What happens when a client doesn’t Pay?
If you’re working in private practice, you’ll most likely experience a client (or two) who end up having unpaid invoice(s). The money part of private practice counseling can be really challenging for a lot of us. This profession brings ALL the helpers together, and we just want to do that - help. Brining up the financial aspect of counseling sessions, especially after there has been a lapse in payment, is common to avoid. It’s uncomfortable and often we let this build and build until avoidance seems like the only option.
Similarly to discharge planning, discussing the cost and expectation of payment with client should begin at intake. I recommend making a Consent for Therapy that you go over with each new client. This will help make sure you hit a lot of the key “business” aspects of counseling that sometimes we overlook. Putting these topics into a document that your client signs helps with accountability on both the counselor AND client’s parts in addition to improving clarity and creating a space for questions or concerns from your client before therapy begins.
My rule of thumb is once two invoices in a row have gone unpaid, it’s time to discuss this with my client, coming from a place of curiosity. I find that most often a client has forgotten to check their email, or didn’t click the “submit” button on the payment, or something similar that is easy to trouble shoot and remind of the expectation of timely payment.
Repeat issues with non payment may result in the requirement that payment be rendered by the date/time of the session. I love electronic invoicing, and never plan to go back to cash/checks. With this in mind, I may send a client who consistently has not paid invoices timely, the invoice for a session 1 week in advance, with a due date of the date of the session. This all, of course, would be discussed with the client before hand.
Don’t let invoices pile up to high. Allowing non payment for too long just moves your client into a large financial debt that can be very difficult to get out of. If you’ve had the conversation about expectation of timely payment, and prompt payment (or any payment at all) still is not forth coming - it’s time to discuss pausing counseling sessions. This is where having had conversations about payment expectations throughout the counseling relationship really becomes relationship saving. For clients who continue to need counseling, or clients that you recommend (due perhaps to risk/safety concerns) to continue counseling - but cannot continue with you due to financial strain, provide a list of community mental health providers and other providers in your area that offer sliding fee scales. Often even larger agencies/practices offer this, even if they don’t advertise it that way.
Above all - have the conversation about money with each of your clients at the beginning of treatment. Make your expectations clear, be thoughtful about your process and the mediums you use to collect payment (things like venmo and cashapp may seen appealing but….privacy? hmm). As always, any further concerns about having this convo with clients or payment for counseling in general - as your supervisor!
