[MusicMike]

I'm incredibly blessed to have found a therapist who believes that once a client needs him, once a client has a deep bond, if that client gets in financial difficulties and can't afford his full fee, he will charge only what they can afford, with no lower limit. I have been seeing him for a long time and I had a horrible childhood plus an adult illness that has disabled me and left me with very little income. He is charging me only a tiny amount.

He seems to have committed to caring for people. He seems to have decided early in his career that he's not in it to make money but to care for people and he is so 100% committed to this that he doesn't have any resentment when someone can't afford his full fee.

I am incredibly blessed to have found him.

He also doesn't take long vacations. He has never been gone for longer than one week.

Only once in the very long time I'm been seeing him has he had a personal emergency and cancelled a session but that was only one session, plus he provided an alternate therapist I could see (who was great).

I've read the stories here of people getting dumped by their therapist for financial or other reasons and it horrifies me. That is not ethical behavior on the therapist's part. That can create a real crisis for someone.

For anyone who has ever been hurt by the lack of commitment on the part of their T, you have my compassion.

[divine1966]

That is awesome!

Sent from my iPhone using Tapatalk

[anilam]

I'm glad you find a T that is able to meet your needs.
However, I disagree with the statement that Ts are unethical if they don't offer reduced fees.
You wouldn't expect any other professional to work for (practically) nothing- why should Ts be any different? They have their own families to think of too...

[stopdog]

Originally Posted by anilam

I'm glad you find a T that is able to meet your needs.
However, I disagree with the statement that Ts are unethical if they don't offer reduced fees.
You wouldn't expect any other professional to work for (practically) nothing- why should Ts be any different? They have their own families to think of too...

I think a lot of professional governing bodies encourage some pro bono work.

Originally Posted by stopdog

I think a lot of professional governing bodies encourage some pro bono work.

Of course, but that doesn't mean that a therapist is obligated to offer this to every single client just because they have worked with them previously which is what the OP was saying all T's should do or they should be considered uncommitted and unethical.

[stopdog]

Unless a therapist was very unlucky or chose a very limited clientele to work with, it would be, I believe, very unlikely the therapist would be offering such a thing to every client or even most clients at the same time. I am not really concerned about whether doing it or not doing it makes one of them more or less committed or ethical. I would think it rough for a long time client to be summarily disposed of due to financial distress.

OP - glad the one you see is someone who is flexible for you.

Mike, you've got a keeper there!

That is great, mike.

I read mike as saying it is unethical for a therapist to just dump a client out of nowhere for financial or other reasons. I doubt he was saying therapists should just keep seeing a client who couldn't pay. I do think therapists who are ethical will try to work something out with the client or help them find someone else. Just "dumping" a client for whatever reason IS unethical. I doubt anyone would expect a therapist to just keep seeing them for free or almost nothing.

[WrkNPrgress]

I was feeling very lucky to have the copay amount that I do. It enables me to go about two or three times a month but I've since learned that our health plan might be changing next year and I'm a little terrified that I will be forced to drop therapy.

* deep breath *

[MusicMike]

Originally Posted by anilam

I'm glad you find a T that is able to meet your needs.
However, I disagree with the statement that Ts are unethical if they don't offer reduced fees.
You wouldn't expect any other professional to work for (practically) nothing- why should Ts be any different? They have their own families to think of too...

The key word was "dumped" -- in other words a therapist who has cut off someone without warning or even a show of concern. It happened to a good friend of mine when her insurance plan changed and she was devastated.

You are one of the lucky ones. My therapist also does this, reduced fee, to no fee if the situation calls for it. Her focus is healing families, so she has an exceptionally soft heart, some will say stupid, when she see a family working hard to stay together, and then there is an income loss. She doesn't take insurance. I have to be very careful not to refer every hard luck case I hear to her practice. I wish I could though.

I've seen ethics examples I have seen do state that a therapist continue to work with a client whose income been upset, as to how long there were no definitive answers. IMHO it should be up the therapist.

[MusicMike]

Although it's probably not a matter of "ethics," therapists do vary in what kinds of personal sacrifices they are willing to make. I see this in two areas. (1) Financial. (2) Taking emergency calls.

Regarding taking emergency calls, my therapist has from the earliest days of seeing him had a pager or cell phone and will return a call in an emergency, no fee charged for this service. I went through a very scary few years early in therapy and needed this service regularly. I don't know how I could have survived or continued to have a trusting relationship with him without knowing that he was within reach at all times.

My T tells me that most new therapists these days don't take emergency calls. Their answering machines say "If this is a client emergency, call 911." That's it.

I'm thinking about becoming a therapist myself someday and I definitely feel like "giving back" the blessings I have received, so I will have a policy of taking emergency calls and a sliding scale fee.

I think therapists should be VERY clear form the beginning what their policies are about financial hardships and termination and taking emergency calls. Too many therapists seem to be clueless about healthy boundaries for their clients and end up changing the boundaries and causing harm to the clients. I get that things in therapy might change, but many of them just make egregious errors in this area.

[Lauliza]

It is expected that therapists do some pro bono work throughout their career. I also think it is true that a T cannot ethically "dump" a client who suddenly finds themselves in a financial crisis. Obviously they need to work something out or eventually they might not have enough paying clients. I'm sure some older ones who are set financially can be more flexible with clients. A couples T I saw my H as a solo client for a year when we finished couples work, and he never charged him. He was close to retiring and must have had enough money to do this, which I thought was very kind.

Regarding emergency calls, it definitely depends on the therapist. Private practice Ts can do whatever they want and t probably depends on the level of emergency that it is. When they work in a hospital, clinic or group setting they usually refer you to the ER. The practice my pdoc is at does has an emergency pager line where the pdocs have a week on call. Still if you were in serious crisis, they still refer you to the ER.

[PinkFlamingo99]

Originally Posted by Lauliza

Regarding emergency calls, it definitely depends on the therapist. Private practice Ts can do whatever they want and t probably depends on the level of emergency that it is. When they work in a hospital, clinic or group setting they usually refer you to the ER. The practice my pdoc is at does has an emergency pager line where the pdocs have a week on call. Still if you were in serious crisis, they still refer you to the ER.

I think the problem is when their policies on this randomly change. You know, normally emergency calls are fine, then suddenly they don't return your call for a week... It can be really damaging if you're in a vulnerable place. Especially if there is no explanation about why, beyond "my boundaries have changed."

I have talked to 5 therapist in the last year, less than 7 years of practice (includes their licensing hours), and are in solo private practices. Two take insurance, the others do not, but they all have on 1-3 pro bono clients. They all have sliding scale fees for cash clients.

Their answering machines all say to call 911 in an emergency.

[MusicMike]

I just read your post about how all the new therapists' machines say to call 911, and then I thought about my scary early years in therapy and how I can't imagine getting through it without those emergency calls to my T, and I just burst into tears. Half with gratitude, half with grief at the memory of those years, and a little bit of "what if I hadn't had that" fear.

[Lauliza]

Originally Posted by PinkFlamingo99

I think the problem is when their policies on this randomly change. You know, normally emergency calls are fine, then suddenly they don't return your call for a week... It can be really damaging if you're in a vulnerable place. Especially if there is no explanation about why, beyond "my boundaries have changed."

It's pretty standard practice for Ts to refer clients in crisis to an ER, mainly because outpatient therapy is technically a lower level of care- meaning if clients need higher levels they are inpatient or in partial programs in addition to regular therapy. If their policy changes, one reason I can think of is because their definition of an emergency may be different than that of some clients. So they could end up getting a lot more crisis calls than anticipated. If not that then they shouldn't offer emergency calls in the first place. I have a feeling that's why most now will expec clients to call 911. It's mostly an issue of liability but can also clarify to clients that their definition of emergency is a much higher level of need.

[stopdog]

The first one I see has call 911 as her voicemail response. The other takes calls.

[MusicMike]

Originally Posted by Lauliza

It's pretty standard practice for Ts to refer clients in crisis to an ER, mainly because outpatient therapy is technically a lower level of care- meaning if clients need higher levels they are inpatient or in partial programs in addition to regular therapy. If their policy changes, one reason I can think of is because their definition of an emergency may be different than that of some clients. So they could end up getting a lot more crisis calls than anticipated. If not that then they shouldn't offer emergency calls in the first place. I have a feeling that's why most now will expec clients to call 911. It's mostly an issue of liability but can also clarify to clients that their definition of emergency is a much higher level of need.

The system thinks outpatient therapy is a lower level of care, but (you probably know this) as someone who's been to a mental health hospital, I can tell you that there are few genuinely caring people there - - certainly no one who can compare with a T that you have a strong therapeutic bond with.

The hospital is mainly for people who are putting themselves or others at risk, or who need intensive medication management, or truly 24/7 supervision. I went through many "dark nights of the soul" where I was in psychological hell, but I wasn't suicidal. No hospital would have taken me. Yet I felt like I was locked in a dungeon alone in the world with no hope, and the only person in the entire world I trusted to understand what I felt like was my T. I was experiencing states from infancy, so to ask me to wait a few days for the next appointment might as well be asking me to wait a few years.

This actually connects to the financial aspect. My T doesn't work full time, i.e. doesn't make as much money as he otherwise could, because he wants to engage in plenty of self-care and have time for things like emergency calls. He knows that some clients will start to overuse the emergency calls system and he skillfully redirects them to other sources of help without coming across as non-empathic.

[Mike_J]

My therapist is much the same way, though she is taking a break of a bit over a month to open her own practice, but I can forgive her for that, and wish her nothing but the best of luck working on her own. Though I am counting the days until she opens up shop and I can see her again.

[Lauliza]

Originally Posted by mike1127

The system thinks outpatient therapy is a lower level of care, but (you probably know this) as someone who's been to a mental health hospital, I can tell you that there are few genuinely caring people there - - certainly no one who can compare with a T that you have a strong therapeutic bond with.

The hospital is mainly for people who are putting themselves or others at risk, or who need intensive medication management, or truly 24/7 supervision. I went through many "dark nights of the soul" where I was in psychological hell, but I wasn't suicidal. No hospital would have taken me. Yet I felt like I was locked in a dungeon alone in the world with no hope, and the only person in the entire world I trusted to understand what I felt like was my T. I was experiencing states from infancy, so to ask me to wait a few days for the next appointment might as well be asking me to wait a few years.

This actually connects to the financial aspect. My T doesn't work full time, i.e. doesn't make as much money as he otherwise could, because he wants to engage in plenty of self-care and have time for things like emergency calls. He knows that some clients will start to overuse the emergency calls system and he skillfully redirects them to other sources of help without coming across as non-empathic.

It's true that higher level of care is not synonymous with a higher quality of care. It simply indicates security measures to be taken. it is also true that many Ts don't offer this level of service. It does depend on the type of therapy as well as the therapist themselves. I know clients who have daily phone check ins with their Ts, and some who can call them any time of day or night. So it's true that many will refer you to 911 if you use the word emergency, there are still a lot that offer a lot of care outside the office (within reason) before sending you to the ER.