You know what is the hardest thing to talk about in therapy?

Money.

Weird, no? But true. Clients will talk about anything, and I mean anything, but when it comes to money, they suddenly clam up.

As a therapist, I need to look out for those money secrets. Because not always do I read minds and when I do not read my client's mind, I do not realize that when is happening in front of me is all about money.

You want to know what I am talking about?

The first thing I look out for is when a potentially new client calls me for an appointment, and one of the first two questions she asks me is how much I charge for a session. She has every right to ask my fees, and if she would not ask, I would most certainly tell her before putting down for an appointment to make sure she is okay with it. But when a new client calls to make an appointment, usually a crisis precedes that phone call. She or he is pretty desperate to get help and absolutely realizes that she needs therapy as soon as possible. If a person in crisis is still thinking about money, worried about the price of therapy, then I know that money is an even bigger crisis for her.

What do I do?

I immediately give this person other options. I suggest going to a clinic or agency where her insurance will be accepted and money does not need to exacerbate an already difficult situation. I will explain exactly how to find a clinic, what to look out for, how to find a proper therapist there, and the benefits of a clinic over a private therapist like me. That is generally what I do. I may also help the person find a therapist who has a private office but accepts insurance. That is much harder but definitely doable.

In another article I have already discussed the pros and cons of private therapy versus seeing a therapist in a clinic so I will not review this here. Suffice to say that if somebody is struggling financially, seeing a private therapist will often not be productive. The client will cancel or avoid scheduling sessions whenever they are short with money. The client will not be able to schedule collateral sessions with parents or spouses because of the added expense. The therapist will be limited in how she collaborates with family members or school personnel because of the lack of funds available for additional sessions or even phone consultations with principals and other important collaterals to the client. And if a client needs an additional session during a week, it will often not materialize because of a lack of funds.

As you are reading this, there may be critical readers who fault the therapist. You may ask, “Why are therapists so money hungry that they will not do this for clients who are tight with money? It is so heartless, as if you are only in this for the money!”

Yes, being a therapist is a job. And payment is exchanged. A therapist need not apologize for expecting payment for her job, including when her job includes additional hours of consultation that is billable.

It is true that therapists charge money for their services. It is also true that they have become therapists to begin with because it is a calling. But we need not confuse the two.

Do you question the expense when your surgeon excises the tumor from your body?

Is he only in it for the money? Probably he became a surgeon because it was his calling too. And we are truly lucky when the things we love to do are also what we get paid to do. I felt that way when I taught high school writing, I feel that way now. My salary as a teacher did not detract from my dedication, not then, not now.

One of the most important aspects of therapy is that it is a service. It is not a chessed or volunteer position. Payment is a boundary of therapy. For so many clients who have gone to mentors, teachers, volunteers, rebbetzins, there is an amazement when therapy works in ways they have not gotten relief in other relationships where they just “talked.”

Very simply, if a person cannot afford the service of a therapist and self pay, there are options. Like obtaining services in an agency. And when I recognize a potential client will have difficulty with payment, I address it in that first phone call and help her recognize that so she can make an informed decision about her care.

I was a therapist in a clinic and did excellent work with clients who had seen therapists charging $250 for a session. I was getting paid a tenth of that in the clinic! So no, I do not think a client will be getting inadequate or even inferior care in a clinic. There may be other limitations (addressed in a different article), but they are reasonable within the circumstances.

If you ask me what happens when I realize that a client cannot afford to pay for therapy once therapy begins, that is a more difficult questions.

Maybe I am putting myself out there with what I will say next, but if a client asks for a reduction in price, I usually refer that client further. To an agency, to another therapist.

Because clients that value the therapy they are receiving always feel they are not even paying their therapist what they are worth and would not dream of asking for a reduction.

And that is when I need to be more aware of what is not being said. Or of the unexplained requests to skip a week of therapy. And when I hear a client explaining financial difficulties in attending therapy weekly, I make an assessment. Can therapy be effective bi-monthly? If yes, we adjust accordingly. If I assess that my client would be harmed by a reduction of sessions then and there is a good therapeutic alliance that would be best served by continuing specifically with me, I usually work out a payment that works for my client.

Part of the ethics by which counselors in all licensed fields operate is to do pro-bono work. But who we choose to accept has to do with our decisions, not clients (or readers) who judge therapists for accepting fees for our service. When I assess that money is hindering therapy, it is I who will broach the subject and explore therapeutic options and reduced fees.

Money is prevalent in the therapy room in its non-verbal form. It is in how a client pays us. Grudgingly. Making snide comments about our fees. Always late. In crunched up dollar bills, fives, tens, and twenties. Or crisp hundred dollar bills. It's in how they shove the money at us the minute they walk in, or begin filling out the check after the session is over. It is in their dismay when they realize they have forgotten their wallets at home. When their gestures convey how valuable their therapy experiences are and wish they could truly show their gratitude with a Mediterranean Cruise. When the money has no value to begin with.

Money—as every other topic in the therapy room—is simply grist for the mill. And I would not trade my job for any millions! Not even a money mill...

NOTE: THIS ARTICLE WAS ORIGINALLY PUBLISHED BY BINAH MAGAZINE--AND RECEIVED MANY ANGRY RESPONSES...HMMM

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