In Arrears: When You Owe Your Therapist Money

Talking about therapy as a service rendered for money is admittedly, pretty cold. While not all therapy involves the exchange of money, therapists working for themselves will charge for their services, which for many, is their livelihood. But it’s not something that we as therapists like to bring up, lest we ruin the vibe of what is being offered, even though most counsellors love what they do and are super-grateful to be doing it. Work we love? Sign me up!

But because we care deeply for our clients, because we rejoice in their successes and because we empathize with clients’ struggles, it’s difficult to talk about money—as if somehow this takes away from the care we feel for clients, or clients’ experience of feeling cared for.

And it can be a particularly challenging discussion, for both clients and therapists, when we move beyond the standard session fee and enter the domain of the unpaid counselling session (or in some cases sessions).

But before getting into all the whats, hows, and whys, of unpaid counselling sessions, I need to put it out there that almost all unpaid counselling sessions are unintentional. And, I’m not thinking of anyone in particular, as I put fingers to keyboard: I write this article in the spirit of open communication about this issue because I think discussions about fees and payments should be free of stress and stigma. And open communication also allows us us to spend more time counselling and less time focusing on administrative details.

Scenarios and Solutions

“I Forgot”

It’s pretty easy in this world of ours to get distracted by many, many things all vying for our attention: work, school, family issues, friendships, worries, health concerns, stress, grief, housing and more. Sometimes even the therapist forgets to ask for payment!

Possible Solutions

  1. For some it helps to put a credit card on file with your therapist so you never have to remember to pay again.
  2. Others who prefer e-transfers, PayPal or other forms of payment sometimes may choose to set a reminder or, use the appointment reminder itself as a cue to pay for the session.
  3. Attend more sessions in-person, if available. The visual cue of being in the office can be helpful.

E-transfer Doesn’t Go Through

Most folks don’t realize when their e-transfer doesn’t go through. This problem is usually related to forgetting to complete the transaction before logging out.

Possible Solutions

  1. As you know, there’s usually ‘confirm’ and ‘submit’ buttons that both have to be clicked, which I find misleading because both confirm and submit feel like “final” words to me, so it’s easy to forget one of them! Instead, thinking “1, 2,” may help.
  2. If in doubt about whether the e-transfer has gone through, check to see if you’ve received a text or email confirmation. Also, has your therapist sent you a receipt?
  3. Therapists may want to consider registering for auto-deposit which eliminates the need to produce the answers to e-transfer passwords which, even when seemingly obvious, often get misspelled, are not obvious to the counsellor or have things like spaces added. This also eliminates the problem of therapists forgetting to accept deposits!

Credit Card Has Expired

A common issue, especially if you have a credit card on file with your counsellor that you otherwise never think about.

Possible Solutions

  1. If you happen to remember and have the option of adding your new card to your electronic profile (if you have one), great! Or, some folks like to let their therapist know at the start or end of the session so that the counsellor can take their new information.
  2. For therapists, some practice management software options will flag a client’s file if the credit card is expired or expiring, so that therapists can then notify their clients.

The Counsellor Doesn’t Have a Payment Policy or The Payment Policy is Vague

This often comes up as an issue around situations like missed appointments or late cancellations. The client may be unsure about much is actually owed?

There can be several reasons for this such as counsellor avoidance, counsellors not being upfront about their policies (possibly not on their website or client service agreement), or counsellors being unsure about how to create a policy and what their stipulations should be. Clients may not have the information about when or how to cancel their appointments or under what circumstances. The counsellor and client may be on different pages about what to do.

Possible Solutions

  1. Counsellors should create a robust client service agreement which spells out their payment policies clearly. Clients should be given this information well before the appointment, so that they decide whether or not they can accept the payment policies before commencing therapy.
  2. Clients should approach their counsellor ahead of the appointment if they do not agree with the payment policy or have questions. Doing so before the counsellor’s cancellation period increases the chances that another client could take that appointment time and also avoids further complications around late cancellations.

There Are Barriers To The Payment Method

Clients and counsellors may have preferences about payment that don’t align. A common scenario is clients who prefer to pay by credit card and the counsellor doesn’t have credit cards as a payment option.

Possible Solutions

  1. Counsellors should include on their website and client service agreement how clients can pay for their sessions, alerting clients in advance so that they can approach the counsellor to discuss solutions, well before the appointment.
  2. Clients should feel free to approach their therapist, if the therapist doesn’t offer their preferred payment method, to find out why or to explore alternatives. Some therapists are opposed to having to pay associated credit card fees which cumulatively, are significant.

Client Can’t Afford to Pay

Private therapy is expensive, especially if a client is seeking to hire a counsellor with a master’s degree or PhD. It is especially difficult for clients who are unemployed, underemployed, have no employment benefits, or face other systemic barriers.

Possible Solutions

  1. Therapists fees should be clearly stated on their website so that clients understand that the counselling service is fee-for-service.
  2. Clients can approach potential therapists to see whether the counsellor that they’re interested in working with has any sliding scale or free sessions available, and if so, is there a waiting list they can join for that? Also, is there a cap on the amount of subsidized sessions available?
  3. Resource lists of lower cost options, both publicly-funded, or sliding scale private may be helpful. I always recommend that potential counselling clients waitlist themselves for as many suitable counsellors/clinics as possible to maximize the chances of starting therapy sooner.

Client is Philosophically Opposed to the Counsellor’s Fees or Policies

As it sounds. The client disagrees with the counsellor’s fees.

Possible Solutions

  1. Counsellors’ fees should be clearly articulated on their website and client service agreement so that potential clients can make an informed decision.
  2. Clients should not sign up or begin therapy with a counsellor whose fees they disagree with. Instead, ask for a referral for lower-cost counselling options.

Client is Unsatisfied With Their Appointment

If a client is unhappy with their session, they may refuse to pay for it. I see this situation very rarely.

Possible Solutions

  1. I recommend that clients give counsellors feedback if they are unhappy with their session so that the counsellors can take steps to improve clients’ experience. This may or may not include waiving the fees, depending on the situation.
  2. If a counsellor is aware that the client is unhappy at any point in the session, I suggest bringing this up with the client, to see if there is anything about the client’s experience that needs to be addressed, which may also include the therapist’s behaviour. Such discussions can be very productive and are sometimes related to a misunderstanding that can be sorted out.