3 Things to Remember that will Help Reframe the Sliding Scale Discussion

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Last time I pointed out the 3 things you need to remember if you struggle with raising your fees. This time, let's dive deeper into one of those – sliding scale clients. I’ve heard from some clinicians concerns about clients who abuse your generosity, for example claiming to only be able to afford a fraction of your full fee while driving a much nicer car than yours. This concern comes up when you see sliding scale discounts as pitting your client’s interest (getting the best therapy at the lowest price) against your own (providing the best therapy while maintaining sufficient profitability). The following are some thoughts on how you can set things up to reframe the sliding scale discussion so it doesn’t trigger your own emotions.

First Thing to Remember: You Can Arrange Things so Your Profitability is Unaffected

If you want to help less affluent clients without hurting your profitability, set up your practice with a certain percentage of slots open for sliding scale clients and adjust your full fee accordingly. Say you see 20 clients a week, and need to charge them $150 per session. You can set aside two sessions at $50 for sliding scale clients, and increase your full fee to $160 to compensate for the reduced revenue. The result is that your own bottom line is now unaffected by the discount you offer.

Second Thing to Remember: Sliding Scale Isn’t Forever

As I described in my previous post about one of my own recent consulting clients, he asked for a discount for the first few hours of consulting, but agreed to pay my full rate after those. This is a perfect example for how you can approach sliding scale discounts, especially with clients who have a temporary financial challenge that requires help through discounted therapy. It’s perfectly reasonable to offer the discount for a month and agree to reevaluate at that time. Then, since you’ve set things up where your own bottom line is unaffected as suggested above (right? :)), you can ask the client if they continue to truly need the discount, or if they’re able to release it to someone else.

Third Thing to Remember: Skin in the Game Is Important

As I discussed in an earlier post, people don’t appreciate things that come free of charge. Similarly, when you get something at a steep discount, you don’t have as much invested, “skin in the game” if you will. This means that a client who gets a discount he or she doesn’t really need, will likely not work as hard on the issues he or she is dealing with, making their therapy less effective. As this client’s therapist, this aligns your interest with theirs, that they get the most effective therapy possible.

Bottom Line on Reframing Sliding Scales

The three simple things above will help you reframe the conversation so it’s no longer your interest vs. that of the client. Now when you discuss discounts with these clients, it’s with the understanding that your bottom line is not affected if a client comes to a $50 session driving a Rolls Royce. What is affected is the availability of discounted slots for other clients, and how effective their therapy will be if they don’t have as much skin in the game. Approached from that perspective, you can have the sliding scale discussion without being emotionally attached to the outcome.

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