Editor's Note

Lynne Azpeitia, LMFT
Voices Editor

Getting Paid: Introducing & Talking About Sliding Scale, Adjusted Pricing & Specialized Alternatives—The Words You Use Make a Difference

What’s your sliding scale? Do you have a sliding scale? How low is your sliding scale? What’s your discounted rate?

These words are often the first thing a therapist encounters when a potential client calls, emails, texts, or DMs about therapy. It’s no surprise that mental health professionals find this a jarring and highly awkward beginning to an interaction about starting therapy—and that therapists, themselves, have many questions, about the best way to respond effectively, both clinically and professionally, to these potential clients during this important first contact.

In fact, the most often asked question I encounter in Money Matters Workshops and at LA Practice Development Lunches is: “What’s the best way to respond when the first thing a caller—or a text, email or message—asks about is a discounted rate or sliding scale?”

As I wrote about in Talking about Sliding Scale Pricing, responding to callers and clients who are asking, but don’t really need or qualify for a lower therapy rate, is a very different type of conversation than the one clinicians trained for and are familiar with—people who genuinely have, a financial need. 

Just because clients are anxious about the price or cost of services doesn’t necessarily mean therapists should automatically give a price accommodation. The price a client can afford and the price a client wants to pay may not always be the same thing.

It’s often hard for us as helping professionals to remember that helping a client doesn’t always have to mean giving everyone who asks a reduced rate or routinely offering the lowest possible price for therapy. It also can mean helping people find a lower priced type of treatment and referring them.

While I wholeheartedly support the values that the term “sliding scale” represents, that professionals can help people in need by sometimes—at their discretion and when their schedules allow it—charging less or making other specialized arrangements, so that people can still get affordable help when they need it, I also firmly support mental health professionals charging and being paid a fair price for the professional services they provide to clients.

As therapists, our task is to find the right balance of how, and how much, we can adjust session prices, for which clients, and how many—and not go out of business. In the current climate, navigating talking about prices with these clients takes more specialized skills and requires a totally different mindset, approach, and vocabulary.

The Wording You Use Can Make Difference in Your Income

As in any clinical endeavor, the words you use to describe your services do make a difference. Yes, the meaning our words convey can either increase or decrease the amount of money we earn and are paid for our professional services. You’ll find that more people will pay in full and out of their own pocket for your services, when they believe you are the professional who can give them what they want—and the wording you use to describe your services conveys that.

Money Talk: Words & Phrases to Consider
Here are some examples of words that can make a difference in income when a clinician talks, writes, or communicates about therapy or money matters—and how and why these words can affect the perceived value, and subsequently, the amount a person is willing to pay for the therapy services provided as a clinician.

This information applies equally to face-to-face conversations in real time or virtually, to emails, texts, social media postings, and what’s printed in marketing materials or is on your website. Each one of these words and phrases can have a direct effect on the amount a client pays you for your clinical services.

As you read the following information, be sure to remember:

●      Only do and say things that fit for you, your clients, and your practice—and always within legal and ethical guidelines.

●      You can ignore everything written in this article and still be successful. Discover what works for you, your clients, and the practice setting you work in.

1. Pricing & Adjusted Pricing: Specialized Options Based on Income and Financial Need

When therapists talk about the price or hourly rate for services and clients ask about sliding scale or a discount or even the lowest amount that can be charged, that’s a good time for the therapist to talk about the price of therapy and options for those who need a price accommodation to pay for therapy sessions.

When therapists do make price accommodations for those in financial need, using words and phrases such as

adjust the price/amount/rate . . . adjusted price(s)/pricing/ amount(s)/rate(s) . . . adjusted cost of services /therapy/sessions . . . alternateprice(s)/amount(s)/rate(s) . . . special/specializedprice(s)/rate(s)/arrangement(s)/accommodation(s)

enable potential clients to understand that it’s okay to discuss a different price but that it’s not guaranteed to everyone upon request.

It’s also possible for a therapist to say that instead of a sliding scale, they offer different type of specialized pricing or rates for those with lower income or who are in need, when their schedule allows. Clinicians can do this by sharing the type they offer. Some examples are:

●      College Student price/rate

●      Teacher price/rate

●      Unemployed price/rate

●      Professional Courtesy price/rate

●      Introductory price/rate

●      Retired price/rate/pricing

●      Limited time price/rate/arrangement

●      Family & Friends price/ rate

●      Cash Payment price/rate

2. Low Cost Options as Alternatives or Additions to Sliding Scale

If a therapist decides not to offer a sliding scale or wants additional choices to go along with a sliding scale or specialized rates, here are some of the options that mental health professionals in private practice are using to make therapy more affordable and accessible.

1.    Pricing Based on Lower Income or Financial Need

●      Adjusted cost/price/amount/rate for session(s)/ services/ therapy

●      A set number or unlimited number of sessions or amount of time

2.    Fixed Number of Lower Priced Client Spaces

●      A certain number of places or a percentage of the practice

3.    Shorter Session Length for Lower Price

●      40 or 45 minutes Instead of 50 or 60 minutes

4.    Less Frequent Scheduling/Flexible Scheduling at Full Price

●      Three sessions per month, every other week, etc.

5.    Specialized Session Pricing

●      A lower price is paid during slow periods of the day or week

6.    Scholarships

●      A lower session price

●      A set number or unlimited number of sessions or amount of time

7.    Payment Plan—for adjusted session prices

●      Pay a set amount now and another amount when therapy ends until balance is clear

8.    Special Arrangements Based on Special Circumstances

9.    Pro Bono Sessions

●      For 1 or two clients

●      A set number or unlimited number of sessions or amount of time

These are just a few of the arrangements available for affordable therapy options. It’s up to each private practitioner to decide what will work best for their own practice, and clients, when their schedule permits.

3. Words & Phrases to Consider for Presenting Pricing & Adjusted Pricing

These days the term “sliding scale” seems to come with a lot of baggage for clinicians, clients, and those seeking therapy. For many lay people, the word “sliding scale” means: the price can slide all the way down to zero; the rate will, of course, upon request, always be adjusted to the lowest possible price regardless of the financial need or available resources of the asker; and therapists will always give a lower price to anyone who asks because it’s their job to take care of people’s needs.

An alternative to using “sliding scale” is to use more definite or declarative wording:

For those with a lower income or who demonstrate a financial need—and are eligible, pricing based on lower income . . . special arrangements . . . specialized price/prices/pricing . . . price accommodation(s) can be discussed/made. The adjusted price for a 50-minute session of therapy is . . . The charge for your therapy session is . . . 

Here are three examples of what can be said when callers or clients ask about or mention a sliding scale, discount or reduction. These are meant to be tailored to what works for you, your practice, and clientele.

Example 1

1. There are A/1/2/3/couple/few places/spaces/openings when my schedule allows it 

2. For clients who pay/receive/qualify for/ are in need of
3. An adjusted fee/alternate price /special rate/economy rate, etc.

   and

4. Those are filled/there aren’t any openings/I can put you on the waiting list

or

Those are reserved for low income and those who have a financial hardship when possible/when available/ when my schedule allows

5. To qualify for those, you’ll need to submit proof of your household’s income—pay stubs/ tax return/bank statements etc.

Example 2

1. There are A/1/2/3/couple/few places/spaces/openings/slots when possible/when available/ when my schedule allows it
2. For clients who pay/receive/qualify for/ are in need of
3. An adjusted fee/alternate price / special rate/economy rate
4. You don’t seem to qualify for those.
5. We can talk about other options to be able to manage paying the session cost—less than weekly sessions/shorter length sessions/group therapy/family loan/ credit card payment/
6. If you’re not able to work out paying the session price/If you don’t want to pay the session price
7.  I can refer you to a low-cost counseling center, free clinic, training center, or counseling practice specializing in low income clients.

Example 3

1. If you’re not able to pay this session price
2. I don’t offer a sliding scale or adjust the price for a session
3. I can refer you to a low-cost counseling center, a training center, free clinic, or counseling practice specializing in low income clients.

By using this type of wording, the therapist will be conveying the message that the stated cost of services is the actual price and not just a negotiation starting point when no fee adjustment is realistically needed—but that some pricing accommodations are available to those in need of them. As a result, of making this wording change the clinician’s money conversations are usually shorter and the amount decided upon is usually higher but still what the client can afford.

Only Do What Fits You, Your Clients, and Your Therapy Services Best
Confidently take charge of money conversations about prices by using any of aforementioned professional and clinical language recommendations that work with your client population and clinical practice. Focus on the value, cost, worth of the therapy service to the client and their life.

Remember to keep the language, wording, and focus of the clinical and professional money matters conversations on the client responsibility for payment for services needed, received and provided— not on what or how much the therapist gets or charges or how much the number is. Allow the client to pay a fair price for the therapy benefits they receive from you, the highly skilled and trained professional that you are.

See for yourself how the words you use can increase the amount of money you earn in your practice while still serving the community and keeping your services affordably priced.

The therapists I coach and train find that when they can set a session price that works for their practices and clients, they stop undercharging and reducing the price for every client but limit accommodations to a certain number of clients when their schedule allows it—and refer those who can’t or aren’t willing to pay the clinician’s set minimum amount—their practices fill (and stay full) and they earn more money while helping more clients.

I encourage more clinicians to consider taking the risk to do this—set the session price at a rate that represents the worth of the therapy and professional services they provide; have a set minimum that no adjusted pricing goes below (you can still have a pro bono client or two at your discretion); and refrain from adjusting session prices for every client who asks—it benefits both clients and therapists as well as the profession.

That’s enough about how to introduce and talk about sliding scale, adjusted pricing, and specialized alternatives. I hope the information presented about how the wording you use as a clinician to talk about sliding scale pricing can increase or decrease the amount of money you earn from your client work has been useful—and that you’ve found this article—and the others in the Getting Paid Series—to be supportive and encouraging of your efforts to be paid what the valuable therapy services you provide are worth in the professional marketplace.

Lynne Azpeitia, LMFT, AAMFT Approved Supervisor, is in private practice in Santa Monica where she works with Couples and Gifted, Talented, and Creative Adults across the lifespan. Lynne’s been doing business and clinical coaching with mental health professionals for more than 15 years, helping professionals develop even more successful careers and practices. To learn more about her in-person and online services, workshops or monthly no-cost Online Networking & Practice Development Lunch visit www.Gifted-Adults.com or www.LAPracticeDevelopment.com.