Discussing the Cost of Counseling and Schedule of Next Session

Question 37. Now, back to the initial session setting, you can give them a number of options. He can begin the process by completing the forms and Analysis Questionnaire (AQAL) or think about it and can call you back. He can even schedule another session to ask questions and decide after that. At this point, the first peripheral issue that needs to be discussed is the cost of the counseling. You will need to determine how clients will pay for your services. I learned quickly that I had to draft some billing policies (Explain Fees form) for clients to consider: full cost per session, a sliding scale (fee dependent upon household income), charges for cancelations, self-pay or paid by someone else like the church or insurance. Once that policy is created, clients will be able to know what it will cost and be able to make a decision. 

Question 38. I send people a policy statement that lists my charges for sessions, charges for cancellations or not showing up without notice. The costs will be dependent on the market population you serve and your own expenses. People who want help are willing to pay me enough income so that I can meet my office expenses and have an income that's adequate. Now this might sound a little unfair or maybe mercenary. What I found is that if I'm not as good a businessman as I am a counselor, then I will fail in my practice. Bills have to be paid, paper has to be bought, copying has to be done, brochures have to be sent out every four months so that my name is a known option for helping people. Pastors who refer clients move and don't pass on their referral contacts. Clients are a great referral source of course, and they will need a handy brochure to give friends. I can lose my ability to have consistency in referrals if I don't do some things that are purely business. I pray over the brochures and letters that I write, but I am responsible for a level of business expertise that is critical to my ability to present biblical counseling. 

When you think about fees, I want you to keep in mind your cost needs to preserve your ability to be in practice which depends on your setting, and you need to be treated as a professional. To that end, I have a sliding scale fee that allows me to charge according to the client’s household income. I charge insurance companies more because of the extra time required to file a form every session with a medical diagnosis, or a DSM (Diagnostic and Statistical Manual of Mental Disorders) diagnosis, and we'll talk about that later. Another policy is not allowing a client to have more than two unpaid sessions at any time.  Most often, if you allow the client to run up a large bill, you won't receive your payment. Without these policies, I lost about $20,000 in uncollected fees over the first 5 years of counseling. Now that's a lot of money. This happened because I had no one to mentor me.  I strongly suggest setting policy before you start to counsel, especially if you're going to be in a setting where you're trying to earn an income from your counseling. The Lord challenged me to provide 10% of my counseling fees as a gift. I do that partially out of gratitude to the Lord for the life he's given me, and my desire to help those that don't have the income that can pay for their counseling.

I found if I charged too little for a session, I tended to get clients who had already talked to a lot of counselors, but really didn't want to change: they just wanted an audience to hear their story again. They won’t be faithful to the process or treat you as a professional. 

It can be a very frustrating and discouraging feeling after counseling 30 sessions in a week to find you collected less money that your expenses demand. You can border on being bitter and angry, because you have genuinely tried very, very hard to help people. But the end result is you're exhausted, you weren't paid adequately, and you feel frustrated. That's not the way to try to counsel. You can't have things in your own life that don't work, or a place of unrest or unhappiness, because it doesn't take very long for whoever you're working with to see that something's wrong in your life. And the next thought is, how can he or she help me if they don't even have their own life together? 

It is best to send them a policy statement or speak to them about it over the phone when they make the initial contact, and set up a session. At the end of the initial session, you want to review the cost policy and collect payment for the first session. Most clients know their income and will be honest in reporting it to you. I found that most people will overpay you, rather than underpay you. You may need to postpone counseling for a few weeks if the income is too tight or an emergency prohibits them from paying. That's a hard thing to do, but you'll find it in the long run, you're better off. People feel guilty because they don't pay you, which can hinder their progress. If you are counseling in a church setting or a pastor refers clients, the church might pay for the client’s counseling or provide some of your income. There are obviously many issues to consider. 

Question 39. You can never make the decision for any client to receive counseling. It is best to tell the client at the beginning of the session that you will ask them at the end of the session to make a decision about counseling: to continue by making a second appointment, take the material that I've given them to review, and take it to their pastor, friend or counselor to review. If they do that, they will need to call me back later to tell me if they want to continue to counsel. The reason for all these options is because you'll really never help anybody that doesn't want to receive help. If you sense any hesitancy, then don't try to schedule. When I first started to counsel, I spent a lot of time begging people to get help, to return, trying to convince them; I wore myself out. There are too many people who want help. In time you will have enough to do without trying to convince anybody that they need help. If they choose to counsel, you'll know it's because they have initial interest and they will receive help. 

Question 40. You will also need to make a schedule of office hours. I have found that afternoons and evenings provide the best time for people to be available. My schedule started at one or two o'clock, for 55 minutes with a 5-minute exchange break between clients. The last session of the day began at 7:00 pm. I try to keep one hour in the afternoon free to return calls and do office work for Monday through Thursday. On Friday, I just have sessions from one until five pm. I don't work on Saturdays or Sundays. If you don't set the hours, people will set them for you. And what that'll mean is you may go in at seven o'clock one day and be there until 10 o'clock the next night. You have to have clearly established counseling hours. If a client doesn't make a decision to counsel with you in the initial session, you need to make them aware that waiting reduces the options for future sessions at that time.

 If you have a busy practice, your times will open and close like quicksand. For example, I see an average of 50 to 70 different people every month, and I have a minimum of about 100 sessions every month. I've worked this way for about six years. So, if I have an evening which is a premium, say a Tuesday night at six, and I see somebody on that night, and they think maybe they might want that session, I can’t guarantee it will be open the next week. It's not uncommon for me to have 3 or more calls every day from clients wanting to schedule a session. Before I had a secretary, I used an answering machine to take those calls. You have to work with people according to when they call, so first calls get first choice. When I've tried to hold a session for a day or two, I discovered that people make decisions with emotions. It'll absolutely destroy your schedule. Also, it will keep you from being sensitive to God's leading in who to help. You have to control when you work, with fairness to how you fill your schedule. Having a person to help with scheduling reduces a great deal of stress for you.