Money talk… top tips to engage the subject

In a recent telephone survey counsellors, psychotherapists and counselling psychologists were asked which they found harder to talk about with their clients: money or sex. Perhaps not surprisingly ‘money’ made people more anxious than ‘sex’.

Those interviewed mentioned feeling guilty about charging people who are in emotional distress, fear of being envied by their clients - and colleagues - for having too much money and difficulties in putting a value on their work as the main areas of difficulty. On the other hand most of those interviewed admitted that in more challenging therapeutic relationships often only the knowledge that they were getting paid kept them from throwing in the towel. The majority of those interviewed also admitted that they had difficulties with seeing their work as a business and didn’t like to dwell on the financial arrangements. Others didn’t feel that it was that important to dwell too much on the aspect of money, as it would inevitably throw up areas for work in therapy no matter how clear the contracting about fees had been.

Kearns (2007) has written that the therapist’s lack of clarity about money is frequently the starting point for the disintegration of the therapeutic relationship. As a supervisor she noticed how the therapist’s anxiety over losing clients – and the fees they pay – is often conveyed non-verbally by not keeping to agreements about fee and cancellation arrangements. She warns that what may feel to the therapist like a ‘kindness’ to a client may be felt by the client as the therapist not being strong enough or even too needy. For clients whose ability to stay in relationship is impaired bending or ignoring agreements about money may leave a well-meaning therapist open to attack.

Money is a crucial component of ‘the frame’ in psychotherapy. It could be said that our attitude to money reflects our existential attitude to life. In other words how we view money in the world will influence how we choose to live and relate to others. Having enough money can lead to satisfaction, generosity and guilt; not having – or fearing not having – enough may lead to a sense of scarcity, deprivation, envy and greed. Just because we don’t consciously think about the significance of money doesn’t mean that all this isn’t affecting us unconsciously pretty much all of the time. Seen in that light it’s now surprising that disagreements or misunderstandings about money are a recurring theme in complaints and civil actions.

• Get to know your vulnerabilities where money is concerned. Do you feel like you have enough money, or not enough or too much? How do you feel about asking for it? About spending it? How would you know if you were giving value for money? And how would you feel if a client challenged you about this?
• Be clear from the start about fee arrangements. Practitioners who have been complained against often experienced a pull from their client at the beginning of the work to negotiate a lower fee. If you do decide to reduce your fee be clear that this will be for a certain time period and renegotiated. Otherwise the client may experience a lack of firmness around boundaries and may even feel that you don’t value the work. Furthermore the therapist may begin to feel exploited by clients who pay a reduced fee and then talk about how they spend money elsewhere.
• Give your clients a monthly invoice or receipt. Some therapists find money in the therapeutic relationship easier to manage when they give their clients an invoice at the end of each month. If ‘giving credit’ until the next month makes you anxious then give your clients a receipt at the end of the month for fees paid. This is particularly important if the client pays you in cash. In any case issuing a monthly receipt or invoice of which you keep a copy serves as a written contract about agreements about fees.
• Put all fees through your books. It is tempting when paid in cash to put it in your pocket to pay your own cash expenditures. One therapist tells of a colleague who was investigated by the Inland Revenue because a former, unsatisfied client told them that she paid in cash for many years. The therapist had not declared this. Be warned.
• Think carefully about third-party payments. When someone else is paying for the therapy they become an element in the transference relationship. When a parent pays for the therapy the client may feel reluctant to talk about that relationship. When an employer pays the client may fantasize that you will reveal details about the therapy to their boss. A third party who pays as ‘compensation’ for injury or abuse is particularly open to transferential difficulties. In any case all negotiations and communications about the fee and payment need to be made with and through the client.  One former client tried to get the third-party to sue her therapist for fraud, claiming that the therapist charged for sessions that did not take place.
• Make pro rata charging a habit and include details of this on your monthly invoice. If your client is someone for whom you need to write to other professionals or who asks you to spend time outside of the therapy reading letters or reports charge for this.