You’re in practice to help people – no one doubts that. But you find yourself thinking about whether you want to build a cash-only private counseling practice.
This article is not meant to castigate therapists who accept insurance; however, the transition to a cash-only practice is clearly on the minds of many therapists and we’d like to address it.
We approach this topic from the perspective of watching therapists move from insurance to cash-only from either having once only accepted insurance or having some sort of sliding scale policy (or some other variation).
So, here are some of the fundamentals we’ve observed and researched when it comes to building your cash-only private therapy practice.
This is really, really important. To some extent it’s your #1 priority; when you put your heart and soul into helping others, you need to make sure that you’re going to come out with a healthy practice that sustains you holistically. That means developing an income plan that corresponds with your true lifestyle expectations.
It’s also important that you don’t feel bad making this plan, otherwise you’ll temper it down into something that’s just not fulfilling. If it’s not fulfilling for you, even at the stage of first dreaming it up, it’s just not the right fit.
We’ll borrow this brief explanation from the Kelly Higdon, LMFT, who posted this for the National Association of Counselors in Private Practice:
“Based upon your hours and the income, what fee do you need to set to be able to meet your goals? Sit and play with the numbers to determine your gross income (before taxes and expenses):
10 clients per week at $100 an hour for 48 weeks = $48,000 10 clients per week at $150 an hour for 48 weeks = $72,000 10 clients per week at $150 an hour for 50 weeks = $75,000 15 clients per week at $150 an hour for 48 weeks = $108,000
Playing around with a few factors – you can start to see the impact of small changes in your business plan. The factors that can be changed are the amount of clients, the fee and the amount of weeks worked.”
If you’re honest with yourself about your income plan from the get-go, your business plan will become far clearer.
Therapists network with other therapists, offer coaching packages and teletherapy, create groups and workshops, write books, develop digital products (e.g. videos and podcasts), and even teach local college classes to diversity revenue streams.
The options are seemingly limitless, but the point is this: if demand for your services is high, you set the price you believe is fair. If demand is very low, your price is somewhat guided by broader market forces, which may mean accepting insurance. None of this is bad, by the way – it’s a decision you make personally, and the only person who needs to be happy with it is you.
Given the fundamental high-demand, low-demand affect on the cost for your services, that will suggest to you whether you want to either (a) diversify your revenue streams, (b) adjust your income plan, or (c) focus on developing your niche and brand via marketing (more on this one coming up).
A “brand” may feel like a weird business concept that doesn’t belong anywhere near therapy, but it’s probably the least offensive ethically of all the business concepts out there. Fundamentally, the clearer, bolder, and better well-known your brand is, the more confident clients will feel contacting you, all by knowing exactly who you are and how you can help them.
Thus, developing your brand by (a) obtaining a niche for yourself, (b) creating a clear online presence, and (c) working to expand your outreach online and offline is a very important method for moving to a cash-only practice. The reason is simple: clients frequently select therapists based on comfort level, which is determined with fairly limited information and frequently what is only available to them before meeting you. So, information about you on Psychology Today, from a friend or family member, and – in our opinion most importantly – explained in your digital office (a.k.a your website) is almost all of the information someone can glean.
The challenge, however, is that most online directory listings look roughly the same in terms of style and format and a referrer may not provide a complete and concise definition of your services and practice. Your website then becomes the hub and personal representation of who you are – it is the single greatest opportunity currently for explaining yourself in the way you see fit. Pictures, content, videos, and the like help to communicate what is unique about you, which helps a greater number of clients feel comfortable with you.
And now the last point – therapy services are incredibly high value. In case you forget how essential you are, just look at this! The issue with purchasing therapy services is not the cost, at least not usually, it’s the concern that the client will not resolve their problem or in general receive sufficient value from the experience. The better educated they are about the possible (and even likely) benefits of therapy, the more likely they are to be compelling to contact you, almost irrespective of whether or not you take insurance.
It may take something of a leap of faith to believe a cash-only private counseling practice is possible, but clearly many therapists have achieved it. It may not be for everyone, and there is nothing wrong with accepting insurance – we can’t possibly overstate how genuinely we mean that – but if for whatever reason you elect to move to a cash-only practice, you should know it is possible. We see it all the time, a confident and well-branded mental health practitioner can request a very broad range of fees. Just also keep in mind the more energized you are by the health of your practice and the lifestyle it affords (again, it’s totally up to you what your goals are), the greater the compassion you’ll bring to each session.