[atisketatasket]

The money thread put me in mind of this: are there circumstances under which a therapist should morally not accept payment for a session?

Let's say in session a therapist makes a serious mistake that profoundly affects a client. I'm talking profoundly, not they say something the wrong way and upset the client. (I know someone will nitpick at what serious and profoundly mean. Just define them for yourself. Eta - define mistake for yourself too. This is not an objective enterprise.)

In case this matters, let's say the hourly fee is $150. Client pays out of pocket.

I would say a session in which a therapist terminates a client against their will qualifies. I can think of other scenarios - maybe a therapist runs a session so insensitively that a client self-harms in response. Etc.

Legally and contractually, the therapist should get their fee. But should they refuse to accept it or refund it as a way of alleviating their mistake?

(I would be curious as to whether this has actually happened to anyone. No. 2 once told me that if an EMDR session she runs doesn't turn out well and makes the client worse and the client has to return for an emergency session, she doesn't charge them for the extra session.)

[unaluna]

Yeah. I think my t did when we spent extra sessions talking about the email he "accidentally" sent me.

[Raindropvampire]

I had a T freak out on me and kick me out early on our first session(apparently I triggered her). She refused payment and just wanted me gone BUT if she hadn't I would have been upset to pay for a shortened session and to be yelled at like I was. It was very traumatizing.

Define "mistake". Therein is the problem. Clearly, if the therapist does something that is clearly a mistake -- double-booking or scheduling mix-ups, having to call a session short on time without prior warning, etc. -- then they should comp that session (mine always have in those rare instances). But I suspect "mistake" is a very subjective descriptor.

[AllHeart]

When excessive self-disclosures and irrelevant stories from t take up half of the therapy session time, and, when certain situations arise that the t's wrongdoings created need to be discussed. Sessions should at least be prorated when these things happen, anyway.

Both of these instances have occurred for me. In the first scenario above, t did not charge me for the sessions at all. Second scenario I've always prorated.

[atisketatasket]

All future readers: define mistake for yourself. I gave three examples.

[stopdog]

Originally Posted by atisketatasket

All future readers: define mistake for yourself. I gave three examples.

The life of a pollster is not an easy one.

[Argonautomobile]

When my T left in the middle of session for ~20 minutes and did not make up the time, and when he was `40 minutes late and did not make up the time, people on here said he ought not to have taken payment. I'd have had a hard time paying $150 out of pocket for those sessions, and would have appreciated nonacceptance. As it was I was out a $30 copay both times.

[atisketatasket]

Originally Posted by AllHeart

When excessive self-disclosures and irrelevant stories from t take up half of the therapy session time, and, when certain situations arise that the t's wrongdoings created need to be discussed. Sessions should at least be prorated when these things happen, anyway.

That's a good point. What about sessions spent discussing the wrongdoings? Should there be a charge for them?

[stopdog]

I don't think so - but I never found any benefit to discussing it.
I also refuse to pay to leave

[AllHeart]

Originally Posted by atisketatasket

That's a good point. What about sessions spent discussing the wrongdoings? Should there be a charge for them?

Not if the t caused the wrongdoings and it resulted in emotional distress. I have a session tomorrow with my t and plan to spend a portion of it talking about her recent wrongdoings and I will not pay her for that time. Basically, she has blatantly been compromising my therapy time in order to better suite her own personal needs. I can't justify paying my t a cent for my session time over problems that she brought to the table. She does agree with me on that so at least payment deductions aren't a problem.

[ruh roh]

Mine did not accept payment for a rescheduled session due to double booking, which was the right thing to do, especially since I drive from another town and the whole thing took about 4 hours of my day, plus gas. I think there was one other time she offered to waive payment, but I can't remember why and I did not accept the offer and paid anyway.

Waiving payment doesn't make up for things that are not recoverable--like time (if there's rescheduling)--but it's a good thing to offer. It shows an effort to take or share responsibility.

[Pennster]

Mine waived the fee for the next session once when he had to suddenly cancel for a reason other than being sick.

We were once in a bit of a dispute and had to hammer it out. I paid for one session of dealing with it and then we had an extended phone call about it, which I didn't get charged for. I thought that was fair that I didn't pay for the entire process of dealing with it, as we both were responsible for what was going on.

[Merecat]

Mine didn't charge once when she was sick but had thought she'd be able to work. She coughed and croaked her way through the session, we finished a bit early and she refused payment. She's also reduced her fee when there's been a scheduling error.

There was one session. One session in 13 yrs where it did go very wrong.
T did the next time I see her want to not take the fee for that session.
I still paid. She's a solid T and would never have chosen what happened, to happen. I could see past it.

[Out There]

I got refunded for a session that retraumatised me ( and it was the last session ). And recently I have not been charged for a session to repair a rupture. If there were repeated ruptures in my therapy I would not continue , I wouldn't keep paying to repair ruptures.

[Sarmas]

I think that their are certain circumstances that either a portion should be returned or not accepted. There are times that a T might need to end session early or if the session is spent talking about Ts issues. Basically if a client is not getting their 50-60 min then they should be reimbursed a portion especially if it happens often. My kids T was creating a habit where she would only see my one child for 30 min and then telling me 10mjnninto my other child's session that she has nothing to address. My thought process was then are you going to charge the insurance for both visits as if you saw them and gave them their time. She ended up seeing my second son for the time needed once I enlightened her and intervened. Otherwise she would've dismissed him. other times she would make a phone call in between which was becoming habitual and then end early on top of that. Now she stopped the phone calls in between and when she ends is still up in the air. She has more than enough material to work with. I think that there are times where things should be questioned.

[LonesomeTonight]

Originally Posted by Argonautomobile

When my T left in the middle of session for ~20 minutes and did not make up the time, and when he was `40 minutes late and did not make up the time, people on here said he ought not to have taken payment. I'd have had a hard time paying $150 out of pocket for those sessions, and would have appreciated nonacceptance. As it was I was out a $30 copay both times.

My marriage counselor told us at the start of one session that he could only stay for 20 minutes because an emergency had come up. He said he wouldn't charge us for it (we pay before the session and had already paid, so he just had the receptionist make a note that the next session would be free). I think if because of the therapist, a session is half or less the regular time slot, then the client either shouldn't have to pay or should pay a reduced rate.

As for other situations, I'm not sure, because they could be fairly subjective. I mean, I've had a few sessions where I've left very upset at my T or MC, but I didn't necessarily think I should have gotten a free session because of it. (For me, those sessions have generally led to some sort of out-of-session contact with T or MC to resolve it, like phone, text, and/or e-mail, and they don't charge for that. If they did charge for that, then I might have more of an issue if I thought it was their screwup that led to the need for that additional contact.) Now if they had terminated me midsession, say, then yes, I shouldn't have had to pay.

[Ellahmae]

T works in an office with a few other T's - there was something so incredibly triggering to me at that time that I couldn't focus and kept breaking down, etc. We both left - she took me on a drive around and talked to me, and didn't charge me as it wasn't a session, and it wasn't in her control.

[bounceback]

Yes you shouldn't have to pay if the therapist isn't there for the whole session or at least most of it or if the therapist wants you to help do something for him/her in the office and it takes up all the time that was supposed to be focused on you, or if they spend too much time with the previous client and leave you with very little time to see them. I can't think of any other situations.;

[velcro003]

My T once offered me not to pay a session bc she ran 1/2 hour over, and I wasn't there, but was walking around nearby when she called, and decided to go back. She told me I wouldn't have to pay-but we ended up doing a full session, so I paid anyway. I am pretty sure she wouldn't have said anything if I walked out without paying.
I

[ScarletPimpernel]

I've always wondered if ex-T charged Medi-Cal for our 9 mins termination session...

Current T triggered me so bad one day that I had to have an extra session right then or go to the hospital. She charged me for the extra session even though it was her fault.

With my former therapist, I wanted to participate in a group thing once but I was the only one showing up from the group. We decided to just use the time for a regular session for me but it wasn't really like that... we talked a lot about the group and why people may have decided not to come, then a bunch about the theoretical framework the T liked. In the end I did give a usual check to him but before I even got home, he emailed that he thought he should not charge a regular fee for that meeting and decided not to charge at all.

Never happened to me, but if the T unexpectedly needs to cut a session short, it would not be fair to charge the client. For me, I would not regard mistakes and conflicts as something that is easily defined in a general or universal way so it is probably best discussed between in therapist-client scenario. For me, I can't easily imagine a therapist screwing up throughout a whole session in talk therapy in ways that I have no control over but the EMDR thing might be a good example as that is not simply about words and conversation. I would not allow a therapist to keep forcing something upon me repeatedly though, not even theoretical ideas and interpretations. I had that issue with my former T -- he was not willing to change it, and I decided to leave because it was no longer useful, only frustrating. I did pay him in full and then just decided he was not worth my money and time anymore and stopped going.

[BudFox]

For me the whole of my last therapy was a mistake and massive transgression. The whole process traumatized me. I actually think it would be ethical for her to offer a partial refund of what I paid for the entirety of the ~50 sessions. Instead, she encouraged me to pay her for the few phone calls we had after termination, because these calls were technically off the clock. I guess she was sick the day they taught ethics at therapy school.

[88Butterfly88]

I voted for the first one. Everyone makes mistakes on the job. I wouldn't want to go unpaid if I made a mistake at work.