How can you get your numbers working for you as a group practice owner? In this episode, Linzy dives into the steps group practice owners need to take to make your numbers start working for you.
Money Scripts for Private Practice with Kelley Stevens
“One mistake I see people make is let’s say they have some sort of policy around raising their fee… kind of like you said, we’ll have these stories in our head, and then they’ll push it off and push it off and push it off, instead of making it a regular part of the emotional health of their practice, and then they are in a position where four or five years down the road, they need to make a big jump.”
Kelley Stevens, LMFT is a private practice business consultant for therapists. Kelley teaches online courses for therapists looking to build successful and sustainable private practices.
In This Episode…
Are you looking for ways to talk with your clients about money and fees? Are you unsure about what to do when it comes to sliding scales and reduced rates? Do you need ideas about how to discuss fee increases with clients? Kelley specializes in helping therapists know how to navigate these challenging aspects of running a practice.
Do not miss this packed episode full of great ideas about specific things to say and do to address these tricky situations and more. Linzy and Kelley really dig into all of the ways that fees and raising rates can impact your therapy practice.
Kelley’s new scripts book for private practice owners is out now! It is all about how to have the nitty gritty conversations that are often part of having a private practice. Find the book and so much more on Kelley’s website: www.theprivatepracticepro.com/
Connect with Kelley on Instagram @theprivatepracticepro
Are you a group practice owner who’s tired of feeling overwhelmed and stressed about your finances? – Do you feel like you’re doing all the work for none of the money and are tired of constantly worrying about your bank account?- Do you want to create a group practice that is financially stable, reflects your values, and takes good care of you and your team?
If you answered yes to any of these questions, you’re going to want to hear all about my brand new course Money Skills for Group Practice Owners! This six-month course will take you from feeling like an overworked, stressed and underpaid group practice owner, to being the confident and empowered financial leader of your group practice.
To learn more about Money Skills for Group Practice Owners click here.
And to book a call with Linzy to talk about whether the course is right for you, click here to get in her calendar now. She looks forward to chatting with you about it!
Kelley [00:00:02] One mistake I see people make is, let’s say they have some sort of policy around grazing their fee, kind of like you said, we have these stories in our head and then they’ll push it off and push it off and push it off instead of making it a regular part of the emotional health of their practice. And then, they’re in a position where four or five years down the road, they need to make a big jump.
Linzy [00:00:28] Welcome to the Money Skills For Therapists podcast, where we answer this question, How can therapists and health practitioners go from money, shame and confusion to feeling calm and confident about their finances and get money really working for them in both their private practice and their lives? I’m your host Linzy Bonham, therapist turned money coach and creator of the course Money Skills For Therapists. Hello and welcome back to the podcast. So today’s guest on the podcast is Kelley Stevens. Kelley is a private practice business consultant for therapists. She first came across our radar on Instagram, where we started seeing and liking her content. And as I chat with her about, at the beginning of our conversation, it kinda seemed like she came out of nowhere. She has now 20,000 followers on Instagram. She’s obviously saying things that are resonating with lots of folks, lots of energy and conversation in her corner of Instagram and we’ll get the links at the end if you want to jump into her world. But we met up recently and got talking and she’s doing very cool things and we decided to do this podcast together, which turned out to be a great conversation. We really got into the issue of what to say. It could be so easy in private practice to trip over our words when we’re trying to have conversations about money. And we dug into some of those hard conversations, and Kelley gave her standard script, kind of what she tends to say. And we compared notes, to what I would say or what I have said in the past, and it ended up being a really interesting conversation. Not just the points that we agreed on, on ways to address things with our clients, but also we had a lot of different ways of doing things, which turned into quite a rich conversation and thinking about how who we serve, you know, the structure of our client or client population, actually means that we do have to do things differently in business as well. And that needs to be a factor that we think about when we’re rolling out fee increases or policies, changes in our policies. Who you work with really does make a difference. Here’s my conversation with Kelley Stevens. All right, Kelley, welcome to the podcast.
Kelley [00:02:47] Thank you. I’m so excited to be here.
Linzy [00:02:50] I’m excited to have you. So, Kelley, you came across my radar on Instagram, where you kind of like came out of nowhere. I remember when we chatted a few weeks ago, I was like, I basically asked you like, where did you come from? Like, who have you worked with? And you kind of like –
Kelley [00:03:07] Came out of nowhere.
Linzy [00:03:09] Came out of nowhere. That’s not inaccurate, right? So you’ve built this big following on Instagram, helping folks with practice building.
Kelley [00:03:15] Yeah.
Linzy [00:03:16] And I was wondering with that, like, what are the things you notice people are like the most responsive to? Like, what do they want the most help with?
Kelley [00:03:23] Yeah, it’s interesting. You know, it’s so funny when I first started – and I think this is so true of any type of following online, you kind of start out with this vision of what you think people will want. And then all of a sudden it evolves as you – ideally as you’re listening to people who follow you. And so what I kind of thought people would want, would be a lot of tips on how to build a private practice, which is what I started out posting. And I do still post that, but what I find, just like blows it out of the water, is scripts. People want to know like, what to say when a certain situation happens in the therapy room. And then specifically, I tend to talk more about business development and practice development. So I get a ton of questions just about, kind of the nitty gritty things to say when a client’s late or when there’s a confidentiality issue or when there’s a fee issue. And so people often will respond to like exact scripts that they can take and kind of make their own. So I would say that would be my number one thing.
Linzy [00:04:26] Right, people want to know what to say. Like, we don’t know what to say, I guess is the problem.
Kelley [00:04:30] Yeah. I mean, I was this way. So this is a tangent, but I, I follow a ton of mommy accounts, you know, and toddler – and the ones that say, okay, say this or do this with your toddler, I’m saving this.
Linzy [00:04:44] That’s true.
Kelley [00:04:44] Like I didn’t even know what to say. You know like, learning how to word things in a certain way is trickier than we think sometimes, you know.
Linzy [00:04:52] I think especially in a situation where there’s kind of like a lot at stake, right. Or, you know, that you have power, which I think, you know, there’s a parallel there, right, between being a therapist and being a parent. It’s like you are in this position of power in the relationship. It’s not like an equal footing. And they need you and they need something from you. And I think – I wonder if that’s part of what contributes to us wanting to make sure we say the right thing or not really knowing what to say because we’re so mindful of the impact of what we say.
Kelley [00:05:15] Oh, 100%. I mean, I think that’s so true. And the parallels are spot on. Like I love following Dr. Becky on Good Inside, she does a parenting podcast and she will often say, I want you to be a sturdy leader for your kids. You know, and I think that that’s such a great way of putting it. It’s like, we learned to be gentle and to be kind, but we also have to be sturdy in our own boundaries. And I think that that totally applies to the therapy room. And I think about that when it comes especially to, what to say around scripts related to finance and to boundaries, that we have to be kind of sturdy in our boundaries, while still being kind. And learning how to word those things, is not always how we would word things clinically, you know, like we can be super, super empathetic and we might not be quite as boundaried in a clinical setting. But then it comes to our fee and we have to all of a sudden have a different way of saying something, while still being a therapist and it’s challenging.
Linzy [00:06:11] Yeah, I imagine it, you know, kind of like switching hats. Like you have to switch hats when you move into these business conversations because they’re no longer, you know, simply therapeutic conversations. Now you’re talking about your relationship and the container in which you’re doing the work. Right? And that requires you to have other things on the radar, besides just like your client feeling, like, comfortable or supported in that moment.
Kelley [00:06:32] Totally.
Linzy [00:06:33] So let’s jump into money scripts.
Kelley [00:06:35] Yeah.
Linzy [00:06:36] I’m sure folks listening already have, you know, situations in their own mind of like, oh, it’s always so hard to deal with this or to say this. And so, let’s start with what do you see as like some of the money scripts that folks tend to need the most?
Kelley [00:06:49] I would say, okay, so this one’s always a tricky one, which is why I love following your content because I think you break things down in such a simple way. I feel like that’s what I always get from everything that I hear from you, because I think we all have our own stuff around money.
Linzy [00:07:05] Oh yes.
Kelley [00:07:05] So much of our own shit comes into it.
Linzy [00:07:07] Oh, for sure.
Kelley [00:07:07] And so first of all, I just want to like name that, that that’s a huge part of this. And so obviously the ones that come up I think of are like, raising your fee is the one I get asked the most. But I think what I like to remind people is that raising your fee isn’t the first conversation you should probably be having about money, but it’s the one that I think a lot of times is kind of the red flag that people say like, Oh, I haven’t done some of that, but we’re already talking about money.
Linzy [00:07:36] Hmm. Yeah.
Kelley [00:07:37] That’s the question I get asked the most.
Linzy [00:07:39] Yeah, that makes sense. So it’s like, if you have not practiced having conversations with money about your client when they started working with you, or maybe even in a therapeutic relationship. If money is something you never touch, suddenly you have to have this conversation with them that you almost like have no footing together in this topic.
Kelley [00:07:55] Exactly. As opposed to, like, laying the groundwork before. I mean, I think that the best place to start is just like, in your paperwork and in your initial phone call. Which is – I never get those questions on Instagram, but they’re definitely the most important place to start.
Linzy [00:08:09] Right. Yes. Yes. Because that’s the foundation that you lay before it becomes a problem. Right. Like, I think that probably like, we notice the pain point, how painful it is to raise fees because we’re like, oh, god, now I have to do it. And now we’ve never talked about this. But it’s like, what I’m hearing is you can actually set yourself up to kind of mitigate this long before you ever raise your feet with a client.
Kelley [00:08:30] Definitely. So I guess we just talk about that.
Linzy [00:08:33] Yeah.
Kelley [00:08:33] I usually tell people – and I’m interested to know what you think about this. So the question I get asked a lot is, should you put your fee on your web page? And I am a big believer in, yes. There are – there’s kind of another camp for no. But I don’t know, what do you think?
Linzy [00:08:49] I think I’m a yes. I have certainly been a no before. I think I evolved into a yes. And I think the reason I probably wasn’t a no before, would have been probably out of my own fear of like scaring people off. Right. Like, I could see the argument for like, you want to have people talk to you and get a feel for you and understand kind of like what is on offer before you tell them how much it costs. I think that would probably be the argument for the other side, is that kind of it?
Kelley [00:09:13] Yeah, I think, you know, obviously a big caveat is if you take insurance or not.
Linzy [00:09:17] Right.
Kelley [00:09:17] So obviously, if you take insurance, you want to list what you’re in-network for. But if you’re in kind of the cash pay, private pay world. Yeah, I think that that’s people’s main fear is if I put it out there, am I going to automatically turn people off, that might of actually been able to afford my fee but didn’t feel like they got that warm welcome or something. But usually what I say to people in kind of the private pay – and I tend to specialize in working with therapists who have cash based practices, you know, certainly clients who don’t, but the majority of mine do. So what I usually would tell people is, number one, like therapy is typically pretty ongoing. Whether you’re running short term or long term therapy, they’re going to have multiple expenses. And so we do want clients to be able to afford our services comfortably. You know, we don’t necessarily want clients that are mortgaging their house in order to go to therapy. So those are the types of clients that we’d like to help find options for therapy that work for their life. Because if therapy becomes such a financial burden, that it’s actually causing stress, then it’s doing the opposite of what we want therapy to do. So that would be my first thing. My second thing is like, as your practice grows, if you don’t have your fee on your website, then that first initial phone call becomes about trying to figure out if the client can afford you or not. A lot of times, clients don’t even look at what your fee is anyways, so you have to have that initial phone call conversation. But I find that it makes it easier if people are like, You know what, I have to use my insurance no matter what. Well, then it’s good that you listed on your fee that you don’t take it.
Linzy [00:10:53] Yeah, right.
Kelley [00:10:55] I find for me, when I’ve been afraid to put it on my website, it comes more from a scarcity place of like, there’s not going to be enough clients that can afford me or I have to convince them that they can afford me or something like that.
Linzy [00:11:06] Yeah, that makes sense to me. And I think that, I’m thinking about the context around the fee. Like I think if you have a website where you have really put yourself across clearly and you’re not just like using jargon that they can’t understand, which I think is always our temptation when we’re kind of feeling insecure, is like drop a bunch of educated words. But when you are actually authentic on your website and people are getting a feel for you on your website, that really is you. Then, that also be part of the context where they see the fee and they’re like, okay, the fee is like maybe higher than I would have thought, but I can afford it and this is my person.
Kelley [00:11:37] Oh, totally. 100%.
Linzy [00:11:39] I think that absolutely is possible, just from your website.
Kelley [00:11:41] Yeah. Oh, I think it’s 100% possible. And I think sometimes therapists will ask me, like on other types of offers they have, you know, on courses and things. They’re maybe not putting their fee out there. But I would argue that therapy in that it’s a 1 to 1 therapy, is different than like an online course where you might not pitch it right away or a book or, you know, other things where you kind of build some momentum behind it because, because therapy is ongoing and because of the health care nature of it, versus just like a course or other services where you might not necessarily say your fee right away, where you might warm people up first. But because it’s health care – and obviously, look, we have no surprises. You know, we have a lot of other things happening to kind of create more transparency in health care. We can probably go on a whole tangent about that. But I am a, put it on your website type of person and then I’m also obviously a put it in your paperwork, really clearly line it out. And that relates to the raising your fee, where I usually suggest to people that they put their fee raise policy into their paper.
Linzy [00:12:42] And tell me about that. Like what would be an example of a policy that someone might put right in their paperwork that the client signs when they start working together?
Kelley [00:12:49] So I usually suggest to people that they raise their fee once per year and that they really think in their own kind of financial planning for 3 to 5 years of what that fee raise is going to look like, that ideally there – obviously there’s inflation right now, in the US with a lot of inflation happening. So I usually suggest to people that you put right in your paperwork something that says something along the lines of, “I raise my fee once per year to accommodate for X, Y and Z.” So usually that’s like inflation, increases in my experience, increases in my business cost. You list a few things and then you say that you’ll notice that that phrase happens on X day. Usually I suggest people do it in January, but you can do it at any time. And then saying something along the lines of, “that fee raise is typically x percent or x dollars,” if you know what it is ahead of time, even better. And I tell people, you know, you’re going to see that on your charges starting on January 1st. However, I also will shoot you an email on December 1st, reminding. So it’s all laid out there. It doesn’t mean that the client’s going to read it. It doesn’t mean that they’re going to see it later on. You’re still going to have to have a conversation around it. But at least they know, Oh, this person raises their fee. Just like, I don’t know about you, but my gym does this.
Linzy [00:14:03] Right.
Kelley [00:14:04] Where they say, “we raise our fee this time of year,” and I expect it, you know?
Linzy [00:14:09] Yeah, that’s a really interesting approach. It’s like, it’s definitely different than what I have done personally, and it makes me think about just kind of that difference between kind of setting a course in business. And you’re like, basically, this is the level I already want to be at. So that sounds like a good policy if it’s kind of like you set your fee to a good living level for you now. But you also know that there’s going to be inflation, like inflation in Canada, which is where I am, has been 7% in last year, which is huge, right. So if you’re charging the same amount that you were a year ago, you’re actually making 7% less. Yeah, there’s a loss there, right. So it’s like, I can see that really, it’s almost like when you hit your cruising altitude, that’s like a good policy, right? Where just like my fee is going to just go up a little bit every year, just to accommodate like cost of living or whatever. What I have seen before, though, and I’m curious about your thoughts about this, what about for someone who’s coming in and they’ve maybe set their fee to low and they realize like, oh, shit, I can not do this work for $110 an hour. Yeah, right.
Kelley [00:15:09] I’ve been in that position.
Linzy [00:15:09] Yeah, me too. Me too. Where you have to do a fee raise that’s more like $10 or $20 or $30. Right. What do you suggest in a situation like that?
Linzy [00:15:18] So, you know, everybody is really different. And I think it really depends on where you’re at in your practice development and where you’re at in your senses. So let’s say you’re super full and you have enough referrals coming in, that’s going to be different than if you don’t have enough referrals coming in. What I usually tell people and what I’ve done, and certainly I don’t know if it’s always the right thing, is I usually – if I’m going to do a big fee increase, I tend to just make that fee increase for new clients. I find that that tends to be the path of least resistance, meaning like, okay, every new client you have come in, they’re going to go up to that higher fee. And then any client that you have existing, you can have that conversation. And I usually tell people to take that on a case by case basis. You know, if someone started seeing you a month ago and you’re going to raise their fee $50 a session, you probably want to recognize that you might lose them as a client or they may not be able to afford it. They might or they might not. And I found, it’s interesting, different therapists have different thoughts on this. Like, I have a great family friend who is like, no, I would absolutely raise it. If they leave, they leave.
Linzy [00:16:20] Mm hmm. Yep.
Kelley [00:16:21] And I tend to be more in the like, let’s raise the new ones and then let’s take all the existing clients on a case by case basis. And I’m curious, what do you do? What would you do?
Linzy [00:16:33] I’m definitely the raise everybody person. I am. And like, it’s – I definitely hear that the other way is the path of least resistance, and I’m almost like, that’s why you don’t do it. Don’t do the path of least resistance, right? Because if I think about the work that I did and it can depend on your practice, right? And who you’re serving, like there’s so many variables. But I did like long term, you know, like deep trauma work. Like I might work with you for five or ten years, right? So, like, that would still be the core of my caseload. So if I did that approach, I would maybe only be raising, like I might have three clients come in.
Kelley [00:17:06] Could be a year.
Linzy [00:17:07] In a month or two, yeah. It would take me – and folks wouldn’t leave, right. And so I think that in my case, like my bread and butter in my practice was those repeat folks who I was seeing for months and years. And so that’s where I would do it across the board. And I’m a big fan and a big proponent, and I don’t know how you feel about this, but like that, you communicate verbally before you get a letter.
Kelley [00:17:29] Oh yeah, 100%.
Linzy [00:17:29] So it’s like, it’s a clinical conversation, right? And they might decide not to work with you or it’s going to bring up their own like, stress about money. And that’s – but it opens opportunity, right, for you to support them and talk about, okay, so you’ve been having a lot of stress about money. You know, let’s talk about that. And I’m also a really big fan of giving a long runway when you’re doing a significant fee increase like not we’re not talking about like the five or $10 annual fee increase. I’m talking about like a $30 fee increase, a $50 fee increase. And for folks especially, like I know I’ve had students who have made the decision when they’ve looked at their numbers, they’re like, I have to be a premium fee therapist. I’m like a single parent. Nobody’s coming to save me. If my daughter is going to have, like a life where she’s well cared for, I need to go premium. So they’re making a jump that might be like $75 or $100, right. So that that is a clinical conversation to have and you give like three months notice, right? You need to give folks basically time to say goodbye if saying goodbye is their decision.
Kelley [00:18:24] Yeah. Oh 100%, it’s so interesting. I – first of all, I love this and I’m learning from this. And it’s super interesting because I historically have specialized in teenagers who don’t stay a long time. So it’s such a different – and I love that it’s – there’s that difference because I tend to, you know, like if a teenager stays a year, it tends to be like, that’s pretty typical. It wouldn’t be abnormal for a teenager to stay three months, and it would be less typical for them to stay more than 3 to 4 years.
Linzy [00:18:55] Right.
Kelley [00:18:57] By the time they get out of high school, would be a longer time. So it’s so interesting because you’re right, it does. And I never thought about it that way, that if you tend to see long term clients, that could be a very long time.
Linzy [00:19:09] Yeah, for sure. Very, very long time.
Kelley [00:19:12] That totally makes sense.
Linzy [00:19:13] Yes. And I will say too, like in my practice, I also had a certain amount of sliding scale folks. And I think that’s another conversation, we’ll talk about that in a minute. Let’s talk sliding scale, in a minute. But I had, let’s say, five clients who were on a sliding scale. And what I would do when I raised my full fee is I would let them know that I was raising my full fee and say, let’s reassess and talk about your fee, now. Would a higher fee become possible or be possible for you to use that as an opportunity to open those conversations because they’re not going to jump up to $175, right. But they might be able to jump up to $80. And I have also raised my sliding scale at the same time. So it’s like, it’s not that I brought everybody up to full fee, but it’s like my floor is now $90.
Kelley [00:19:52] Right.
Linzy [00:19:52] And so, that’s that’s how I’ve managed that as well, because I also think it’s really easy for us to, like, tell ourselves stories about people’s financial situations and make all these assumptions, when maybe somebody has gotten a small inheritance and they do have a bit more money available. Right? Or they’ve started making a little bit more at work and they don’t always tell you. They don’t always come and report their financial situation to you. So it’s easy for us to have a story about them, that might not be accurate.
Kelley [00:20:14] It’s so, so true.
Linzy [00:20:16] So sliding scale. Let’s talk about scripts for sliding scale. What do you suggest?
Kelley [00:20:20] Okay, so let’s – I have two ways that I’ve done it in the past. So I’ll tell you the way that I just have done it internally, and then I’ll also talk about the way I’ve been doing it more recently. So historically what I’ve done, is I’ve always had four sliding scales spots in my practice at any one time, and so that’s the way it’s worked for me when I’ve a full caseload, as opposed to like being part time as a mom or something like that. So I’ve always had four and my personal way of doing this is that I save those spots for clients who are making at or below minimum wage. And then I charge them what it would cost for one hour of work. Now, I don’t ask for a tax return, you know, like we do this on our system. And obviously if they come in and they tell me they’re an investment banker who makes minimum wage, like we’re going to have a conversation. But generally I find that people are really honest. And so I – when somebody calls me and says, Do you take a sliding scale? I say, I have four spots in my practice at any one time for individuals who need a sliding scale spot and I reserve those spots for people who are at or below minimum wage, is that you? And I just leave it there and I pause and I find that people either say yes or no and if they say no. I can find that it’s usually not a bigger conversation, you know. And so the reason that I do that is, I’m not a big advocate of lowering my fee $10 or $20 to kind of make it more comfortable for somebody. I would rather make it more accessible for somebody who can’t afford it normally. And then I will say that. And so if somebody says, yes, that is me, I’ll say, Great, then I will charge you what it costs for one hour of work. And I don’t ask them to see their paycheck or anything like that, they just say, I make X amount per hour and I’m like, Great, that’s what it would cost for you to come to therapy. Now, imagine that those spots fill up really quickly. And so if that is the case, I do keep a waiting list. But now, what I do is I refer them to Open Path, which I’m a huge supporter of. I think they’re awesome and they’re basically – I’m sure you’ve talked about them before, but they are a nonprofit that pairs clients who need sliding scale spots with private practice therapists who have those spots available. And my understanding is that they pay between like 30 and 100 a session. But basically the way Open Path works, is they pair you with the client, but then beyond just pairing you with a client, no finances go through them. Does that makes sense?
Linzy [00:22:53] Yep.
Kelley [00:22:53] The client pays you directly. Once you’re paired, it’s between you guys, which is a great way to go. And so if I’m full in my spots, I’ll refer them to Open Path or I’ll take on an Open Path client. And I’ve found that that’s a really nice way to do it, because they do a lot of that footwork for you, of like helping you find someone.
Linzy [00:23:12] I mean, what I love about that approach, Kelley, I mean, gosh, there’s like as many ways to do this as there are therapists in the world, right. But what I do really like about that, is your point about how you’re then really making therapy accessible to somebody who otherwise would not be able to access it, right. And I think that we do conflate like a sliding scale with – I had another podcast guest on last season, Nick Bognar, and he made this point that kind of like stopped me in my tracks a little bit, where like you’re basically actually negotiating with a client when you’re talking about $10 or $20, you know, like you’re talking to somebody who has the money, but you’re having a conversation about what would make it feel more comfortable for them, what they would be willing to pay, right? To see you. Whereas when you are seeing someone for $14 an hour, you are truly creating a spot for someone who could not pay you $150 or $200, right. Like that is truly making therapy accessible. And I really love that approach because I think so often, we get caught up in this like concept of accessibility and like, but I have to be accessible, you know, and I even find this myself with like pricing my own offers in my course where it’s like, well, I want to be accessible. But it’s like, what does accessible mean? And accessible to who? Because there are folks who literally – who couldn’t pay you $20. So no matter what, you’re never going to be accessible to those folks. But your solution actually does catch anybody who’s employed.
Kelley [00:24:30] Yeah, ideally. And well, and and to be honest, I’ve had it other ways too, where I’ve had clients who truly aren’t employed or are significantly below minimum wage, and I’ve had clients pay me in $1 bills, you know, I have had clients whose family members showed up the next day to bring a payment in $1 bills. You know, so yeah, I had as little as $5 a session and I am kind of a believer of a little bit of skin in the game just because it holds you accountable to showing up to your appointment and that sort of thing. But I’ve had clients pay very little and I think that there’s also a pride in that. You know, like I really value that they’re paying me for services regardless of what the payment is at that point. Whereas when I have had clients maybe slide $10 off my fee, I’ve seen them for a year and I’m like, What are we doing with this $10? You know, what is it? Would this $10 make a difference? You know, why did we do this? It’s like what you’re saying, it feels like a negotiation. And then that’s when it feels icky.
Linzy [00:25:28] Right.
Kelley [00:25:29] I wouldn’t go into my dentist and say, can I get $10 off? Unless I truly couldn’t afford it. And then ideally my dentist would have some way to accommodate that, or they’d help me figure out something else.
Linzy [00:25:41] Mm hmm. Yeah, well, if you truly couldn’t afford it, it wouldn’t be a $10 negotiation.
Kelley [00:25:44] No.
Linzy [00:25:45] Yeah, no, I like the clarity of that. That feels very clear to me, because I also think it’s checking with yourself about what will not foster resentment inside of me. And that’s like a question you have to really honestly ask yourself. And that’s what I guide my students sometimes when they’re talking about thinking through like their sliding scale and how many spots they can offer. And it’s like, what would you actually be okay with? Truly down to your bones, would you be okay with? Like, would you be okay seeing three folks who pay you $30 each? Would that be okay? If that became five, would you start to feel resentful? Right? What are you actually okay with? Because I think sometimes there’s what we want to be okay with, but then there’s what we actually experience emotionally when we’re three or four months into an agreement with somebody.
Kelley [00:26:26] Oh, totally. And I like to tell people to like, it’s really hard for us to show up and be the therapist that we want to be if we’re feeling insecure about money ourselves.
Linzy [00:26:35] Yes, of course. Yes, 100%.
Kelley [00:26:39] So like, regardless of sliding scale, this also comes into like the question of do you take insurance? Are you on any tech platforms? Are you contracted with any fee? What do you call it, EAPs? Whenever you decide to take money for the services that you provide, being able to come at that from a place of financial security is really important because otherwise it seeps into the clinical work. And we received so many messages as therapists about being bad people or being, you know, to make money. But the reality is, we live in a world where we have to pay money for things. Like I go to the grocery store, just like anyone else. So, yeah, it’s a tricky conversation and it’s one that I get so much hate for on Instagram.
Linzy [00:27:18] Yeah, you were saying that off mic when we were talking, that you actually get like hate messages about this.
Kelley [00:27:23] Oh yeah, every single day. For me, you know, that’s part of being on Instagram. That’s part of facing some sort of public facing profile, right? Role situation.
Linzy [00:27:33] Yes.
Kelley [00:27:33] But what makes me more sad, I teach up at Pepperdine and I work a lot with grad students and it makes me sad that therapists get this message that, just because you’re in a helping profession, that you don’t deserve to make money. I tell my students, like, if you were a lawyer, no one would tell you that if you were a doctor, people don’t talk. Well, doctors sometimes get that message, but like, you know, we don’t say this to other professions, and yet we have this assumption that just because therapists are here to help people with mental health struggles, that they shouldn’t charge money for that. And unfortunately, especially here in the States, we don’t have a very good insurance system that’s helping therapists make a livable wage, and some do, some don’t. But I like to help people take the guilt out of it. And as a result of that, I get a lot of trolls.
Linzy [00:28:24] Yeah, right. Because I think there are people who do want therapists, women, people who have emotional skills, they want us to stay small. They want us to keep doing the work for free.
Kelley [00:28:36] Yes, literally. I posted this a few months, maybe a month ago. I was awake at four in the morning, I wrote this post out on my phone. It was just going to be like, it’s not a coincidence that therapy was so often considered women’s work, you know, anything – and there are amazing male therapists out there, and I wish we had more. And it’s not shocking to me that then, a job that was often considered a female job is also being told that you shouldn’t make money for that empathy and those skills that we have. And so I got tons of people being like, yes, yes, yes, right. And then I got a ton of like, I got a lot of men saying like, yes. And then I got a lot of guys saying like that, there’s no way this has to do with being female. I’m like, What do you mean? You know.
Linzy [00:29:22] Yes, you are thicker skinned than I am, I will say that. I don’t know how you deal with that all the time, because it’s true. When you are visible, you attract, you attract everybody, right? You get more of everything. You get more love and you get more trolls and more men telling you their opinions that you absolutely did not ask for. But I think you’re absolutely right and I think something that I have talked about before on this podcast and something I’ve thought about a lot is also how there’s often at the micro level, a personal repetition of a pattern on the individual level, right? Because often those of us who become therapists, we were always caretakers for our friends or family members, or maybe we were a parentified child, you know, and where we experienced trauma and we had no support, we had to just like keep it inside and take care of everybody else. And then we actually got these messages to stay that way, like, no, stay small. Don’t think that you’re allowed to have a vacation. Don’t think that you’re allowed to pay for your kid to go to college. Keep staying small, keep being helpful, don’t speak up, be good. And I’m so fucking over it, like.
Kelley [00:30:16] Oh my God, 100%. I just, I keep wanting to say, like, the world is a better place if therapists know their value. There’s plenty of other people out there in other professions that make tons of money that know that they are deeply valued and we are in a public mental health crisis. If we don’t value therapists and pay them what they deserve, they burnout and then they don’t – they’re not good therapists, number one, if they were burnt out. I’m not a good therapist when I’m burnt out. And then number two, then we don’t want – we don’t have therapists who are wanting to be therapists. We have a shortage of therapists here in Santa Barbara. I know my husband is a psychiatrist and his waiting list is a year long. He’s booking in 2023 and like because there’s just not enough service here. And he takes every insurance plan on the book, you know, I mean, like so I agree with you. I want more therapists to know that they deserve to make money.
Linzy [00:31:07] Yeah. And I will add to this conversation, there are also folks who can’t pay $150 or $200 an hour. That’s real, right. And you’ve talked about, like a very elegant solution today to take care of some of those folks within your practice, while not compromising your own financial security and well-being, right. But I think sometimes also as women or marginalized folks, we also take it onto ourselves to personally carry the failings of systems, right. That’s like a systems failure. It’s a systems failure, that like mental health is not covered by governments, right. And even in Canada, where I get coverage, like I can go to a hospital for free, you know, when I gave birth, it was free. Medical care is covered, but still it’s very hard to access free mental health because it’s like, you know, a doctor’s office will have like one social worker you can see once every two months, you know, and they’ll do CBT with you because that’s really all they can do. They can’t do any depth work at all, right. And so even here, it’s still a problem, even though we’re, you know, have a good health care system in so many ways. But like, I as an individual could not make up for like the failure of the state. Like, I can’t take that on and make my personal financial life imperiled to try to make up for something that is like a government issue and a nationwide issue. And I think that’s what we do, we try to carry it all on our shoulders.
Kelley [00:32:18] Yeah, we try to take it all on and I often will say to people, okay, so like here are other things you could do, right? Like, you could vote. First and foremost, you can vote for politicians that are supporting more mental health funding for nonprofits. You could write letters to insurance companies. Any time in your own personal life that you have claims denied for your own mental health services, advocating for yourself. I think that there’s a lot of things we can do to advocate for the system to change without sacrificing our own practices. And often I’ll say, like as therapists and as clients, in many ways we’re in it together. First of all, a lot of us are clients ourselves, therapists go to therapy. And I know for me, like affording my own therapists is not an easy expense. But I think when the system is not supporting the mental health needs of clients, what we have to realize, is it’s also affecting therapists. And in a way, we’re kind of in the same boat. The system is not doing good things for therapists, and it’s also not doing good things for clients. And so as a collective, we have to advocate and vote and write letters and do all those things to change the system as a whole, without sacrificing our own being. The same way that we don’t want clients to.
Linzy [00:33:32] Totally.
Kelley [00:33:32] It’s a tricky balance and it’s especially a tricky balance to talk about in any sort of public facing platform without people saying, What do you mean? I know tons of therapists that charge X amount per hour and it’s impossible to afford. And I agree with them, in many ways. But we don’t as therapists, have to necessarily fix the whole problem yet.
Linzy [00:33:53] And I don’t think we can as individuals, unfortunately. I think even if a half of our caseload was a sliding scale folks, paying us $15 an hour, we still wouldn’t solve the systemic issue. It’s systemic, systemic reform. We can have a whole other conversation about that. So thinking about then these difficult conversations, like let’s talk a little bit more about why these conversations are so hard and like some of the mistakes that we make because of it, like what are the mistakes that you see folks making or maybe that you’ve made yourself around these conversations, that we need to watch out for as therapists?
Kelley [00:34:25] That’s a really good question. You know, first of all, there’s so, so many. And I think obviously the biggest mistake is not holding your boundaries from the very beginning around your fee, you know, it’s like – it starts from that very first phone call. That would be one. One mistake I see people make is, let’s say they have some sort of policy around raising their fee, kind of like you said, like we have these stories in our head and then they’ll push it off and push it off and push it off, instead of making it a regular part of the emotional health of their practice. And then they’re in a position where four or five years down the road, they need to make a big jump. They’ve already kind of gotten in that status quo, like of raising or being where they need to be, but then they don’t raise their fee. I think making the mistake of doing it less often because you’re putting it off, I don’t know. I equate it with like not breaking up with someone when you know need to.
Linzy [00:35:16] The conversation should have happened like, a while ago.
Kelley [00:35:18] Yeah, I think that that’s a big one. I think one big one I see a lot is, the over explanation of your fees.
Linzy [00:35:24] Yes.
Kelley [00:35:25] So like, when you’re on call, someone says how much you cost and you say I cost $150 an hour. And then you’re like, but… and you immediately offer. It’s like they might not – you know, I think there’s so much power in the pause. I think, all of us like to fill the silence in many ways, and so stop filling the silence.
Linzy [00:35:44] I 100% agree with you. And I gave this, I give the same advice when I’m talking to my students about having these conversations. It’s like, say it and then stop talking. Stop talking. Because I think in that silence, a lot is happening for your client and you’re giving them time to process and respond, right. Your client or that prospective client on the phone, right. It’s like, if you don’t give them a chance to respond, they might have just been about to say, great, that sounds good. And instead you’re offering them a sliding scale. And so you don’t even get the chance to hear that. But I think also clinically, when it’s like a fee raise conversation, it’s like give them a chance to have a moment. Right?
Kelley [00:36:20] Yeah.
Linzy [00:36:21] Yeah, like we need to stop talking.
Kelley [00:36:22] Yeah, just stop. I think that’s one of the biggest ones. I’m trying to think, do you have any other ones? Do you see any common mistakes around money conversations? Probably a million.
Linzy [00:36:33] That I mean, that one up front, they offering sliding scale up front is huge. The overexplaining with fee raises is huge. And I’m also a fan too, of just like, this is a little different than what you had suggested earlier, in terms of working into your policy of why you raise fees. I’m also a fan of just like not explaining why you raise your fee. Folks can ask.
Kelley [00:36:50] Yeah, you can, like we do it once or whatever, you know.
Linzy [00:36:53] Yeah, it’s the same as any kind of boundary setting, right? Where it’s like you don’t owe an explanation. And I think there’s a lot of just like, power and groundedness – and I say power in like a, not in a power over, but in just like it’s a very solid thing to do to just say, I just wanted to let you know that as of January 15th, my fee will be $150 an hour.
Kelley [00:37:11] This is like, goes back to the sturdy leader thing.
Linzy [00:37:13] It’s sturdy, right? There’s nothing to say, right. And like, I remember when I raised my fee $40 once, I went from 110 to 150, that at the time was like my nail biter fee raise, right? I was like, I’m going to lose everybody. And of all of my clients, probably 25 people or something, I had this conversation with. Only one asked me why, and they were the most boundary pushing client that I had. They actually pushed my boundaries to a point that I actually had to fire them eventually. So it was like, it was interesting that the only person who pushed back and said, why? Was actually someone where there were boundary issues already and everyone else just accepted it, right. And then they made their decision. Nobody left immediately. And then the folks who did leave, it’s because they really, the work was really not that important anymore. You know, they were kind of in a coasting space as it was. But I think that, yeah, we don’t have to explain it.
Kelley [00:38:03] Totally and I mean, any time, any service professional raises their fee, I don’t ever think, I wonder why?
Linzy [00:38:11] Yeah, tell me why?
Kelley [00:38:11] My hairdresser raised her fee recently. I have my lawyer, I feel like I have all these people, you know mechanics, gyms. And granted, they’re all different but it’s like, yeah, I just expect it like once a year or once every so months or something, the fee will go up.
Linzy [00:38:28] And we are offering a service, just like everyone else. Like our life is getting more expensive, just like their lives are getting more expensive and we also need to raise our fees. So and then, I think, like when I think about it like that, like just that solidity of it, as like that sturdy leader analogy is great, right? That’s exactly what it is. And what I did notice when that one client did push back on me, is I actually had a really good explanation. I was like –
Kelley [00:38:48] Well, what was it? Now I want to know.
Linzy [00:38:50] Well I said, you know, at the time my response was, Well, I’m very specialized in complex trauma. The work that I do, actually almost nobody else in town is doing. And in order to do that, I actually have to do a lot of ongoing education and travel. I travel the United States twice a year for international conferences, which costs money and events. And I, you know, get the best training that I possibly can to be as effective as I can be in treating dissociation, which is a specialty that many people do not have. And when I said that, I’m like, damn, I should be charging for them.
Kelley [00:39:20] Yeah. Amen.
Linzy [00:39:21] Because that’s the thing too. I think, you know, when you are an effective therapist, we also have to think about like quality over quantity, right? Like folks can be paying you $50 more than the person down the road, but they’re going to see you for half the time, with twice the impact, right. So when you really do have a gift and you’ve honed in on your niche and you know that you were like literally changing lives, you don’t have to justify a fee raise. Like you are changing people’s lives in profound ways, that you can’t even understand because you don’t even get to see all the wins that they have, when they’re done working with you. I notice myself when I connect to that, then it’s like, Oh no, this work is immensely valuable.
Kelley [00:39:58] 100%. And I always say like, put yourself in the shoes of the client. Like if you said that to me, you know, and if I thought about that for my life, like, I could see somebody who’s extremely well trained, talented, really, really a professional and an expert at what they do. And I’m going to pay them X amount more, but I’m going to see them less in the long term. Of course, I’m going to choose that person.
Linzy [00:40:19] Yes. And people know what effective therapy feels like. You know, they’ve had therapists who are effective. And if they’re with you and if they love working with you, they know the difference of what you’re offering them. So I think that’s also part of it. Right, is like you need to trust that the work that you’re doing is impactful. And if it wasn’t impactful, they wouldn’t be there.
Kelley [00:40:34] Oh, 100%.
Linzy [00:40:35] So, Kelly, I feel like I, you know, we could talk forever about this, but if folks want more from you, where should they find you and follow you?
Kelley [00:40:44] Okay. So number one, you can follow me on Instagram and it’s @theprivatepracticepro. I have the same handle on Facebook, I have the same handle on Tik Tok, me and my 39 TikTok followers. And then also, I have a book coming out which is Scripts, all about these kind of difficult conversations for therapists. And so gosh, I think we have like 30 something of them, of all the different kind of nitty gritty conversations that you have to have to run a private practice. So you find that on – links to that on my Instagram. But you also could find that on my website, everything has the same handle, @theprivatepracticepro.
Linzy [00:41:23] Great, yeah. And we will put links to your Instagram and your website and that Scripts book as well, which is so valuable. I wish that I’d had a book like that when I started in practice. I feel like I had to construct these conversations myself and it’s always nice, as you say, to just have like, start here because then you can always modify a script, you can always make it yours. But it’s like you have somewhere to start, which is like such a groundbreaking thing to have. Oh, thank you so much, Kelley, for joining me today. It’s been wonderful talking with you.
Kelley [00:41:48] Oh, fun.
Linzy [00:42:03] It was so great having this conversation with Kelley and it definitely went in directions that I would not have anticipated. Got a little fiery there for a bit, but because I think these conversations on money are so important and the way that we present these conversations to our clients are important, and the way that we think about money and our own entitlement to have money, to recognize the value of the work that we do and recognize that it’s okay to be paid well for having an incredible gift that changes people’s lives. It’s just a bit of a passion point, for me. I think that resource she has around scripts is awesome. We will have the link for it in the show notes. So if you are either just starting out a practice or you find that you tend to get lost and find these conversations overwhelming, definitely check out Kelley’s package of scripts that she’s going to have available. Such a great starting point, I think she said there’s more than 30 scripts in there, so it sounds like a wonderful resource for, if nothing else, a jumping off point to think about how you want to have these conversations with your clients. And these conversations are so important, they really inform the way that money exists between us and our clients, you know, like whether it’s a thing in the room that we never talk about or whether it’s a space that your clients can actually start to have honest conversations around money and see boundaries around money modeled to them, because many of us have never had that either. So the way that we have these conversations don’t just benefit us, they also benefit our clients. If you want to hear more from me, you can follow me on Instagram @moneynutsandbolts. We are sharing free content on there all the time and as usual, if you’re enjoying the podcast, please take like 2 minutes to jump over to Apple Podcasts and leave us a review. It is the best way for other therapists and health practitioners to find me. Thanks for listening today.
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