In the first episode of the second series of the BBC2 drama Fleabag, Fleabag is given an envelope by her father that turns out to be a voucher for a counselling session. She later goes to her first therapy session, trying – unsuccessfully – to redeem the voucher for cash.
Round about the same time this episode was aired on TV, I received notification from the company that runs the credit/debit card reader I use, explaining that the system now had a new feature – the ability to send my ‘customers’ an electronic prepaid voucher. I could attract business with an ‘exciting’ offer. It seemed too easy. I could send all enquirers a voucher, effectively offering them a free first session in order to tempt them across my portal. I know that some therapists offer a free first session anyway, but the existence of a voucher with money on it (albeit electronic) would make it more concrete and potentially more attractive in some way. I could give all my ending clients a voucher for another session, encouraging them to return at some future date, if they wished to do so. My assumption would be that the existence of the voucher would make it more likely that they would return. I could make all my existing clients aware of the voucher system (and advertise it on my web pages) so that they could buy sessions online to give away as presents. After all, most clients in their therapy tell us that their partners, their parents, their children, their friends need therapy and would benefit from coming to us. So why not explain how they could easily facilitate that? (I accept that there are moral and boundary issues about working with relatives of existing clients, and that would have to be appropriately managed.)
There is a strong business case for vouchers, and after the Fleabag episode, there were certainly enquiries in online discussion groups for therapists, asking whether or not counsellors could offer vouchers. A quick Google search revealed that there are many therapists who are already doing so. (One couple counselling organisation is trying to encourage people to buy counselling vouchers as wedding presents.) However, after a few minutes of reflection, once my honed desire to maximise my business income had cooled down, my equally honed moral voice started to ask questions.
Surely the essence of effective therapy, regardless of modality, is the ability of the counsellor and client to mutually engage together. Most of us have experienced clients who are there under compulsion – the 19-year-old being sent (and paid for) by parents; the alcoholic sibling being sent (and paid for) by the other concerned sibling; the father having to do yet another course on anger management to satisfy the courts in an attempt to get contact with his children; the mother doing counselling in order to attempt to comply with a child protection plan. Despite her father’s good intentions, Fleabag was an unwilling client. We know that unwilling clients are difficult, and that the unwillingness seems to build an often-insurmountable structural problem in the architecture of the sessions.
At best, the take-up of a voucher suggests that the client is not entirely motivated by a desire to come to counselling, and that money has played a significant part in the event. At worst, the voucher enables well-meaning and caring people to send non-assertive acquaintances to counselling and therefore builds problems into the relationship from the start. Regardless of how the relationship may develop (and I accept that in some cases it may eventually turn out for the good), I feel it is wrong to attract people to therapy by using money, and wrong to implicitly compel them to come. Neither of those actions seems in the best interests of the client, however much additional income they may generate for the private practitioner. I want clients who want to see me and who are prepared to pay a reasonable price for my service. For me, vouchers would significantly muddy that.
Is it right to give discounts?
Personally, I find the subject of discounts very difficult, and I suspect that I’m not alone. I think part of the reason is that most private practitioners do not arrive as fully formed sensible business owners and start out primarily wanting to help as many people as possible rather than make a reasonable profit. However, being in business inevitably means drawing boundaries and excluding people, and most of us are initially reluctant to do that. If I run a taxi firm, I am inevitably (however reluctantly) going to exclude clients who do not have the ability to pay (regardless of the genuineness of their need). Unless we are willing to work in private practice for nothing and end up paying thousands of pounds of our own money in order to practise, we will have to exclude potential clients who do not have the ability to pay our fees. In my experience, many counsellors, especially those who have gained experience in the voluntary sector, never quite grasp the concept of necessary exclusion in running a business.
I know many counsellors who do give discounts to their clients (and are proud to do so), and I also know several others who refuse to do so (and are confident in their refusal). For me, there are both moral and pragmatic issues to consider. The first moral issue is the way the discount can inevitably impact on the relationship with the client. The powerful non-verbal message to the client is that they are special in some way. It can change the power balance. There may even be an implicit, ‘I am doing you a favour. You owe me. You had better not be difficult or complain. If you find our relationship difficult, you had better not be too honest.’ Of course, such messages may not be powerfully existent in all cases, but the potential for the relationship to become skewed is there.
The second moral issue for me surrounds the other non-verbal message I’m potentially giving to the world. It seems to me that in offering a discount, I could be saying: ‘I do not value myself or what I do. I’m embarrassed about what I’m charging. I’m therefore choosing to rob myself, because actually, I’m not worth it.’ Over the years, I’ve spent many hours with many clients who have had similar messages about themselves and have worked with them to resist such scripts. Thankfully, I’m now more confident in resisting giving off such messages about myself. I’m far from perfect, but I’ve learned to be proud of my years of training and of professional experience, and I feel that I charge a reasonable fee for what I do.
I now do occasionally give discounts, but in a very managed way, in an attempt to overcome some of the practical problems. Although now willing to consider any request for a reduction in fees if asked, I do not advertise that I offer them (for the reasons stated above), and if I choose to give a discount, I always limit not only the amount per session given, but the number of clients who have discounts, and the amount of time the discount runs for.
I choose to limit the impact on my income by never giving a discount to more than any one existing client, and I also choose to limit the number of sessions the discount is for. The former limitation stops the ‘problem’ of the word getting out and of you being inundated with requests for ‘cheap’ counselling. And because I’m a firm believer in the benefits of short-term work (though like many in private practice, I offer both long-term and short-term work), I set a time limit on the number of discounted
sessions. The clients are aware of this at the beginning, know the work cannot be open-ended, and this helps them focus on a specific, manageable issue right from the beginning. This may all seem inconsistent and clumsy, but it is my way of trying to be flexible, as well as protecting income and living with the potential moral problems involved.
Is it right to take card payments?
I have heard it argued that we shouldn’t do this, because technically we could be encouraging clients to get into debt, especially if credit cards are used. Thankfully, although I’m now old enough to understand the force of the argument, I think I’m pragmatic enough to laugh at the question even being asked. Credit cards were first introduced into the UK in the mid-1960s and I can remember the dire warnings that my parents gave me about owning one in the 70s. (I seem to remember having fears about my children getting into debt when they owned them in the noughties.) And it is true: some people do have trouble managing their spending on credit cards.
However, there are equally potential problems with clients using cash unless they are competent in managing their own money. And Britain is fast becoming a cashless society (although it is way behind other countries, such as Canada and Sweden). Last year, debit card payments overtook cash purchases for the first time, with cash payments dropping 14 per cent in a single year from 2016–17.1 In my own business in the past financial year, nearly 70 per cent of individual client payments were made by card and I only see that percentage increasing as card payments become the norm. At present, because the limit on contactless payments is £30, I already have clients who are annoyed that they cannot wave their card or phone over my reader to make a contactless payment and have to actually remember and type in a PIN number.
Because we are offering a paid-for service, we have to trust our clients to be able to manage their own money. I’m not intending to start interrogating clients about whether or not they are putting a debit or a credit card into my reader, or about whether or not they can afford it. If they hand me £20 notes, neither do I ask if by paying me they are getting into debt.
Is it right to ask for advance payments?
Have you heard about the supervisor who asks her supervisees to pay in advance for sessions, including paying for the missed sessions that happen while the supervisor is on holiday? Yes, I did write ‘while the supervisor is on holiday’. This isn’t a joke question. There are some supervisors who do that. I personally find that so astonishing that I cannot discuss it here, other than to say that although there may be compliant counsellors willing to agree to that, asking for such advance payments is unlikely to be an attractive business model for counsellors to use when wanting to attract clients.
Of course, many counsellors do ask for advance payments. There are those who ask for a double payment for the first session at, or after, the initial assessment. Others negotiate payment for a series of sessions (say six or 10, for example). What that means is that the counsellor always has a deposit that can be kept if the client fails to turn up or cancels late. In essence, advance payments are an attempt by the therapist to manage financial risk, thereby ensuring that the therapist faces minimal risk at the expense of the client. I suppose, for the therapist who has to pay for room hire and who additionally faces loss of income from a late cancellation or a no-show, it could be argued that a single advance payment held as a deposit is a reasonable insurance policy. Others might argue that, from a business perspective, advance payments present it more difficult for some clients to begin therapy. It can give off a non-verbal message about the over-importance of money to the therapist. And it can encourage clients to feel trapped in their therapy – ‘Once I’ve started and paid, I have to finish, even though I cannot relate to this therapist and am not finding the sessions useful.’ To me, the practice does not seem in the best interest of clients and feels more about therapists’ attempt to control. Clearly, I have even more difficulty with the practice of asking clients to buy a number of sessions in advance and then encouraging them to do so by offering financial incentives – for example, buy 10 and get one free (see the arguments against vouchers and discounts above).
James Rye is a counsellor, supervisor and trainer based in King’s Lynn.
Reference
1. Harris N. A person of no account? Prospect Magazine 2018. [Online.] https://www.prospectmagazine.co.uk other/a-person-of-no-account (accessed 28 May 2019).