases every year...

[Moodswing]

Mine charges me $125 hr and he is not that good! I could not afford to see him twice a week. I would have to terminate therapy if he raised his fee.

I think fee increases are fair.

Electricity increases, rent increases, water increases, heat increases, etc, etc, etc. Raises for the staff, increases in the cleaning people, etc etc, etc.

He needs to be direct and not so wishy-washy, but his request is fair. Just think about how your bills go up every year!

[anilam]

I think Ts are allowed to ask for what they need- raise fee to all clients or keep the old ones on the same rate... However, both times it should be discuss beforehand - preferably in the beginning of therapy so the client can freely decide (after some time you already invested a lot into the RS- not only moneywise- and are not really free to just stand up and leave).
My T is a bit awkward re the payment (got the feeling he doesn't like to take money from his clients- weird I know)- his clients are kept at the same rate (thank god). Having said that, he's not nearly as bad as your T. WTF? Don't have to pay, just telling you that you should? Would not go well with me. Perfect time to practice standing up for yourself- not saying not to pay (I would) but tell him how hurtful his approach was. Fr what it's worth, I don't think he's trying to get rid of you...

[Perna]

Originally Posted by Kitty527

Shouldn't therapists give advanced notice if they are going to increase their fees?

Hi, Kitty, welcome to PsychCentral (PC).

I'm really glad your T talked with you for the whole session about this, it sounds like he cares and like he sees how important and shocking/difficult the subject was for you. My T raised hers, out of the blue, after I'd been seeing her for 5 or 6 years. . . the second time (I saw her 1978-87 then 1996-2005). I thought the whole thing was ridiculous because she raised it all of $5 :-) I was relieved though, too, that it wasn't more, as I was paying out of pocket too. I was surprised because she'd never raised the amount before and that seemed "not enough" to me, like she was afraid to raise it? At the same time she gave me all kinds of "contracts" and things to sign that I'd never had to before either and they sort of offended me.

How would you "warn" someone? "Oh, by the way, in 3 weeks, mark it on your calendar, we're going to discuss my raising my fees" Could you have "heard" about pay raises at the beginning of therapy when you did not know what was going on and were scared to death, etc.? It is shocking as it is, like the "we have to stop, now" at the end of a good therapy session when you are just getting into stride and feel like you're being shaken awake from an interesting dream.

I hope it wasn't a whole lot. I would think of it sort of like rent increases on one's apartment or one's own pay raises at work?

[Mapleton]

Originally Posted by Perna

How would you "warn" someone? "Oh, by the way, in 3 weeks, mark it on your calendar, we're going to discuss my raising my fees" Could you have "heard" about pay raises at the beginning of therapy when you did not know what was going on and were scared to death, etc.? It is shocking as it is, like the "we have to stop, now" at the end of a good therapy session when you are just getting into stride and feel like you're being shaken awake from an interesting dream.

If you think about it, therapy is (or should be) a little like an alternate universe... The same but, different, where your concerns, fears and desires are what truly matter.

The thing with 'times up', 'im going on vacation' or 'okay you can pay me now' are that they break the illusion or pantomime of this altered state.

It's a comfortable place to be in, if the transference is good, I'd imagine (and I haven't been lucky enough to be there yet.) I would have to think that makes it all the more painful and jarring when one of those actually-this-is-real-life moment happens.

[WikidPissah]

I think after two years it may be time for a rate increase...I think you are actually fortunate that he isn't demanding you pay the full fee as well. But spending a whole session talking about it? He should have done that for free, or he should have let you know by mail.

[murray]

I agree Wiki. The idea of paying for a session to discuss the fee increase would bother me.

[granite1]

my guess is he just remembered it when you paid in person. talking about money is always a miserable subject to bring up especially if you are struggling as it is . .i think he should have probibly should impliment some sort of increase policy and give you time and give people a year to comply if you have already been a client

Yeah, I was kind of calculating in my head about the amount of money that you are spending to discuss an increase in the fee. If you spend two sessions talking about it, it would be less of a "waste" from my perspective to simply eat the increase and and go on. My T is $130 an hour. If he raises his rates $10 a session, and I spend two sessions talking about it, I could have easily paid the extra $10 for the next 26 sessions and spent the same amount of money as if I talked about it for two sessions and talked him out of the increase. Maybe that is just my weird way of thinking.

[tinyrabbit]

I think the important thing is for Ts to own their need to raise fees and not project awkwardness onto their clients.

Originally Posted by murray

I agree Wiki. The idea of paying for a session to discuss the fee increase would bother me.

I was going to agree with this, but actually it's not just about the fee increase, so it seems like a valid use of the time.

[ScrewedUpMe]

My T also increased her fee after I had been seeing her for about 4 years. I wasn't expecting it and to be honest was not really happy about it. It was only a £5 increase so it wasn't the money that bothered me, but I guess I saw her as a well off person, living in a big house, probably not needing the money and I was a loyal long-term client. She also approached it rather awkwardly and did not give me much notice. She began with "I hate talking about money but from November (or whenever it was, which was only a few sessions away) is x amount alright?". I was taken by surprise. I would prefer if clients are kept at the rate they started at since it is alot of money in the first place and if you are in long-term therapy, you are giving them that regular guarantee of income. Just my opinion.

[Raging Quiet]

My T has increased her fee by £5 over the 5 years so I guess I'm really lucky.

I found out very recently that my friend (who is on £10k more than me) is paying the same for the same T that I see so I guess my T's sliding scale isn't as sliding as I thought.

[tinyrabbit]

Originally Posted by Rect0pathic

My T has increased her fee by £5 over the 5 years so I guess I'm really lucky.

I found out very recently that my friend (who is on £10k more than me) is paying the same for the same T that I see so I guess my T's sliding scale isn't as sliding as I thought.

But the amount you earn and the amount you can afford are two different things.