Why Setting Appropriate Fees is Important

by Kellen Von Houser, M.A.

Like time and space, fees are a basic element in the framework of the therapeutic relationship. Fees distinguish the therapeutic relationship from a non-professional relationship. The therapeutic relationship is not social or romantic. It is business. The failure to successfully negotiate a fee agreement clouds this issue. Fees form a boundary.

Just as a therapist must successfully manage the boundaries regarding the length of the session or the space in which it occurs, they must also manage the cost of the session in order to establish healthy boundaries in the relationship. Therapy is not a chat between two friends or a romantic interlude. It is a professional relationship. Successfully handling of the fee arrangement makes this clear from the beginning.

Discussing and setting fees also establishes a framework. Clearly establishing the fees, the number of sessions per week, the length of the sessions, the format of sessions, how missed appointments will be handled, how emergencies will be handled, and how holidays are handled builds a solid and reliable frame. Should difficulties over fees arise later, the importance of this occurrence within the transference can only be assessed accurately if a solid framework has been established and maintained by the therapist.

When a therapist competently negotiates the fee arrangement, he or she shows confidence in the value of therapy and in the ability of client to benefit from the treatment progress. Naturally, a therapist’s failure to competently negotiate the fee arrangement communicates exactly the opposite. It can cause a client to doubt the efficacy and value of therapy and the therapist’s competency to handle other issues. How the fee arrangement is handled foreshadows how the therapist will handle other sensitive issues.

Failure of the therapist to handle fee arrangements personally, by allowing other office staff to handle them instead, may create a concern in the client’s mind about confidentiality and privacy as well. This may also create a breach in the therapeutic process.

Furthermore, disregard for the fee represents in some degree a disregard for the self on the part of the therapist and deserves further examination. Would you ever advise one of your clients to work for free, or for less than their value? How would you interpret such behavior on the part of a client? How can a therapist advise a client to value their own self worth and to stand up for their own intrinsic value while modeling just the opposite in their own affairs?

Setting fees also determines the therapist’s income. It is appropriate for a therapist to want to be paid for the services they provide. It is also appropriate to want to be paid enough to live comfortably without having to worry about how to pay the bills or care for their families. To have a decent income a therapist much set appropriate fees for the services they provide.

Maslow’s Hierarchy of Needs postulates that the basic needs have to be met before an individual is able to address higher needs or function on a higher level. If the therapist’s basic needs of having stable shelter, being able to pay their bills and being able to take care of their families are not met, how can they function on a higher level? I once worked with a massage therapist who frequently gave away her services or undercharged. I immediately recognized the lack of self confidence, the low self esteem, the self-sabotaging behaviors, and the devaluing of her skills in her inability to charge an appropriate fee for her work. I was much slower to see the same issues within myself and my inability to set appropriate fees.

Why do I say “appropriate” fees? Many therapists are able to set and collect fees, but consistently set them too low. This undervaluation of their skills undermines their own self-esteem and estimation of their self worth. It also undermines the perceived value of therapy, both with the therapist and their clients. This affects the perceived value of therapy in the community as a whole.

Despite the importance of establishing an appropriate fee agreement, this issue is often ignored by therapists. This avoidance of dealing with fees can cause serious compromises within the therapeutic alliance. Powerful psychological motivations drive our beliefs and behavior regarding money. These factors and the effect they can have on the therapeutic relationship will be examined further.
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