[mindmechanic]

Therapy, especially for therapists in private practice, is a business after all. But you would hope that therapists would extend some compassion in the transaction. After all, they want you to get better.

I first met the therapist through a clinic. The clinic starts at $150 per session. The intake coordinator set the fees at $25 for me, and assigned the therapist to my case. We have been working together for two and a half years now. Given that we do psychodynamic and a bit of analytic work, I see her three sessions a week: one single and a double later in the week. But she had to leave the clinic fall of last year because the university that she worked with had a new policy that forbid full-time employees to moonlight (have a contract with another company). So I have been seeing the therapist in private practice since then. But she said that she would honor the same therapy fees I had been paying the clinic.

Without sharing too much, I'm a recent college grad who hasn't been able to find a stable, full-time job due to immigration-related issues. I make money through doing gigs, which isn't consistent. I also do not have health insurance; I pay out-of-pocket.

A few months ago, I told the therapist that when summer comes around, I might have trouble paying for therapy. She said that we will figure it out then. Well, summer is finally coming now. So I brought it up earlier this week. She said that she cannot go any lower than what I currently pay her - not even $5 off of what I pay her now. $20 each session during the summer would be more bearable than the regular $25. The therapist said that we could set up a payment plan. I objected to that idea. She said that even the clinic doesn't go any lower than $25.

A payment plan would only work if someone actually has the ability to pay it off over an estimated period of time. Given the legal restrictions, I do not have any prospect getting a job anytime soon. So even with a payment plan, I would be like a dog chasing its tail. I also do not like being indebted to another person. And I just can't deal with the added stress of having to pay it off. And what was her point of telling me that the clinic doesn't go any lower than $25? That's the clinic - a non-profit organization. You're in private practice now.

This has been troubling me a lot. On one hand, I really appreciate how she has been gracious enough to keep the $25 fee even after leaving the clinic. Not many therapists who have an MD and PhD at the back of their names would be willing to provide therapy at that price. On the other hand, knowing that she lives in a mansion that's worth over one million dollars in a wealthy suburb yet doesn't want to or can't take $5 off of $25 really bothers me. What is $5 to a 64 year old woman who doesn't plan on retiring and lives in a house that's worth over one million dollars compared to a recent college grad who is struggling?

She said that what I'm paying her now doesn't even cover parking. She also mentioned office rent. Are you trying to fool me? You have a contract at a prestigious university. And as an MD and PhD, they must be paying you over $60,000. To top that off, you are seeing patients in private practice. What is $5 off of each session during the summer to you?

I understand that therapists have a business to run and have to make an income as well. If I'm working with a young therapist who has kids to raise, I would understand if s/he can't do $5 off each session during the summer. But what is it to an old woman who has been working for years and lives in a mansion and have no plans to retire? She's also a healthy person. She has never been sick - not even having a cold or the flu - during the two and a half years that I've known her now.

Another thing that really bothers me is how she thinks that the parents should be paying for my therapy. But she said that she respects my decision to pay for my therapy. So what if they are responsible for me needing therapy? I'm not going to play the blame and responsibility game. Therapy is something that's incredible personal. And I want to own it. I am also an adult now, and do not want to live off the folks. Following her logic, should a 50 year old patient with an established career and a well-paying job also turn to his or her parents for money to pay for therapy maybe because the father is an abusive alcoholic and the mother was absent - assuming that she has a patient along those lines?

I've seen her for two and a half years now. I would think that she'd have more compassion to take $5 off each session during the summer. Are my feelings valid? Am I being unreasonable?

I understand your frustration. My first therapist gave me a slightly reduced fee, not much but at least it was something. And she hassled me about it a lot. I was struggling at the time, could barely afford food, was wearing old clothes, could never buy anything. ALL my money went to therapy.
Meanwhile, she was wearing designer clothes, lived in a huge fancy house, always had new clothes and new shoes, bought herself “treats” all the time, etc. She was private practice with a lot lf clients and a huge fee. She did not seem to get it that I didnt even have enough money to live on and there she was, rich. It was very annoying,

[mindmechanic]

@Starry_Night: Thank you for sharing that.

We are all free agents to do as we please and live our lives how ever we want, but I think that everyone has some social responsibility. I can't see myself working with a therapist who is capable, but not willing to extend compassion. I've been seeing her for two and a half years now, and had several unethical therapists terminating me. This woman is the last mental health "professional" I would see. Granted, the therapist said that she thinks she has done her share of social responsibility. Hmm.

[Salmon77]

I can see why you're struggling with it but I have to say, $25 is already a very reduced fee and so it sounds like she has extended a good amount of compassion already. If your fee doesn't cover her expenses (rent, parking), you're asking her to pay to treat you.

If you can't continue to pay $25 a session, maybe you could reduce sessions to 3/month or something like that.

[Deejay14]

She is in private practice and can set her own rules. I would be more than grateful an honored your SS fee for so long and continues to do so. That is compassion for me. I would think you could come up with the five dollars. I have a very strict budget and do not drink or smoke. My spending $$ is 5.00 a week. I think most humans spend some money stupidly every month. It's sometimes hard to say no to ourselves so we can afford our needs. That means some of the "wants" go by the wayside. Maybe you could go every other week during the summer?

[Thalassophile]

I think your T has already shown lots of compassion letting you pay $25 for a session and I TBH I don't see it as fair that she should reduce it further. I appreciate that it must be difficult for you seeing as you have been seeing her for so long and you are having financial difficulties but you must appreciate her position on this.

I also do not like being indebted to another person.

This surprises me as you that you don't like to be indebted to another person yet asking someone to see you for $20 an hour doesn't bother you?

I really appreciate how she has been gracious enough to keep the $25 fee even after leaving the clinic. Not many therapists who have an MD and PhD at the back of their names would be willing to provide therapy at that price.

I'm glad you are able to appreciate that as you are right not many therapists would.

On the other hand, knowing that she lives in a mansion that's worth over one million dollars in a wealthy suburb yet doesn't want to or can't take $5 off of $25 really bothers me. What is $5 to a 64 year old woman who doesn't plan on retiring and lives in a house that's worth over one million dollars compared to a recent college grad who is struggling?
She said that what I'm paying her now doesn't even cover parking. She also mentioned office rent. Are you trying to fool me? You have a contract at a prestigious university. And as an MD and PhD, they must be paying you over $60,000. To top that off, you are seeing patients in private practice. What is $5 off of each session during the summer to you?

It doesn't matter where she lives or what bills she does or does not have to pay. This is her job and also her time.

I think as another poster said you should appreciate the fact that she is already seeing you for $25 and if you can't afford the $5 then I would reduce your sessions to once a week.

[AllHeart]

If you really want to "own your therapy," buck up and pay the $25 with gratitude. Your financial problems are not your t's to take on. And, her financial status is irrelevant. Doesn't matter if she is a billionaire. She has been extending you great "compassion" by only charging you $25.

I'm sorry you are having financial difficulties. It kind of sounds like you are taking part of your fears, anger, and stress out on your t though. You have options and choices to make this work. Your t not giving you an additional $5 off really isn't the issue at hand here as I see it.

[ruh roh]

That's a phenomenally low rate. Instead of trying to nickle and dime her, why not go 2 times a week instead of 3? That will reduced your outflow even more than what you proposed.

[justbreathe1994]

I can understand how this would be hard, and please forgive me for saying this (if it comes across as invalidating), but I would literally be over the moon if my T only charged me $25/session. Granted I have insurance, but the clinic I see her at charges $250.

Part of the issue here is that by reducing the fee too much, that could possibly be seen as unethical and unfair for her other clients. In order to make a living and be ethical, she must charge a certain fee for her service. Your T would not be able to stay in business if she charged $20 for every client who was financially struggling, so it’s important that she treats all of her clients fairly. Nonetheless, she sounds like she’s been very willing to accommodate you and I doubt she could be making that accommodation for very many of her other clients. While it may feel like a personal/individual issue she can easily be flexible on, providing clients therapy for nearly no fee is not how the system works. It’s really not fair if therapists allow this for some and not for others and if they start making exceptions, it’s hard to figure out where to draw the line.

[elisewin]

Your T is extremely generous for seeing you for $25. I find it unfair to try to make her go lower. Taken the rent and parking, she is probably getting nothing out of that. And it sounds the small sum is her limit, boundary. If you really can not pay that, I think you need to see her less often instead? It is nor relevant how rich she is or isn't.

I was the exact opposite problem. My therapist won't be in-network, but offered a sliding scale. I'm not starving, and spend impulsively, but in no way could afford her full fee 1-2 a week. Turns out the sliding scale for private practices is mostly off your income, and most won't drop below 45/50$ unless you're seeing an intern.

Also found that apparently, it can create a bit of a headache with insurance companies. To where they'll pay off the therapists sliding scale instead of their full fee. Many therapists don't like raising their fee for current clients, so I feel like if she did lower it for the summer, there might be some resistance in the fall to go back up especially if your financial situation stays the same.
There's also to the whole boundary crossing, and how she has her limits and can't do for you what she can't do for other clients...

I agree with others said mostly. I think if you can’t afford the 25 then I would try see her every second week!
I have a few clients that pay €25 and by the time I pay my room rental, tax and Seidel I make around 1 Euro and that doesn’t even cover supervision which costs me €220, a month. I don’t think its fair for clients to expect Ts to work for almost nothing because training is so bloody expensive too.
At one stage all my own money was going on room rental and supervision because I didn’t get paid for seeing clients.
I don’t want to make you feel guilty but just to show you that therapists invest a lot emotionally and financially to be able to see clients but a lot of the time clients don’t appreciate or even realise that.

You are in a difficult place. Perhaps look for a charity or something that can offer help?
To be fair even here in the UK, Being in analytical therapy is only available for those in a good financial position.
Many who could do with it but can't afford it either go without or eventually get time limited theraoy in the NHS.
It's not fair. But life doesn't work like that.
The fact you've had this amount of therapy at a lower rate is a plus. Hopefully in the future when circumstances change you can pick up where you left off.
Your T has done good by you but she can't carry all the "burden"

[lilypeppermint]

I think your T has to draw a line somewhere, and this is where she’s drawn it. I know it’s hard but can you see her every other week?

You don't have to like it, but honestly if someone asked me to take a $5/hour pay cut I wouldn't go for it either. How much money she has is irrelevant. She is offering a service and already providing it to you well below value. You're getting a huge break. Gratitude is being thankful for what she has done. Entitlement is feeling like you are owed more.

[LonesomeTonight]

I agree with the other posters that it's not fair to expect her to go lower than her boundary. I think her mention of the clinic not going below $25 was just for comparison. She would have considerably more expenses in private practice. I've discussed this with my T a bit, as he's in private practice. Unless she's seeing you out of her home, she'd have to be paying rent or mortgage on an office, which could be quite expensive. Plus malpractice insurance, continuing education (which would be required to keep her license), etc. And she probably has other personal expenses you're unaware of, too. I do think it's more about being fair to her other clients rather than her actually *needing* the $5 a session. (Because if you went with that argument, you could figure you shouldn't have to pay her anything.)

Assuming you're still doing one regular and one double session a week, could you just go less often in the summer, say two regular sessions or just the one double? And then resume going more frequently once you get a job?

[toomanycats]

Everyone has pretty much already said what my thoughts were.

The other thing to remember, though, is that the fee is an important part of therapy. Your paying the fee is an important boundary meant to keep your therapeutic relationship healthy. This might be hard to hear, but being a person's therapist is an emotional load to carry, and the fee represents an exchange that prevents 1. You from becoming overly indebted to your therapist (you shouldn't feel like you owe her something - you are paying what you owe her) and 2. Your therapist from feeling taken advantage of.

Therapists are people too, and they need to be paid for the work that they do. Most therapists also make and have far less money than people think. You don't really know 1. How much she makes and 2. What her full situation is - yes, even if you know the value of her home.

It sounds like your only other option would be to reduce the number of sessions per week you see her. That would save you the money you are looking to save.

[mindmechanic]

Thank you all for your honest thoughts.

Personally, if I'm already a millionaire working as a therapist, I'd be seeing low-income patients or do pro bono work. I am grateful that she stuck with $25. Maybe it's my superego that's pushing it.

I think therapists in private practice make more than you guys think. Suppose they are seeing patients for $75. Say 30 sessions a week. $75x30=$2250 a week. $2250x4=$9000 a month. $9000x12=$108,000 a year. Just saying.

[lilypeppermint]

They don’t keep all of that money though.

[NP_Complete]

And they likely take vacations and don't work 52 weeks a year.

[LonesomeTonight]

Originally Posted by lilypeppermint

They don’t keep all of that money though.

Yes, exactly. That's what I was talking with my T about at one point. I mentioned making $40 an hour on a freelance job, saying that's probably laughable amount to him, but quite good for what I do (editing). He said how that's actually a pretty big amount. I noted how he gets $175 an hour, but how I imagine he doesn't actually take all that home, because of taxes, rent for his office, etc. He said my assessment was accurate. He said he'd love to work somewhere where he actually took home $175 an hour, like a government job or something. I also made a comment recently saying I hope he isn't about to take a 3-week vacation, and he said, "Not unless I win the lottery." He also has a school-age son and wife (not sure if she works or not). Plus I know he doesn't see 40 clients a week--he keeps a fairly light load, more like 20, I think.

So your T probably isn't rolling in money as much as you think. Just because she's living in a million-dollar house doesn't make her a millionaire. She could be quite in debt, on the contrary. Actually, is this something you've discussed with her before? I mean, the feeling that she's wealthy and your emotions tied to that. Because it seems like it could be a useful topic. Maybe she could better explain why she won't go lower than $25.

And they have to pay supervision and do CPD regularly, pay room rent, tax, and insurance and pay membership to accreditation committees.
Also maybe her husband is a millionaire and she isn’t!

[LonesomeTonight]

Originally Posted by NP_Complete

And they likely take vacations and don't work 52 weeks a year.

True, if they're in private practice, if they don't work, they don't get paid. Same if a client cancels (unless they charge them) or if a regular client is on vacation and doesn't come in. Or she might not have a full caseload, especially if she's fairly recently started private practice.

[healinginprogress]

Originally Posted by mindmechanic

Thank you all for your honest thoughts.

Personally, if I'm already a millionaire working as a therapist, I'd be seeing low-income patients or do pro bono work. I am grateful that she stuck with $25. Maybe it's my superego that's pushing it.

I think therapists in private practice make more than you guys think. Suppose they are seeing patients for $75. Say 30 sessions a week. $75x30=$2250 a week. $2250x4=$9000 a month. $9000x12=$108,000 a year. Just saying.

I get what you're saying. It really feels like the "haves" should give more to the "have-nots." But she already is, and I think that's the point that people are trying to make.

But, remember:
Self-employment tax
Space Rental
Office Insurance
Malpractice Insurance
Continuing Education
Parking
Potential Utilities
School Loans
Marketing
License Renewal
Professional Memberships
Consulting Fees
Supervision Fees
Supplies
Potential Software Subscriptions
Maintenance Costs
Etc.

[stopdog]

an established therapist is not likely to have all those - not all have to pay for parking, supervision, marketing, consulting, software, school loans,. further utilities, office rent, maintenence fees, office insurance are not likely to exist individually but rolled into office lease. The cold truth is they charge what the market bears and some of them are willing to make bigger sliding scales than others based on their own whimsy. I don't see fairness entering into it anyway you look at it. They are in a business -they're not in it for altruism. I think they charge too much for what they do across the board. Unfortunately you can't make those people be affordable