In this post, I wrap up (for now) Q & A from students.
Question: What do you do when people don’t pay?
Answer: I believe that we train people how to treat us. As counselors, we need to be treated more like the highly trained professionals that we are, instead of some sort of…I don’t even know what. Drop-by service? Come in when you feel like it? Pay what you want? If you got your car fixed, would you tell your mechanic that you didn’t have any money when it was time to pay the bill? Of course not. Would you simply not show up to your physician’s office for your appointment because your kid had to go to a birthday party? No, right? Well, I believe counselors need to be treated just as you would treat other professionals — with respect.
I have talked to many professionals about this problem, and whereas they might agree with me on principle (yes, we should be paid) they are generally unwilling in practice to enforce their own policies when it comes to collecting money. Fear of confrontation, fear of being sued, fear of…clients not liking them? Unfortunately, many counselors will just “let it go” if the client fails to pay, fails to show up or cancels with inadequate notice. I say unfortunately because I think this helps create a climate where people expect counselors to bend. The unintentional effect is lowered expectations on client responsibility. Not only is this poor business practice (no wonder so many therapists fail in private practice!) but it doesn’t help teach clients how to be responsible. Instead, it enables unhealthy behavior.
What do I do? Now that I have an automated system, where people pay for the appointment when they schedule it, I really no longer have the problem with late-cancels and no-shows as I used to. People are much more likely to show up if they have already paid for the appointment! My current policy is half the appointment cost if they cancel within 48 hours, and full fee if they don’t show up. Emergencies excepted. And by emergency I mean heart attack, car accident, or illness. Not things like “I ran out of money,” or “I had to work.” This is all spelled out clearly in my paperwork, and included on the initial message new clients receive during the booking process. And I follow through with this policy. Consistency is not only key, it is ethical practice.
Question: Do you think about your clients when you go home?
Answer: Not really. What I do think about is what I said, what I did and how I can improve. Depending on my perception of how the session went, this could be anywhere from the 10 minutes I spend writing my notes, to a few hours (intermittently). Sometimes, a client says or does something obnoxious or really surprising. If I feel upset, or think I won’t be able to process it myself, I will call a trusted colleague and spend 5 or 10 minutes processing. This always helps me feel better. If it can wait, I will note it and discuss it during peer supervision. Which, by the way, is an excellent idea. It took me several years to find a group, but it was worth it. Our group has 7 people in it, and includes MFTs, MHCs and a psychologist. I’ve been meeting with them for about five years now. We meet once a month for an hour and a half, and we also get together socially on occasion. Therapists need a way of processing what clients are telling them, and so I highly recommend finding a peer consultation group, and including in your paperwork that you consult with colleagues while protecting clients’ identity. As an added benefit, if you are ever sued a documented discussion with your peer group about the case will help your defense.
Yours in the Joy of Knowledge,
Dr. Barbara LoFrisco
