Negotiating Sliding Scale

Negotiating Sliding Scale

Curt and Katie chat about the pros and cons of sliding your fee for therapy services. We look at the theories around fee-setting, sliding fee scales, and conversations around money. We discuss what actually makes a difference in determining if clients are invested and will benefit from your services. We also dig into the laws, ethics, and practicalities if you choose to offer sliding scale in your practice.

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.

In this episode we talk about:

  • Feedback from our conversation with Tiffany McLain
  • Clinical theories on how fee impacts the clinical relationship
  • The different ways that people enter into therapy, different financial situations, etc.
  • A more nuanced conversation about sliding scale fee
  • Freud’s views on having direct conversations with clients on fee
  • How clinical orientation can impact how therapists view fee-setting
  • The idea that fee must be set at an “uncomfortable enough” that clients invest in therapy
  • How fee paid impacts attending the last session
  • Different types of investments that might impact how much people benefit of treatment
  • Practical ways to assess what fee would be in the sweet spot for sliding scale (e.g., written out scale, financials, etc.)
  • Do therapists show up differently for clients who pay more or less?
  • How fees average out among larger caseloads
  • Incorporating outcome measures and practice-based evidence to assess whether you are showing up differently for clients who pay more or less
  • Mythology around what we have to do and what is best to do
  • Laws and ethics, practical considerations
  • Usual and Customary fees
  • Advertised fees
  • Philosophy related to how you set your fees
  • The impact of insurance on our profession related to sliding scale
  • Ethical codes on fee setting related to services provided and client ability to pay
  • Models of subsidy for mental health services
  • The need for a standard justification
  • The risks for insurance fraud related to fee-setting and accepting copays
  • The ability to adjust usual and customary fee as needed as long as it doesn’t violate state law
  • What we have to do and what the softer, virtue ethics might recommend
  • The importance of accurate billing and justification
  • The tension between the equity argument and the practicalities of business
  • Are you unfairly treating clients who are paying less?
  • The need for pro bono work, but not sliding scale work
  • The need for clinician-led discussions and opt-in from the client
  • Check your insurance contracts, advertise your fees correctly, written basis for a range of fees
  • Options for sliding scale
  • Other models for addressing access
  • How to create a sliding scale practically
  • Why you need to identify what you need to make on average per session
  • Moving your sliding scale or pro bono work outside of your practice
  • Our recommendations for Open Path Psychotherapy Collective and Give an Hour

Doing some math and making sure that you are making enough per session on average:

What’s Needed:

Required Annual Revenue (includes practice expenses, taxes, and required take home pay)


(Preferred number of Work Weeks per year)


(Number of Scheduled Sessions per week)


(Your typical Attendance Rate – usually 80 or 90%)

What you’re actually making on average per session:

Actual Revenue per month


Number of Actual Sessions per month

A Message from Therapy Reimagined:

Therapy Reimagined 2021 – The Modern Therapist Conference

Our Call for Sponsors is out!

We’re looking for right-match sponsors & exhibitors. We are seeking collaborative relationships that support the psychotherapist community. We commit to intensively engaging our audience with our valued sponsors and we love when our sponsors are actively involved in our conference.

Our conference attendees are:

  • #ModernTherapists who understand the value of business and technology
  • Ready to invest in themselves to launch (or scale) their small businesses
  • Building their networks of treatment providers
  • Hungry to engage in the resources in the psychotherapy community
  • Savvy with social media and have (or are in the process of building) an engaged online following
  • Marriage and Family Therapists, Social Workers, Counselors, Psychologists, and other mental health and wellness professionals

Learn more here:

Resources mentioned:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Articles mentioned:

Tiffany’s Fun with Fees Calculator

Alternatives to Sliding Scale within your own practice:

Open Path Collective

Our interview with Open Path

Give an Hour

Relevant Episodes:

Overcoming Your Poverty Mindset

Making Access More Affordable

Who gets to have therapy?

Antitrust for Therapists

In It For The Money?

Connect with us!

Our Facebook Group – The Modern Therapists Group

Get Notified About Therapy Reimagined 2021

Our consultation services:

The Fifty-Minute Hour

Who we are:

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at:

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also Past President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at:

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch:

Our Facebook Group – The Modern Therapist’s Group


Voice Over by DW McCann

Music by Crystal Grooms Mangano

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