Overcoming Your Poverty Mindset, An Interview with Tiffany McLain, LMFT
An interview with Tiffany McLain about how therapists deserve to make a good living and often do not. Curt and Katie interview Tiffany regarding her perspectives related to how sliding scale fees can perpetuate racist and classist systems, the problem with therapists sacrificing themselves and acting as saviors, and the impact you can make if you amass wealth and seek luxury.
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.
Click here to scroll to the podcast transcript.Transcript
Interview with Tiffany McLain, LMFT
Tiffany McLain, LMFT is a therapist & consultant whose mantra is, “Full fees are the new black.” Via her program, The Lean In. MAKE BANK. Academy, she helps therapists ethically earn 30 to 50% more per month while seeing fewer clients by showing them how to think about and directly address fees in a clinically appropriate manner.
In this episode we talk about poverty mindset:
- Tiffany’s Lean In Make Bank Academy
- How current events are impacting therapists making money
“Most therapists in private practice are conflicted about the fact that they earn money for providing therapy. And this internal conflict is only heightened at a time like COVID when people are suffering.” — Tiffany McLain, LMFT
- The belief system that we are hurting clients by charging them
- Why therapists are so susceptible to these messages
- How women and minorities are external reinforced to sacrifice ourselves
- The stigma of building wealth, living life more fully, seeking luxury
- Grappling with raising fees, with people needing help
- The internal dialogue that comes in when trying to raise fees
- How luxury has been sustained on the backs of others
- The misguided attempt to fix the system through self-sacrifice
- What the cost is when you self-sacrificing
- The problem with Saviorism
- How a sliding scale can encourage racism and classism
- Negating self-efficacy and fostering dependency, through lowering our fees
- Sliding scale = subsidizing our client’s treatment
- Tiffany’s experience with a sliding scale therapist
- How gratitude for a therapist sliding their fee can lead to clients hiding themselves, not fully showing up or engaging in treatment effectively
- The value issue related to people asking for a sliding fee or balking at paying the full fee
- How these issues may come in at the beginning of a therapist’s career
- Talking about your fee as a clinical intervention
- Unconscious dynamics that keep us from acting on what we know re: setting fees and money
- Money is a representation of the therapist’s need and desire
- Processing emotional reactions to fee changes with clients. For example: “When I raise my fees, it hurts you” without collapsing, lowering the fee, or losing boundaries
- The challenge of looking at financial capacity for individuals
- The idea that we do not have to take care of individuals who cannot afford our fee in order to create access – and ideas of how we can increase impact once we’ve had the ability to create financial stability and wealth
“It’s your responsibility to use those resources to make a bigger impact, and on that biggest impact involves luxury for you. Because you’re modeling what it means to be a woman, a person of color in the world taking care of themselves and saying, we deserve to take care of ourselves, too.” — Tiffany McLain, LMFT
- The benefit to society of women gaining wealth, with the ability to make a bigger impact
- The importance of setting your fee appropriately from the beginning
A Message From Therapy Reimagined:
Therapy Reimagined 2021 – The Modern Therapist Conference
Therapy Reimagined 2021 will be held virtually again this year September 23-25th! We are looking for fresh, diverse voices to speak on topics that often aren’t covered in grad school or in other continuing education platforms.
Our learning tracks:
- Business and Technology
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- Ways of Doing (focused on innovative treatment and populations who are often ignored by our profession).
- Misfits, Outliers, Subversives, and Skeptics: Challenging the Status Quo
APPLICATIONS ARE DUE FEBRUARY 15TH
Learn more here: https://therapyreimaginedconference.com/become-a-speaker/
Resources for Modern Therapists mentioned in this Podcast Episode:
We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may 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!
http://www.heytiffany.com/workshop
Tiffany’s Fun with Fee Calculators
Relevant Episodes of MTSG Podcast:
Who we are:
Curt Widhalm, LMFT
Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, 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: http://www.curtwidhalm.com
Katie Vernoy, LMFT
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. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com
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 with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:
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Modern Therapist’s Survival Guide Creative Credits:
Voice Over by DW McCann https://www.facebook.com/McCannDW
Music by Crystal Grooms Mangano https://groomsymusic.com
Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):
Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).
… 0:00
(Opening Advertisement)
Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.
Curt Widhalm 0:16
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. I’m Curt Widhalm, with Katie Vernoy. And this is the podcast with all of the things that deal with therapists and their lives. And we are joined once again by one of our favorite guests, Tiffany McLain. over at Hey Tiffany and talks about all kinds of things money, and she is back. We’re super excited to have her. For the longest time, the longest time, Tiffany’s first episode with us was our most downloaded ever, and that was like, within our first year of podcasting. And, and you know, we’ve been out here for a couple of years more like, you know, Tiffany, come back, let’s see if you can reclaim your record.
Katie Vernoy 1:00
No pressure.
Curt Widhalm 1:01
No pressure.
Tiffany McLain 1:02
Who beat me? Who was that person is what I want to know?
Curt Widhalm 1:07
I think it was our episode about millennials as therapists.
Katie Vernoy 1:11
It was us. It was…
Curt Widhalm 1:13
It was…
Tiffany McLain 1:14
It was you. Then I’ll give you a pass.
Curt Widhalm 1:17
But for people who haven’t gone through all of our archives and listened to all the way back before, can you introduce yourself and let our newer listeners know who you are and what you are putting out into the world?
Tiffany McLain 1:30
Yes, and if you if you if you are a new listener, welcome. My name is Tiffany as Curt said, I have a website HeyTiffany.com. And I am the founder of the Lean In Make Bank. That’s Lean In Make Bank Academy where our goal is to help all therapists ethically earn at least 30 to 50% more per month, while seeing fewer clients, by learning to address and think about fees in a clinically appropriate manner. That’s what we want to do. That’s what we’re about.
Katie Vernoy 2:01
So we’ve moved this question further up in our conversation, because I think it’s so enlightening, and it provides great learning. So what have therapists been getting wrong, related to money during these truly extraordinary times?
Tiffany McLain 2:20
Yes. I mean, there are a lot of things going on right now, as we know, the Black Lives Matter movement is gaining ground in a way it never has before. The political scene is insane. It’s chaotic. At the time, we’re recording this Biden just won the presidency, in theory, he won. But, you know, things are just politically things are insane. But because of COVID in 2020, therapist automatically jump to, and therapists have said this to me, if there was any time not to address my fees, or even this goes as far as respecting my cancellation policy, and I use that language intentionally, I could say, not enforce my cancellation policy, but I typically will say there’s any time not to respect my cancellation policy, it’s right now during COVID. And this statement goes right to the heart of one of the most troubling misconceptions therapists have about charging in private practice. Which is charging for therapy is hurting my clients. Charging my clients money for therapy is fundamentally wrong. This is at the core of therapists belief system, and we wiggle out of it by saying like, Oh, I’ll just lower my fees or take insurance and that relieves some of their anxiety. But at the in truth, most, most therapists in private practice are conflicted about the fact that they earn money for providing therapy. And this internal conflict is only heightened at a time like COVID when people are suffering, and the suffering heightens the therapists internal conflict about Oh my gosh, charging for the work I do, fundamentally, is hurting people.
Curt Widhalm 3:52
This seems like a super challenging thing, because over the last, you know, 8-9-10 months, by the time that this episode airs, we have as a field been inundated with a lot of people are struggling, more and more people across the country are struggling with anxiety and depression. This is what we have trained our entire careers to be able to do. And we want to go out and we want to help people. And you’re saying for a fee?
Tiffany McLain 4:22
Yes. Yeah. And it makes me think so, when you say that Curt, even I hear in your voice, what is behind the for fee? What’s the anxiety about saying people are so depressed, people are literally dying, loved ones are dying, the political system is insane. And we want to help people for a fee. What does that part imply?
Curt Widhalm 4:44
Well, I’m coming at it from your side. I wrote…
Tiffany McLain 4:47
I know you are. I know you.
Curt Widhalm 4:49
And I predicted this at the beginning of the pandemic. I had written a blog, we had we had done one of our now most popular episodes on this gaslighting of the profession that we should charge less. Because, because everybody’s a need, and therapists are supposed to be nice. And we’re supposed to also have this respect for ourselves and all of this investment that we’ve made into ourselves, in our career to get here, that any other profession, if it’s your time to shine, if you’re an athlete, you’re gonna go and you’re gonna want your contract. If you’re a contractor, you’re gonna go out and you’re gonna want the most that you can command. Why are therapists so susceptible to I’m, I’m trained for this, I’m here to do this. Let me give away this for something at the cost of myself.
Tiffany McLain 5:39
Yeah, oh, my gosh, there are so many reasons. And I work primarily, you know, with women and minorities. And so there were a lot of, and we talked about this at Therapy Reimagined a couple years back, amazing conference, folks. There are a lot of external reinforcements for women, minorities, we should sacrifice ourselves, we should help people out of the goodness of our hearts, our desire should be to make other people’s lives better, and any other desire, like financial security. And I’ll even say beyond financial security, but building wealth, if that’s a desire of yours, if you simply want more time, in order to enjoy your life fully and live, if that’s a desire of yours, that’s not requiring you to sacrifice yourself. Those things are pegged by society historically, for women and minorities as greedy, selfish, and you really ought to be ashamed for the desire to live your life more fully, and to be able to step into enjoying your life more fully.
Katie Vernoy 6:37
It’s interesting, because I’m, I’m one of these people that is struggling with this because I don’t have a lot of debt. I’m very fortunate. And I, I am, I’ve been able to create a good life for myself and the pandemic hit. And although I do have a fee, that is, on the higher end in my area, I found myself wanting to slide my scale, I do take some insurance, I have a value of about access. And I can afford to do that in a portion of my practice. And so I did that. But then I took too many insurance and too many insurance clients. Like I recognize that for me, all of the things that I was grappling with, at the very beginning of my career, especially in private practice, came to the surface because I felt I have a job, I actually started making more money right when the pandemic hit because more of my clients came in, and I wasn’t traveling. So for me, it was like, I haven’t good. I was going to raise my fee. I guess I won’t now. I was able to do what I needed to do I make a fine living, I’m okay. But I know that in order to actually do the things that I really want, which is having more time, working less, you know, saving a little bit more for retirement, helping my husband and I retire earlier, like all of the things that are like they feel very luxurious.
Tiffany McLain 8:02
Yeah.
Katie Vernoy 8:03
I was like, I don’t need to do that now. And I respect half of that decision, but I also am feeling burned out now. And so I’m recognizing like, oh, okay, like, I actually really need to look at it. And so I’m, I’m, I’m gonna put it out there, I’m grappling with this of like, hey, I can help, I’ve got the skills. And there’s a lot of people who need my help. And I don’t want to make myself inaccessible to those folks by either raising my fee or charging my full fee. And it’s, it’s hard. And I’ve seen this all over the Facebook groups where people are like, I’m gonna do this. And then everybody’s like, this is the hardest time to do this. Why would you put the strain on people when they need our help? And, and I kind of, I see both sides of that. I see that the ability to support people during this really hard time when there’s a lot of people who are unemployed and grappling with where they spend their money. And I also see the negative impact on our field, if all of us start lowering our fees, while we actually have an opportunity to demonstrate the benefit of what we do, and increase the stature of our profession. So, so help.
Tiffany McLain 9:14
Yeah, I’m glad you bring it up. I’m so glad you bring it up. And I’m so glad you’re sharing your personal experience because like you said, so many therapists have the same internal dialogue, although many of them don’t even acknowledge the burnout side. They might feel it, but they’re trying to just keep going. So you’re willing to say, I want to give back and I’m feeling the effects. So, thank you. I wish I was taking notes. I wish we had three hours to talk about this. A couple of things that came to mind: I’m so glad you said it feels like a luxury. Oh, almost like one of our core values in the company and I added this within the past few months is luxuriate and I require myself and I got to do it this week. I require myself and all our team members to do one thing to luxuriate each week. And then they have to brag about it. So again, women or minorities, therapists, we have been told you don’t deserve to luxuriate. Those people get luxury, those people get luxury. We don’t get that. So for me, I’m like, what does it mean that we don’t even we say, luxury and feel guilty for the idea of luxuriating?
Katie Vernoy 10:18
Yeah.
Tiffany McLain 10:18
That’s the first thing that comes to mind. A second thing, and this is interesting that my mind went here, psychoanalytic unconscious shit. You were talking about the desire to, you know, really make an impact right now and take on, you know, maybe lower fee, take on more insurance clients, because you really want to make an impact. My mind went to slavery, for whatever reason, in which a society experienced my secret space, what are you talking about, society experienced wealth, and go back going back to the idea of luxury on the backs of…it wasn’t actually a it wasn’t a system that was sustainable, it was only sustainable as long as we’re having people sacrifice themselves and slaved to make the lives of others better. So when I see you saying, Okay, I’ll lower my fees, I’ll get all my insurance, there was a way that you are expecting yourself to do the work of a larger society, something that should be done more equally, and that actually can be done sustainably, and ethically by one person during a pandemic. Meanwhile, the whole fucking I can I swear on this show?
Katie Vernoy 11:24
Yes.
Curt Widhalm 11:25
It’s the internet, go ahead.
Tiffany McLain 11:26
The whole political system, Trump is not addressing COVID at all, and you are trying to make up for it by sliding your fee. It’s um, it’s a misguided attempt to help that’s not actually taking into account the limitations of your ability to impact this larger system that’s fucked up.
Curt Widhalm 11:44
Isn’t that just like imperialism, but at like a smaller scale level, though?
Tiffany McLain 11:51
Say more.
Curt Widhalm 11:53
Well, I mean, if, if this is, you know, us, you know, not doing this for the big system of the things that are outside of our control. But if we’re passing on, you know, taking advantage of the situation to put ourselves in that luxurious one up position, you know, I, I teach at a couple grad schools, I supervise a lot, I hear from people really entering into the field, bright eyed, bushy tailed, haven’t been chewed up and burnt out by the system yet saying, I want to go out and I want to help make people’s lives better. And if I have too high of a fee, then they’re not going to be able to do that. Why take care of me first?
Tiffany McLain 12:29
As if it is a, as if it’s a zero sum game. You know, we all know that I hate saying this, because it’s so cliche now, but putting our masks on first before offering assistance. So when I hear Katie, when I hear you talking about I can do all of this, I my bills are paid, we were taken care of I don’t I’m not in debt, I can do it. What’s the problem? That the my question goes to you can do it, but at what cost? Truly, at what cost? And some people say, Well, I have enough money, I just don’t have enough time. And for me, especially now that I have my kiddo. Money is the only only objective of money is to give myself more time with the people I love, and to be of service in the world. So if we’re saying I make enough money, but I just don’t have enough time, what kind of trade off is that? What kind of trade off is it?
… 13:15
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Katie Vernoy 13:15
And I think the hard part for me is I know this. I know these things, and I still found myself falling into it. And I’m working really hard. And I have an outgoing message. I’m not taking new clients. I mean, I’ve got I’ve, I’ve been able to course correct. And I think there were other, you know, I can talk to my therapist about the other things that came up there. But I think the the piece that I think keeps coming up, and part of this when you were talking about slavery, and that kind of stuff is that when we put ourselves in the position of carrying the load for society, there’s, there’s a thing that set up there. And there’s a question that you had suggested to us that I’m gonna get to in just a second. But there’s, there’s also this kind of Savior-ism.
Tiffany McLain 13:15
Yes.
Katie Vernoy 13:18
And, and I think for me, I can find myself getting into that position. Because I feel like it’s, it’s kind of that notion of like, well, if I don’t do this, who will? You know, like, I can’t stand back and wait for someone else to do it. And, and to me, and I’m not I don’t know if I’m formulating this properly, but it’s kind of this idea of like, I can’t be a sacrificial savior, because then I it’s kind of almost like immolation. Like, I can’t, I can’t continue to do it. You know, and I even and I think we said this the last time I talked to you on this podcast was like, like, if you’re going to be a savior by jumping on a grenade like, that’s, that’s one that’s a one off, like, that’s certainly not sustainable. And so there’s the savior complex that I think a lot of therapists have. But there’s also and you put this question beautifully, so I’m just going to put that there but like, there’s this idea that a sliding scale can perpetuate racist and classist systems. So what do you mean by that? Because like I’m starting to put this together, but your the way that you think it just blows my mind most of the time, so. So what do you mean by that?
Tiffany McLain 15:14
Yes, I invite you, and I invite the listeners to think about this question of What are we doing when we’re lowering our fees? What are we doing when a human being calls us of their own volition, of their own freewill and we jump straight to offering to sacrifice our financial, emotional, physical well being in order to accommodate a request? That often in truth, many clients are not even making the request, we jump to offer the request A: but allow even if they do request it, even if they do say, oh, you know, do offer a sliding scale. My question is, what are we communicating about our belief in their self efficacy, our belief in their capacity, our beliefs about the transformational work that we do. And I think something about the communication is, and this goes to what Curt was saying, around, here’s our time to shine, us being able to own that or not, I think when we lower fees quickly, when we don’t really see our clients as mutual adult patients who are seeking services. I think we’re negating all of that other stuff. We’re negating self efficacy, we’re negating our belief in their capacity, we’re negating the value of the transformational work we’re doing. And right away, we’re entering into a dependent relationship in which they are financially dependent on us. And we become exactly what you’re saying, Katie, we become the giving savior, blessing them with our self sacrifice. And then the therapeutic relationship requires, what it requires is the foundation of respect. And the dynamic of I’m now taking care of you. Even if we say it’s not out of sacrifice to us. It is if it’s lower than the fee, we set based on what we know, we need to be charging, we’re negating the foundation of respect and mutuality, right out of the gate. And that’s what the whole entire therapeutic relationship is founded on. And so for us, we don’t say don’t ever offer a sliding scale. But if you’re going to do it, you have to acknowledge to yourself, wow, why am I doing this with this person? And I think you got to acknowledge it with them. When you’re asking for a sliding scale, there is a way that you are asking me to pay, subsidize your treatment. You’re asking me to subsidize your treatment. What does that mean for a therapeutic relationship? And I would even say, Well, how is that pulling out in the rest of their lives? And if we’re not looking at it between us, they’re coming in asking me to subsidize their treatment? Is that happening in the romantic relationship where they’re coming in as a victim asking someone else to take care of them? Is it happening at their workplace? Are they being taken advantage of and/or looking for people to take advantage of them? If we’re not talking about it, we’re just perpetuating between us an unconscious dynamic that’s likely happening in other areas of their lives.
Katie Vernoy 17:53
That’s so interesting.
Curt Widhalm 17:55
When Katie asked that question, I was getting really prepared to fight back against you and then listened. Well, in my perspective on this was one of the questions that I’m asking more and more students and supervisees, and even licensed people, but it is therapy, essentially, just for white people? That historically, there’s all sorts of evidence for this, there’s the feelings about mental health treatment in all sorts of communities of color and therapy, seemingly, at its core has has been kind of this western white Eurocentric sort of place. And that was the argument that I was getting prepared to have with you. But I’m really glad that you put it into this perspective of subsidizing which just continues to reinforce some of those ideas.
Tiffany McLain 18:51
Say more about how you think about that.
Curt Widhalm 18:53
That, and this is coming from a white male therapist that is, well, if I’ve got this space, it’s my thing. If this is the way for you to come into my thing. If I’m subsidizing that for you, then that makes you buy into that system all the more. That if that’s still that heavy handed, white maleness that seemingly comes at least how I’m hearing what you’re describing it.
Tiffany McLain 19:25
This is interesting. I don’t know if we talked about this on the first episode that we did, where I when I was, I think I was in grad school. I was and am still dating. I don’t know if it if a 13 year relationship with the father of my child is called dating, but we’re still dating. So, I was dating this white man at the time. And I was, he was supporting me primarily because I was in grad school. I was working in an agency job, but it was not a lot of money. And I wanted to go to therapy and needed to go to therapy. I have so much shame. I didn’t want to ask my partner and I did not ask him to subsidize my therapy. So, I had to go find a sliding scale therapist, in my mind. And I found, I called the Analytic Institute. And they said, We don’t have anyone who can see what the rate you’re looking for. And I remember I got off the phone and I was crying and crying. And then the intake coordinator called me back, and I. And he said, I’ll see you. I’ll see you at that I think was $50, $50. And I was so happy and I cried some more, oh, this nice man doing this good for me, right? Why a white therapist, and I, it’s so interesting. And that treatment, I felt like I had to be good. I had to be grateful. I had to show up with my Tiffany shucking and jiving mode, I gotta be good. I got Oh, you’re so ill, thank you so much. And the moment my partner he ended up getting insurance. So, then suddenly, I had out of network insurance and could pay this guy’s full fee. And money became real weird. And the dynamic became real weird. And I felt like I could be more honest, like, now I’m paying this guy’s full fee, let Tiffany really show up. And it fucking fell apart. He didn’t want it. It was uncomfortable. He liked the dynamic where he could be the nice guy taking care of this poor victim II student. And when it became I’m now on equal footing, and I could bring my full self in, it all fell apart. And that’s what allowed me to start thinking about what are we doing? What does it mean when we take on a poor struggling person at a lower fee? And what parts of themselves are they allowed to bring and not allowed to bring when we’re being the nice therapists doing a favor for them?
Curt Widhalm 21:34
There doesn’t seem to be enough discussion around the impact of sliding scale.
Tiffany McLain 21:40
Yes, absolutely.
Curt Widhalm 21:41
That it’s only ever framed and kind of this wonderful, like, here’s this good that you must bestow upon the world if this is the way that you choose to do your pro bono work. Look how great and how much of a savior you are, as a therapist, that’s illustrated in your story here.
Tiffany McLain 22:00
Absolutely.
Katie Vernoy 22:02
And on the other end, and this is, this is where my head went, when you started talking about subsidizing your treatment, is I’m going to be raising my fees, I’m going to be raising the fees on some of my sliding scale clients, I just, I’ve been doing that periodically to bring the longer term clients up closer to my full fee. And I was trying to determine how to do it because this is a time that’s difficult financially for some folks, and I want to have a respectful conversation. And I’ve I’ve set a relationship with them at a certain fee. And so there’s it’s different than starting. But as I was thinking about it, I was like, well, I could also just go to each person and say I need to reevaluate your fee. And this is my new full fee. And where are you at with your ability to pay? You know, I want to make sure that we can continue and that that that there’s not an issue there. But this is this is what it is just laying it out. And in my mind, I was like, all the people at my lowest fees, who truly cannot afford my fee will stretch. And all of my clients who could afford my full free but somehow I decided that it was okay to slide the scale will negotiate. And it’s it’s it was that idea of the advocacy of the wealthy not to pay my full fee, which goes to not valuing what we do. I mean, I had a client at one point, he said, when they just their they’re on insurance, and their deductible started again. And they talked about how their the their full insurance rate, which was only around $100 was aggressive and they couldn’t afford it. I’m like, I know you can afford it. Like there’s just a value issue. And so even just using that word subsidize, I think frames it very differently for me, versus accessibility.
Tiffany McLain 23:55
How what what feels different, what feels different to you? And it’s interesting also to think about, and this is one of the things that we do in our program is really have our therapist clients reflect on their projections into poverty, oh, poor people, and wealthy people. What are they bringing to that? So we’ll put that aside for a moment. When you when you think about subsidizing versus accessibility and I’m curious, like for your less resource clients and your more resource clients, what’s the shift in you that happens with that shift and reframe of terms?
Katie Vernoy 24:28
I think for for my more resourced clients, even using that term will frame it more accurately for them. And I think it would, it would be harder for them to then do the hard negotiation. Right.
Tiffany McLain 24:43
Yeah.
Katie Vernoy 24:44
Or they would have to then verbalize the devaluation of therapy. Right, because, you know, especially if I know they can afford it.
Tiffany McLain 24:53
Yes.
Katie Vernoy 24:55
You know, and I also think about the ones that are at my full fee like I if I raise the fee, you know, $5, $10 whatever it is, you know, like, you know, I’m, I’m pretty high in my market, so I don’t need to raise it a lot. It’s just kind of doing it. They would just, they’re like, Okay, like, it’s not, there’s not been that conversation about, let’s bring the fee down. So I think talking about it as a subsidy. And especially a lot of folks who have resources don’t feel like they need to be subsidized. It just changes it changes it from what I can pay, or what I want to pay, or blah, blah, blah, to how much I value and want to actually pay in. So, it becomes about I think what it truly is about versus them just trying to have a comfortable budget and not being willing to pay the full fee. I think for my less resourced clients, I think some of them will, will recognize that we’ve been able to work through the other parts of the relationship. And yeah, they they do need a subsidy and they want to continue with the work. And they’ll they’ll do as much as they can to diminish the amount of subsidy they need. You know? And for me that that’s, I don’t know, I don’t know, what do you think about that? Because that’s kind of where my head went?
Katie Vernoy 26:14
Well, before I jump in, Curt, I see you I see twisting your beard and thinking deeply. What thoughts do you have, as you’re listening?
Curt Widhalm 26:21
I’m thinking about this for all of our listeners at various points in our career. That the people who saw you mainstage Therapy Reimagined were really in that growth stage of their careers where they were first getting the permission to open their practice, or first wrestling with this idea of being able to step out and charge a little bit mo. T that we go through this very perverted system in our field of teaching people that the value of their services is nothing or negative, you know, starting in practicum, when you pay for supervision, you pay to go volunteer someplace. And then you get thrown out into this world of you know, if you’re working in an agency, you might still be working for free, or group practice, you get you’re barely minimum wage dollar rates per hour, then you go out into private practice, you set this fee, that’s, well, I used to charge $15, for this, and now I’m getting $100 for th. The people who are listening to you were finally getting to that stage of I can charge more. I have bills to pay, I have things to do. We don’t look at this, across a lot of our career, that there are the really established people like you and Katie and me who have our fees. That we are in, you know, above market rates, compared comparatively to some people. We have grad students who are still in that first phase of paying for their supervision. We all know this, we all know that we need to charge, but there’s a hang up that happens here, whether you’re a grad student, or whether you’re well established, that I’m just trying to see like, what is that hang up that we’re all trying to get past?
Tiffany McLain 28:10
So interesting. In our in our program, we have people have been doing this work for 20 years, and they’re still struggling, or group practice owners who are realizing that their the mindset around money they have is trickling down to their people working for them working on their team. And one of the things as I’m hearing both of you talk through this that I think could be appealing to people who have been doing this for some time, more seasoned clinicians, is, and it goes right back to something you’re talking about Katie, how is thinking about, thinking critically about, and talking about the fee? How can that be a clinical intervention actually? And how is avoiding talking about the fees, desire, aggression, betrayal, abandonment, as they’re represented by the fees? How might that be a clinical intervention? And so I think one of the hang ups therapists have and we could talk about, of course, therapists often know something, but they’re alone. They look around them, and they’re like, I’m the only one who’s wanting to charge premium fees. Everyone’s telling me I have to be out insurance. People are telling me I’m greedy, right? So we have we’re, we’re reinforced by other therapists in our profession. It’s reinforced that we shouldn’t be charging premium fees. And I talk specifically about premium fees. Because I’m talking about making good money, and I’m having the choice and the capacity to make good money. If you’re charging $300 a session, you could charge $100 to someone else, but you’re making $300 for you know, you understand how to charge competently, then you can make the choice to do whatever you want. But you know how to. So one, we’re reinforced by our profession, that it’s a problem, Two, to answer your question, Curt so much of the time our knowing is in our head while we know the thing, but there are unconscious dynamics at play, that we’re continuing to avoid and those things need to be made conscious in order, in order for us to move from, you know, knowing in our head to a visceral experience of this. And for me that comes from understanding the clinical implications of the unconscious patterns playing out between the therapist and the client around money. And we talk about them in all kinds of ways. But money is an expression of the therapists need. Money is an expression of the therapists desire. And I think so often, therapists aren’t trying to be nice and good, and you know, supportive, and we don’t need anything. But in reality we do, we have to hire, we want to grow and change. And that brings up that brings the relationship between the therapist and the client, right here in the room, not in a nice, I’m supporting your mom or your mommy. But like, I have needs and desires for growth and change and luxury, and you are the person who pays me money. So I’m not doing this out of the goodness of my heart, I’m doing it because I love the work. And I also want to be financially well off. I want to be taken care of financially. I have needs, too. So, really bringing that understanding how to have clinical conversations around the therapist’s need, and what it brings up can really be translated into every aspect of that client’s life where nobody’s having these conversations with them, where they can hate, where they can feel betrayed, where they can feel like you’re abandoning me, and we don’t say, nevermind, nevermind I’ll lower my fee, we don’t collapse. We say, when I raise my fee, I abandoned you. What’s it like? What’s it like that I’m hurting you like this. And a story shut our mouth. We’re not taking it away. We’re acknowledging what’s happening in their in their minds. And they probably had parents have well, of course, it’s their parents, they had other kids, they have their parents, who when the when the child said, You’re hurting me, the parent either denied it, no, I’m not or collapsed. I am. Okay, no more boundaries in this relationship, no more boundary. To be a therapist who says when I raise my fees, it hurts you. Let’s talk about it. That’s something that those clients don’t get anywhere else. And that’s why those therapists can charge premium fees.
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Katie Vernoy 32:09
That’s such an interesting conversation to have with a client. And I think I’ve had some of those in different places. But I think it’s something where when we go into that conversation, I think there are gonna be some clients that can’t hang. But maybe that’s just me feeling nervous about it. Like, where did clients go with that?
Tiffany McLain 32:33
I think, I think it is, I think it is the therapists who cannot hang. It’s the therapist who cannot tolerate the anxiety of that kind of conversation. And when a therapist can learn to hang in and say, I hurt you, or, you know, I’m raising the fee, and it’s whatever, whatever, whatever we pick up with the client, we can just hang in. I have my experience has been that it’s usually the client leaves when the therapist is no longer able to tolerate the work or a client to projections, or what the client is bringing to them about how this impacts them. It may be a reality that the client, and I have a hard time saying can’t pay that fee, because way back when I was struggling in grad school, and poor me, and I’m so sad, and I really was unconsciously I was a mess. But it was, um, it was a psychic reality. I could have gotten out and got some work, I could have picked up the work of the agency job, but I don’t want to I was looking at some way for someone else to take care of me, I was looking for to play out a dynamic that I hadn’t worked through. And if that therapist had challenged me to, challenge me to go through the psychic work, and also said, you know, where can you actually make some changes in your life to be able to afford my full fee? Oh, I would have been fucking pissed. You don’t know me, you don’t understand my trauma. You you, Who are you white man? But guess what that would have allowed me to do really go into some material that I was avoiding, and looking for a nice white man to take care of me.
Katie Vernoy 33:54
I want to push back on that a little bit. Because I do think that there are people in different socio economic statuses that need good therapy, and not just the stuff they can find in public mental health. Although I think there’s some good therapy that can happen there, too. But I think there’s there are folks that maybe can’t afford, truly cannot afford in their budget a $300 a week or twice a week therapy session. And so or even twice a month. I mean, I think it’s something where people do have different levels of capacity in their budget. And I think there are times that there’s not necessarily something that they can do, want to do. I’m not sure exactly what it is, but I can see where there would be an opportunity to make money specifically to be able to afford therapy. I get that. That seems to be a lot to ask for anything. I don’t I don’t want to have to make extra money to afford an attorney. I don’t want to have to make extra money to afford like I still would pay the fees if I need to do it and I would figure it out. But I think that there is truly each person does have a specific financial capacity. Right?
Tiffany McLain 35:08
I don’t know. I don’t know. So, a couple of things. One, I hear absolutely what you’re saying, I think I balked to like everybody has a financial limit. Like really? Is it true with all the resources? I don’t know. I don’t know. But…
Katie Vernoy 35:22
But I can’t afford a $10,000 a week, business coach, like, I can’t afford that. No matter no matter what I do.
Tiffany McLain 35:31
I was about to pitch my services to you just first, I was about to pitch my services.
Katie Vernoy 35:35
10,000 dollars a week?
Tiffany McLain 35:37
Yes, I’m thinking, you said I couldn’t afford an a, you know, an attorney that cost me 1000s 1000s of dollars. And then you said, Well, I would if I had to, but so I’m like, wait.
Katie Vernoy 35:48
No, I get that. I get that. But I also I also am sitting in a place of privilege and understand that there’s there are differences that each person come to the table with. And so yes, so let’s talk about, you know, Tiffany, the student.
Tiffany McLain 36:04
Yeah.
Katie Vernoy 36:05
You know, personally, if I had been in your situation, I don’t know that I would found it financially responsible to find a therapist that was $300 a session at that point.
Tiffany McLain 36:16
Yeah. And I absolutely hear what you’re saying. And I do agree, even though I’m playing devil’s advocate here,
Katie Vernoy 36:20
I know, I know. But this is more fun this way.
Tiffany McLain 36:23
Say, here’s how I would say to that, certainly there are people and I don’t know, if I would have been psychically able to work with a therapist who said, not $50, but $300. I might have, I needed to work through something psychically. So here’s what I would say, it is not a therapist’s responsibility to make a sacrifice for people who are in a different place financially and can’t afford a $300 therapist. However, if you want to do that work as a therapist, in reality, that’s a long game. So, that means I need to be able to take care of myself financially, I need to be able to create the lien and Make Bank Academy do a lot of hard fucking work to get that going until it’s self sustainable. And then I have enough resources to go and create the Psychoanalytic Institute that provides a low fee therapy, excellent, with excellent training, excellent benefits to our therapists, excellent xy, and z. So, our therapists are really taken care of, and they’re doing good work for the people who come into the clinic who can’t afford $300. But can afford maybe $20. That’s a long game, that’s a problem or or Tiffany is now freed up to go lobby. You guys actually were the ones who started talking about this, like, get fucking insurance to pay us more, the political system so we have universal health care that covers mental health at a great rate for therapists, right? This answer is not in sliding our scale when we feel guilty, when that person comes in and employs us for $50. The answer is getting ourselves in a place where we’re taken care of and have the time and mental bandwidth and capacity to actually make a strategic consistent disciplined, sustainable plan for change.
Curt Widhalm 37:51
That affordability to be able to go and impact those larger systems comes from the ability to have had created that in the first place. To have the wherewithal to set those boundaries to impact the larger systems. Those therapists who aren’t there yet. Can you speak to them? As far as okay, you know, I want to be the Curt’s and the Katie’s and the Tiffany’s who are out there creating all of these institutions and impacting stuff. But I’m still in grad school that I still owe Sallie Mae, you know, $100,000 and working for peanuts. Can you speak to them as far as what they can do now with this. On their way to getting to where those more established people are, who are charging those higher fees, maintaining this balance?
Tiffany McLain 38:41
That’s a great question. I would say, especially to those who are still in grad school and maybe stressed out about what their future holds. I would say absolutely, it’s possible for them to do well financially, in private practice, and they deserve to do well financially in private practice. Rsearch shows has showed that money in the hands of women, specifically, women give I don’t have the numbers in front of me, but exponentially more to charity, and to organizations sorry, Curt, than men do. When men have wealth, they tend to keep it more. When women have wealth, they tend to give back more to their families and to charitable organizations. That’s just the fact. So if you’re listening to this, and you’re thinking like, Oh, can I make money? Is it is it possible? One, it’s possible. Two, It’s your responsibility. I might even go so far as to say you’re not, you know, I think about my family, a lot of them have not had a college education. They’re really struggling financially. They don’t have the resources to make a big impact. They truly don’t. However, if you’re in grad school, and you’ve made it there, and you found a way to work the financial system to be able to pay for it and your education you’re getting, you have resources, you’re not in the same place as the struggling family you came from. So, it’s your responsibility to use those resources to make a bigger impact, and on that biggest impact involves luxury for you, because you’re modeling what it means to be a woman, a person of color in the world taking care of themselves and saying, we deserve to take care of ourselves, too. And you have responsibility to be a person who can amass wealth and make an impact and impact the political system for the better. So it’s possible for you, I would say,
Katie Vernoy 40:25
I want to talk with you for like hours and hours and hours, it just makes me so happy. But I do want to add one piece of advice from my own perspective, given what we’ve just been talking about. For those who are starting out and getting ready to start their private practice, they really need to set a fee that’s going to make sense and start there, because it is so much harder to dig out of a hole where you have clients that are at lower fees or on insurance, or whatever it is that you cannot really afford, then setting the fee and really getting started with building your practice in a way that’s financially sustainable. And of course, you have your fun with fees calculator, which I’m sure you’re going to tell everybody about. But it’s something where if you don’t set your feet properly to begin with, sometimes you’re fighting against your clinical responsibility to the clients that you have. And that becomes a bigger battle than starting and holding your fee from the beginning.
Tiffany McLain 41:18
And look, I created a whole side business to subsidize the clients who I wanted to continue to work with, who I’ve been working with for years. So it’s true. Like, I wish someone had given me this message back when I was in grad school of like, just like what you said, start with fees to take care of you well, and then use your you can make an impact outside of that, versus doing going back with like so much of us have to do where we end up having to charge $300 to make up for the $25 clients that we’re committed to and we’ve been working with for 10 years.
Katie Vernoy 41:46
Yep.
Curt Widhalm 41:47
Where can people find out more about you and everything that you’re putting out there?
Tiffany McLain 41:53
Yes, we actually have a workshop right now, a free workshop, Four Steps to Raise Your Fee. So especially, it’s even in times of COVID, you can raise your fee. If you go to heytiffany.com/workshop. You can watch that and you can check out we have a podcast to The Money Sessions, where you’re hearing therapists talk all day long about the real conversations they’re having, the real struggles they’re having around justice kind of thing, raising fees, talking to clients about fees, getting off insurance panels, etc.
Curt Widhalm 42:21
And we will link to that in our show notes. You can find that at mtsgpodcast.com. You can also find Tiffany at the Therapy Reimagined 2021 conference. She is back by popular demand and lots of voicemails from Curt while I’m driving around. So we are so excited to have you back this year and I can’t wait for September. So…
Katie Vernoy 42:49
Yay!
Curt Widhalm 42:49
…until next time, I’m Curt Widhalm with Katie Vernoy and Tiffany McLain.
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Announcer 42:55
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