In this Episode...

Roxanne [00:00:04] I say to people, take a look at what you need to earn over the course of the year. If people are coming to you asking for a sliding scale, you need to do the math ahead of time. How much of a reduction in fees will that be for you? How far are you willing to slide that scale? And set that limit and make it permanent. 

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. This week we have a conversation with Roxanne Francis. Roxanne Francis, as I mention at the start of our chat, is local to me. She is a Toronto-based, award-winning registered social worker and psychotherapist. She runs a group practice. She offers organizational workshops on lots of topics like race and equity, mental health and parenting. And she also supports and coaches and mentors a lot of other therapists in the field about starting a practice, everything that goes into that, and that is very much what we dug into today was her expertise in that area of mentoring so many other therapists. Roxanne and I talked about the biggest questions that therapists ask. You know, starting out their journey into private practice. We get into fees, sliding scale. And she talks about the biggest oversight that she sees therapists making as they are planning out their practice. It was a lovely conversation with and I’m really excited to share it with you. Here is Roxanne Francis. So Roxanne, welcome to the podcast. 

Roxanne [00:02:07] Thank you so much for having me Linzy, I’m really excited. 

Linzy [00:02:10] Yeah, I’m excited too. We were just saying – off mic – I was just saying that I’m excited to finally have you on because you are- I mean, to me, you are local-ish. You are Toronto-based. 

Roxanne [00:02:20] Yes yes. 

Linzy [00:02:20] I mean, we take what we can get on the Internet, right? You’re only like an hour and a half or maybe an hour drive from me. I go to Toronto to the aquarium sometimes with my toddler. 

Roxanne [00:02:28] Oh, awesome. 

Linzy [00:02:29] Very close. And your focus and your- part of your niche, because you do a lot of things. You’re a woman of several hats. 

Roxanne [00:02:37] Yes. 

Linzy [00:02:38] But you you supervise a lot of therapists. 

Roxanne [00:02:40] Yes. Yes, I do. So I have certification in clinical supervision. And so I mentor a handful of therapists, but I also run group supervision programs. And I also do individual supervision with a handful of people. I coach therapists who are new to the private practice space or who are turning their private practice from part-time to full-time. And I also supervise placement students through the University of Toronto, so I kind of liaise between the classroom and their placement location, making sure about, you know, all of their practicum needs are met and that they’re managing their practicum well. 

Linzy [00:03:22] Mm hmm. That’s like, such an impactful kind of role or multiple roles there that you play. 

Roxanne [00:03:26] Yeah. Yeah, I enjoy it. I mean, it’s multiple, but I find that it’s more or less some of the same work. 

Linzy [00:03:32] Sure. 

Roxanne [00:03:33] And it’s important to me because I find that when I was in grad school, you know, and they spread out these new clinicians, there were still a lot of questions in the how of doing the work. And so a lot of people who are new to the field or who are new to private practice have a lot of those questions and they’re not sure where to turn. So I’m happy to to provide that. 

Linzy [00:03:54] Absolutely. Yeah. I remember just how hungry I was for that kind of like mentorship and support when I was like, you know, brand new in private practice. And I was basically like kind of a brand new therapist and brand new in private practice at almost the same time. It’s like I practiced for, I think, just a year before I went to private practice. So I remember being on the other side of those kinds of relationships. So I’m curious, with all of this support and all these conversations that you’ve had with all these therapists, what is the biggest question you find that they ask over and over again? 

Roxanne [00:04:26] Yeah, it’s usually a money question. As we’re here on this podcast. It’s usually about, you know, what should I set my fees at? Right. To me, it’s such a simple question, but again I’ve been in the field for a little bit, but people will say, you know, you know, I’m new to the field. I’m not sure if I should charge this much. Or everybody else on this directory is charging this fee. I guess I should charge that as well. Or, you know, I’m a registered psychotherapist as opposed to a registered social worker. Maybe my fee should be different. Or I’ve been working at agency and I’ve never had a private practice, so maybe I should start at the bottom. And so there are all these discrepancies and misnomers about what I should charge. And I’m always telling people, first of all, think about your experience, think about your education, think about the transformation that you’re providing to people, right? I also walk them through, you know, how many weeks are you going to be working throughout the year if you are leaving a full-time job, an agency job, to get into this private practice work? You know, are you looking to replace that income? Are you looking to only make a percentage of that income? 

Linzy [00:05:32] Right. 

Roxanne [00:05:32] And so then if you plan that out over the course of the year, how many months are you going to be working? How many days per week are you going to be working? What do your bills and expenses look like? Right. And sometimes people will add up, you know, rent, car payment, electricity bill, phone bill, and then they’ll come up with this much. And then I will say, well, do you plan on eating? Do you plan on going to brunch with your girls every once in a while? You need to live. Right. And so what do those things add up to? And then let’s compare those numbers and then we can talk about what that will look like in terms of a feasible fee for you. Right. Oftentimes, people just pluck a number out of the air and say, well, everyone else is charging that, so maybe I should charge that, too. 

Linzy [00:06:17] Yes. 

Roxanne [00:06:18] You have to look at your lifestyle. And is it- is the math going to be mathing? Is it going to be adding up? 

Linzy [00:06:23] The math needs to math. It does. Yeah. And what I love and what I hear in that is even if you’re X, Y, Z, even if you’re new, even if you’re this, even if you’re that, you still need to live your life and be okay. 

Roxanne [00:06:35] Right. 

Linzy [00:06:36] Right. Because, like, almost sometimes I wonder if there is this bit of this ethos that we, you know, that’s ingrained in us as like New X, Y, Z. 

Roxanne [00:06:45] Yes! 

Linzy [00:06:45] You know, whatever your field is, that you need to pay your dues and like you’re supposed to suffer at first. 

Roxanne [00:06:50] Exactly. 

Linzy [00:06:51] You know, you’re not thinking about brunch with your friends because you’re like, well, I’m I’m not supposed to do well at first. Do you feel like that might be in there? 

Roxanne [00:06:58] Yes, I find that all the time. And as recent as last week, I said to someone – and I will put a disclaimer: no shade to dentists – but when you go to the dentist’s office and you have whatever procedure. We don’t say, well, has a dentist been in the school for 20 years or did they just graduate last year? When you go to the front desk and they tell you what the huge price is without, you know, without batting an eyelid and they’re smiling. We pay the amount and we just leave. But when it comes to our profession, we tend to ask ourselves: Mmm.. Only been in the field for a year, maybe I shouldn’t charge that much. You know – what you know is what you know – and the transformation that you provide is a transformation that you provide. And we’ve been in school for a really long time. 

Linzy [00:07:41] Yes. 

Roxanne [00:07:41] And we would not be doing this work unless we had a certain baseline of knowledge. And that knowledge has tremendous value. And so we have to charge the fee that is appropriate for you. We have to charge what we’re worth. And someone in the field for ten years and someone in the field for two years. Their value isn’t you know, there isn’t a huge difference in. Right. So we have to be mindful. 

Linzy [00:08:07] Absolutely. Yeah. Like that kind of earning your due narrative has a lot of holes in it or problems. 

Roxanne [00:08:13] Oh lots of holes. 

Linzy [00:08:14] And something that I’ve thought about before and I think I even observe this in myself is like when you’re a new therapist, you might not have five years of experience, but you’re fresh. You’re remarkably not burnt out. When you meet somebody, they’re new and you see them as a new thing rather than like, Oh, this is my 60th person with depression that I treated, right? Like, I think I, you know, I think in certain ways, you know, we do become better over time. But in other ways we don’t. Right. Like, it’s not a guarantee that you actually become a more effective clinician over time. Many people become less effective over time. Right. Yeah. And that’s something that I would always notice. This was actually one of my reasons for retiring from therapy at this time is I started to notice, like going to conferences, you know, with people who are working in my niche. And I see people were in the field for like 40 years and I’m like, oh dear. 

Roxanne [00:09:04] Gosh. 

Linzy [00:09:05] First of all, I don’t want your life. Secondly, you seem really like kind of like numb and like very blasé about like ritual abuse. That’s not a great like response to have to something so horrific. But you know, we become kind of vicariously traumatized in our own ways or we numb out to certain things to cope, right. You know, as part of kind of the occupational hazards of what we do. And that doesn’t necessarily make you a better clinician decades in. So longer is not always better. Yeah. 

Roxanne [00:09:35] You’re so right. 

Linzy [00:09:36] So, I mean, thinking about fees, like something that I know I grappled with when I was actively practicing and that I see students grapple with all the time in Money Skills For Therapists and you know, in every therapist Facebook group under the sun, is balancing what we just talked about, that fee you need to live – that like cold, hard math – with like wanting to be accessible and wanting to serve and wanting to have a sliding scale. So I’m curious, like in your perspective, can these things coexist? 

Roxanne [00:10:04] Yes, I do believe they can. And, you know, as someone who used to work in agency myself, I see the need. Right. And there are people who desperately need therapy and they can’t afford the big dollars. And there’s this creation of the haves and the have-nots and who can get therapy and who can’t. Right. And so I understand the need to- wanting to create a sliding scale. And again, I can’t tell everybody what to do, but- or anyone what to do, really, but I say to people, take a look at what you need to earn over the course of the year. If people are coming to you asking for a sliding scale, you need to do the math ahead of time. How much of a reduction in fee will that be for you? Right. How far are you willing to slide that scale? And set that limit. And make it permanent. Right. But also to ask yourself, can I see this person ongoing at this fee or is it I can see one person sliding to this point for eight sessions and then that’s it. Right. Or am I going to have one pro bono client for four sessions and then that’s it, you know, or maybe three pro bono clients for the year. Then set yourself a certain number of sliding scale clients, then set how far you’re willing to slide that scale. And then work that into your math of how much money you need to live for the year. 

Linzy [00:11:27] Right. 

Roxanne [00:11:27] Right. Otherwise, we find ourselves in a situation where we’re giving our services away because we’ve got this giant, giant, bleeding heart. 

Linzy [00:11:35] Yes, we do. 

Roxanne [00:11:36] And then we can’t afford to, I don’t know, buy shoes for our children or put food in our fridge. 

Linzy [00:11:41] Yeah. Yeah. That piece about, like that bound- the boundaries and clarity, right? It’s like, absolutely. Do it. But be clear on, like, what you can do, how long you’re willing to do it, and having that clarity. Cause I think when, when we go in and you have one person at $50, so then the next person calls and you give them $50. And what I found, you know, this happened to me when I started my practice. This is one of the things when new clinicians in Money Skills ask me. Like, What is the thing- what’s the mistake I should not make that I’m probably making right now? This is one of the things I talk about is like, yeah, you’ve got to be super clear on sliding scale from the start because I think also at first that we want to be accessible and that like, you know, bleeding heart but also, you know, social justice values and all of these that also can collide with our desperation and fear that we’re not going to fill our practice. 

Roxanne [00:12:28] Exactly. 

Linzy [00:12:28] You know, I remember at first making the joke, like, I was almost like going around like, will you be my client, will you be my client, begging everybody, I’m making a begging motion which people can’t see because it’s a podcast, but these things can combine and then suddenly, you know, you’ve made this commitment to all these people because you haven’t put limits on it, right? Because that’s part of it, too, is what I’m hearing is like have that clear conversation up front of this is the timeline of what we’re doing so that you’re setting appropriate expectations because that’s also like clinically appropriate. To make sure you’re being clear about, you know, the- what your work together is going to look like. 

Roxanne [00:12:59] Definitely, definitely. Set your quota. Stick to it. 

Linzy [00:13:02] Yes. Because something that occurs to me sometimes too- and I’ve heard people say this in different ways, but I just read an article today in The Globe and Mail, one of our Canadian national newspapers, about a woman in Ottawa who’s a single mom. She has a daughter with autism. She bought a building like I think it was like half of a duplex for her first rental property. And the tenants refuse to pay rent and they’re refusing to vacate. She was a financial advisor, so because her credit started to suffer, she lost her designation as a financial advisor and like can’t get into this building, can’t get people out of this building. And something that she wrote in there that I think – it’s very extreme her situation, but I think it also relates to a therapist is like she was like, I can’t afford to take care of these people. Right. Like, and you know, when we are sliding our scales, we’re making a conscious decision to say like, this is what I generally need, but I can help these people in this way by being clear about what you can do, because there are people who do sit on millions or billions and they could actually afford to have somebody living in their property not paying rent for a long time, and it wouldn’t impact them. This woman, it’s like literally destroying her life. Other extreme. And so for us, it’s like, what will be the impact of this for you and how long can you support this impact? Because we are kind of making this trade of we’re kind of giving them that money back rather than it coming home to our families. 

Roxanne [00:14:18] And, you know, what I also find is that there are some clinicians who I talk to who do not have a sliding scale, but what they do is they might have a very active social media presence, and so they might share general mental health tips and strategies they have. They’re very busy with, you know, email newsletters that go out, that share ‘these are some things that you can do when you have anxiety’, you know, this does not replace therapy, but here are some tips. Right. And so, you know, they leave what I like to call breadcrumbs that people can pick up if you can’t necessarily afford therapy at this time. Right. So, you know, if you have a sliding scale or if you don’t, there are still ways that we can try to do what we can to be, you know, quote-unquote, socially responsible or to offer support to the community. 

Linzy [00:15:03] Mm hmm. Yeah. I love that perspective, because that’s even still within your same brand. Like I’ve heard folks, too, talk about the idea of like volunteer, like be engaged in your community in other ways, right? Right. Yeah. What I’m hearing is even under your, you know, your therapy brand and within that, however you do, you can be helping people for free in other ways besides your one-on-one time, right? So working with all these therapists, as you do, I’m curious, what do you find people usually like overlook or forget when it comes to setting themselves up? 

Roxanne [00:15:33] Well, yeah, I find that I have a day where I sit with therapists as they’re trying to build out their practice. And one of the things that they often forget to point out is that they are going to be taking time off. Right. Or there might be a time when they might need to take some sick time away from the practice for whatever reason, as they’re setting their fee or planning, you know, the income that they expect to make, they are forgetting that they will need income during the time that they’re on vacation. Or they will need income when they are ill or when they’re taking sick time. Right. It’s really important that you factor those things in because you will need to eat when you’re on vacation. Your bills will still come when you’re on vacation. 

Linzy [00:16:17] They will. Even if you’re not home. 

Roxanne [00:16:19] Even if you’re not- and you’re expected to pay it, right? Even if you- let’s say you have to have surgery and you’re on a bit of a short-term leave, those bills will still come. I find that therapists will plan for things like maternity leave or parental leave, but they don’t plan for when they’re taking a vacation. And so you have to build that in as you’re trying to add up, you know, how much am I going to be making for the year or for the month? We need to factor that in. And so you will need to also think about that when you’re planning to set your fee as well. 

Linzy [00:16:50] Right. 

Roxanne [00:16:51] Same thing for if you expect to see a certain number of clients per week. But you know, three people no-show or they cancel within, you know, within reason and you can’t get those filled. You know, we need to factor some of those things in as well. 

Linzy [00:17:05] Totally. 

Roxanne [00:17:06] Otherwise, you set yourself up for, you know, financial uncertainty. 

Linzy [00:17:12] For sure. Yeah. And I find, like, if we’re not thoughtful like that, if we don’t think about, like, wait, what does life actually look like? Right? That’s where you can come up with magical numbers, right? Like the math can look beautiful. You’re like, okay, I’m going to see 20 clients a week and I charge 175. I’m going to work, you know, obviously, I’m working 52 weeks a year and I’m going to make a bazillion dollars. Exactly. But, yeah, that’s not how life works. And, you know, I’m curious, why do you think therapists don’t think about this? Like, what is it about a therapist as a type or as a profession that we’re not thinking about our vacation time, our sick time, when we’re planning out our futures. 

Roxanne [00:17:45] We just don’t think of ourselves. I think we, many of us who are in this field, we live this life of service, of taking care of other people, making sure other people are well. We put ourselves last. Right. We live this life where we just don’t consider ourselves. We put ourselves last. We take care of other people first, and then we wind up not planning for vacation. We wind up burnt out. We wind up ill. Right. And I also say to people, pay attention to if you’ve been a therapist for a year or two, think about, let’s say last year, when did you feel most burnt out? Maybe that’s the time you need to take vacation. Maybe that’s- as you’re planning for the next year, maybe that’s the time when you’ll need to take vacation, when you will now need to plan financially. I’m going to be off for two or three weeks this season. How can I ensure that I will have enough money for when I’m on vacation? Or there are certain seasons throughout this sort of therapy life cycle throughout the year that are not as lucrative where clients don’t come in as much. So you will need to- what will they need to put in place? Think that season. Is that what I take vacation? Is that when I run a group session? A group offering? Is that when I offer a webinar? And then you can start to supplement that income or think to yourself, okay, now it’s time for me to take vacation, but I will still need to eat, pay bills, do all these things during that season. 

Linzy [00:19:09] Absolutely. And I think, you know, that’s really helpful to think about zooming out on that. Like, I know something that I did this year, which I’ve never done before, is I took off a lot of time during the summer because I think I had this story that I don’t like summer because I do- I get really hot, I’m really pale, I’m easily sunburned, I get sunstroke. Like, I’m like kind of not maybe for, you know, hot Ontario summer. But at the same time, what I had found is a couple of years in a row, it’s like the summer goes by and it’s fall. And I’m like, Oh, man, summer’s over. Like, you know, I can’t go to the beach anymore. I can’t go for a nice hike. And so I realized that I was ending my summers with, like, regrets, that I hadn’t really taken the time to enjoy it. And as you say too, in the therapy world, often our clients are away the summer. So something else that comes up for me is like you don’t want to feel regret, like resentful because your clients are off doing fun stuff and you’re like sitting in your office being like, Doesn’t anybody want to talk to me about hard things? And so yeah, it’s also like that. Like think about, you know, like what are those kinds of trends because that can really inform. And something that, that I did this year, which I found immensely helpful, is I plan my vacation the year out. 

Roxanne [00:20:11] Yes! 

Linzy [00:20:12] So not not when it’s right like on the cusp, not when I’ve already accidentally booked something into that week I was thinking about taking off, but make that the default. Yes. And then I actually have to cancel vacation time you know, rather than try to fit it in later. That worked really well. I was really pleased with the results but yeah, I think you’re you’re absolutely right. It’s that like life of service piece and I think functionally when we build a business that basically financially doesn’t work unless we are working all the time because we haven’t paid for that time off. You do end up having to work all the time, right? Because you literally can’t afford to take time off. 

Roxanne [00:20:44] You can’t afford to take time off. 

Linzy [00:20:45] And then you’re going to get into that like worn down, possibly resentful. 

Roxanne [00:20:50] Exactly. And then, you’re no help to your clients and they don’t come back! 

Linzy [00:20:53] And you’re not living like the life that your clients think you are. 

Roxanne [00:20:57] Right? Exactly. Exactly. 

Linzy [00:21:00] Well, Roxanne, it’s been so lovely having you on the podcast today. 

Roxanne [00:21:04] Oh, it’s been great. 

Linzy [00:21:05] If folks want to find you and follow you, where’s the best social media place for them to connect with you? 

Roxanne [00:21:12] Yes, I hang out a lot on Instagram. You can find me @francispsychotherapy. You can also find me on Twitter sometimes @FrancisTherapy. You can just search my name on LinkedIn. But yeah, I’m happy to connect with individuals if they want to hang out with me. If they want to chat slide into my DMS, I’m always here. 

Linzy [00:21:29] Yeah. Wonderful. Thank you so much, Roxanne. It’s been wonderful talking with you always. 

Roxanne [00:21:33] It’s been my pleasure, Linzy. It’s wonderful to talk about this stuff. It’s my joy to pour into therapists and if therapists are out there wanting to build out their part-time private practice into a full-time private practice, I run a therapy day just for that, so people can just slide into my DMs or hit me up if they wanted to go on the waitlist for that. 

Linzy [00:21:51] Awesome. Thank you. I think that Roxanne’s point about therapists kind of living lives of service is a really good one when that is kind of our general ethos. That’s what we’ve maybe been raised to do. You know, even from a young age, always taking care of others. And then we go through professional training that just encourages that. Agencies that foster that. And then you get out on your own and what are you used to doing? But just serving others all the time and thinking about their needs. But as she pointed out, if we don’t think about things like our vacation time and our sick time, if we don’t plan those things, then we end up with practices that don’t work or we end up, you know, trying to skip being sick and skip taking vacation because we desperately need the money. So just thinking about yourself as a whole human who has needs as you’re setting up your practice or if you find you already have a practice that isn’t working, that’s something to think about, is have I actually worked in my real needs financially, energetically into my practice and my practice is taking care of me as a full person, not just my kind of like my maximum productivity version of myself, but me as I actually am. If we are not thinking of that, then we end up making practices that really don’t take care of us and actually can be quite harmful to us. So wonderful thoughts and insights from Roxanne today. If you want more from me, you can follow me on Instagram @moneynutsandbolts. We share practical and emotional focused money content on there all the time, and if you’re enjoying the podcast, please jump over to Apple Podcasts and leave a review. It is the best way for other therapists to find the podcast. Thanks for listening today.