Bartering with therapist

I was reading an article, "The Ethics of Advertising, Billing, and Finances in Psychotherapy" and was surprised to read of the practice of bartering. The client/patient gives the therapist goods or services in exchange for psychotherapy. This practice is considered ethical and is described in the APA Ethics Code. I was surprised as I have never heard of this and would think it strange if my therapist said to me, "hey, why don't you design a website for me, and I'll waive the fee for your sessions for the next month." If done in such a way as to not cause harm to the client, this practice is within the ethical guidelines. The official statement from the ethics code is: "Psychologists may barter only if 1) it is not clinically contraindicated and 2) the resulting arrangement is not exploitative."

So I'm curious, has anyone here ever bartered with their therapist (or any health care professional), and if so, what service or goods did you exchange for treatment/psychotherapy?

Sunny, we talked about this a couple semesters ago in my ethics course. If I remember correctly, bartering is pretty rare, and is used in situations in which both psychotherapy and other services (such as repair services) are not readily available.

For example, since I live in the city and T lives in a city (different cities though), it wouldn't really work to say, "Hey T-- don't charge me for the next five sessions-- I will paint your entire house instead!" Aside from the fact that I would completely ruin his house because I wouldn't have a clue what I was doing, it wouldn't make sense because we are in an area, in which:

A. Psychotherapy is readily available.
B. I have funds for therapy, and he knows that.
C. Home painting services are readily available.

Any other way to look at this would be exploitative.

Pretend that T and I lived in Montana (not to offend anyone-- I just can't imagine there is a lot going on there). Perhaps T was really the only therapist around, and I didn't really have much money or health insurance... but I knew how to paint houses. Perhaps T needs his house painted and it is known that there is really no way to get such a service in the part of Montana that we live in. I think this example would be an example of bartering being appropriate.

So yeah. Maybe these are bad examples, but I'm trying, lol.

I don't know about bartering, but I do a lot of negotiating with fees depending on my circumstances. I'm not afraid to do that and I don't see anything wrong with it, the worst he can say is no to some suggestion I make. However, bartering would seem odd, Pink's example of painting his house; I can't even imagine exchanging a service although in this high tech world we live in it might become more common.

I used the example of web design because that was the first service I could think of that my T would really need. I can't imagine doing gardening or housepainting for him, or cutting his hair, lol. But he is kind of computer-inept and has mentioned a few times how he really needs to get a website up. We talked briefly about it and I gave him some tips on how to go about finding an inexpensive web designer and also some info on how to do it himself if he felt up to that (I don't think he does). I could put together a quickie site for him, but I don't think it would be as good as he needs. But I did not offer to do this. Later I thought, what would that arrangement even look like? Would I do it for him for free, as a friend might? As an expression of gratitude for how much he has helped me? Would I expect to be paid? Would I barter for that service? What if I did a site for him, and he hated it? It was too complicated to think of all that, plus he really needs a professional's services, not mine, so that is as far as that back-of-my-mind idea went.

He did ask me to respond in writing to some questions he gave me for a presentation he was giving. He wanted an example of a client's view on certain things. So I said sure I would do this, but I said I would really like to have his "prompts" or questions in writing as that would make it easier for me to respond to. (I tend not to able to commit to memory very well things that people tell me unless I take notes.) So he said he would email me the questions. Next session, he asked again if I would answer some questions for him, and I reminded him that yes, I would, and I was still waiting for his email. So he did send it to me then. And I wrote an essay for him, about 2 and a half pages. He loved it and has indeed used it significantly in his presentation and will be using it again next month. (He doesn't cite my name but keeps the source anonymous.) So I did this favor for him outside of the session. It wasn't a service I provided, just a favor. It is outside of the therapy fee arrangement so there was never any question that he would not have me pay for a session, and I would have felt weird if he suddenly turned it into a barter situation. I think of it as a favor. Anyway, I can see the line between barter and favor is a continuum. And maybe what one person would consider a favor, another might consider a service that should be compensated. It's interesting. I certainly know that professionals do exchange services, like drawing up a will or other legal documents in exchange for orthodontia, etc. Recently a criminal defense attorney provided my daughter with free legal assistance as some sort of favor for my sister. I felt uncomfortable about that, but he insisted. It's an interesting ethical area to me. I am glad the APA is flexible enough to not prohibit bartering, as in some situations, it might be very appropriate (as pinksoil described).

Reading this I can't help thinking of the stories I've heard or read of days of 'yore when people would barter for medical services. For example, the doctor would visit the house and get a chicken and some eggs for his services.

Sooooooo, should I bring T a cooked chicken tomorrow? Or how about I bring a cow with me?

Bartering has a lot of potential to get sticky. From the therapist's point of view, what if they barter with a client for gardening, and the client accidentally mows down T's favorite hedge that T's grandmother cultivated. How does that affect the therapy sessions?

But i have read about examples of bartering that make sense. For example, client has extremely low self-esteem and feels utterly useless, but T knows that client does beautiful artwork and doesn't display it or attempt to share it or make any use of it. Might it help that client if T asks to exchange some therapy for art?

Boundary crossings have potential for awkwardness, but sometimes can be the best thing for the client. I feel that a therapist who is extremely strict and will never consider any boundary crossings under any circumstances is playing it safe and putting their own needs ahead of considering what might be best for the client. But boundary crossings should be considered very carefully and should be motivated by what is best for the client, and should not be a common convenience that becomes habitual.

HAHAHAHA... Love it.

"Hi T. I brought this goat with me in hopes that we could barter. In fact, I thought that you could waive the fee for each session as long as I bring a different farm animal each time. I'm sure it will be beneficial for both of us. I get free therapy, and you get... a whole bunch of farm animals."

Rapunzel, my reading of the APA ethics code was that bartering was not considered a boundary crossing. They do have a separate section on boundary crossings, though, and their take on it was pretty much what you wrote.

Absoutely! Let us know how it goes.

I've thought of a few skills I have that might be of interest to my T. I think bartering would be appropriate for someone who does not have insurance or the ability to pay their co-pay. I think the APA acknowledging that bartering is acceptable allows T's to provide different options to patients that may need them. I now if I was in a situation where I could not pay, I would feel much better bartering for services than being a charity case.

Interesting idea - the idea of bartering with my T has never crossed my mind. Fortunately I can afford her fees, barely. My music teacher has occassionally talked with me about bartering music lessons for cooking classes (I paid for uni by working as a chef), but so far we haven't actually done it.

I think it would just feel too weird with my T.

I don't have insurance coverage for therapy, so it gets pretty darn pricey. My finances are getting tight, so the barter idea has some appeal. But I don't know what I would offer, except for the website design. Plus, we have this long history of my paying him cash, so somehow I doubt an offer to barter would be accepted. I think my first solution will be to decrease sessions, much as I hate to.

Thats so funny. A chicken lol. I would be afraid it was undercooked and I would kill my T with food poisoning. I think that bartering is awesome. I think If a T could do that it would be awesome. It would only work maybe in private practice. When i was 17 and I lived on my own and worked and went to school I needed new glasses as i had lost mine almost drowning. The eye dr had me paint his out houses and do lawn work and weeding and stuff. He was cool. I was so poor I didnt have enough food to eat everyday.

Today T told me that if things get bad enough with the economy, I could pay for my therapy with a 1/4 pound of rice To which I responded "IF I could even get to therapy" and he said, we'd find a way to meet somewhere. And if that doesn't work, we can send smoke signals

Bartering, here I come!

This is sounding more & more like Little House on the Prairie. I think Pa used to pay "doc" with chickens...

I think I'd prefer to use a bartering co-op or somehow have it involve more parties than just the T and the client, ideally. Seems like that way, it could minimize any implications on therapy or the therapy relationship. Unfortunately, successful barter co-ops aren't always available.

gg

So on Craigslist we'll soon see psychological services (haven't checked--may already be there!) We actually have done a lot of bartering--not with t though. My (**sniff**tear**) ex-fiance is a mechanic and people usually don't plan for their cars to break down therefore not having a lot of money handy it makes it hard, so he used to ask me all the time what needed done--we got part of a new roof on the house, furnace services, snow plowed, all kinds of things. I laughed when I read about the chicken--we joke about that all time at the doctors office I work at. He's been in practice for over 20 years here and has seen a lot of growth in the town and patients aren't used to having to **gasp** pay for their visit--but we sure get a lot of food around here, homemade bread, fresh veggies, flowers, etc. It's kind of cool.

good question.

My T offered a barter but i refused. She is ill at the moment and i drove her somewhere as she couldnt get there (big long story) anyway she offered me a free session for my trouble but that felt wrong. I only drove cos i wanted to and she was sick.

Call me old fashioned but i prefer to pay with cash and not chickens or eggs, lol