The short answer is “no, you don’t have to.” The decisions that you face in your private practice are yours (and yours alone) to make. After all, you are the one who is left to work in your business, and you want your practice to work for you.
You are going to run across colleagues, whether in person or in the therapist facebook groups, who have very strong opinions about many topics including fees, cancellation policies, and really just about anything else you can think of – including sliding scale.
As with any of these topics I advise you to ignore what other people say that you should do – pause – and check in with yourself, what you really want, and what’s going to be best for your practice – because only you will know this.
That’s not to say that you shouldn’t take into consideration what others have to offer. Being able to see what others are doing and taking their suggestions – when they resonate – can be very beneficial as you build your practice.
With that being said let’s talk about all things sliding scale: why you may decide to offer it, why you may decide not to offer it, and why you may delay it for a bit.
Why you may decide to offer a sliding scale…
A sliding scale is a great way to give back to your community, to offer lower fee spots to those who otherwise couldn’t afford it, and to have the opportunity to work with the populations that you love supporting.
A sliding scale has many benefits to the therapist, the client, and the community. In fact, there are no real disadvantages to offering a sliding scale. I have only seen it become an issue when therapists have too many sliding scale spots, have not taken their finances into account, and are struggling to keep their practice open – but this situation is rare.
Open Path Psychotherapy Collective
One thing I want to add here in this section is the option of an alternative to sliding scale. Many of you have probably heard of Open Path Psychotherapy Collective, created by Asheville therapist Paul Fugelsang.
Open Path is free for therapists to join. You can create a profile and be listed on the directory to be matched up with clients who are looking for affordable therapy. Clients pay a lifetime membership of $49 to become part of the collective and to see the member therapists.
Open Path only asks that therapists see at least one Open Path client at a time (although you can see more). Within your profile you are able to update your availability to reflect if you have space for an Open Path client. You can set your Open Path rates between $30-$60 for individuals, and $30-$80 for couples and families.
I offer my low fee spots through Open Path as a way of managing my sliding scale. It makes having a sliding scale really simple and easy to manage. Open Path does the advertising for me, and all I have to do is ensure that my availability is updated and current. I’ve been using Open Path for a while now and I have had a great experience. My Open Path clients have been amazing, and when I open up my availability on the directory I’m able to get a prompt referral.
If you’re not a member therapist already, I encourage you to join. If every therapist signed up and offered only one Open Path slot, a multitude of clients in need of affordable therapy would be served.
Why you may decide not to offer a sliding scale…
Just because you have a private practice does not mean that you have to offer sliding scale spots. Not many people think of it this way, but it may be considered a privilege to be able to offer sliding scale spots in your practice.
Owning a business is not always easy, and it can be really tough financially as well. We do not know the circumstances of our colleagues. Some may have financial support from a partner or other family members – and can easily offer a few lower fee spots. Some may be single parents trying to build their private practice on their own – and need all their spots to be full-fee in order to make ends meet.
It really saddens me when therapists are so judgmental and try to shame their colleagues because they do not offer sliding scale spots. You don’t always know someone else’s situation, and it’s not up to you to decide what someone else should be doing in their own business.
Many therapists who do not offer sliding scale spots are giving back in other ways to their families and communities (and it’s also okay if you don’t have sliding scale spots and also do not give back in another way). I know of some therapists who are donating several hours a week to help out their communities and to volunteer. And, because they do this, they are not able to have a sliding scale.
Remember: You don’t have to give back through your business.
Why you may decide to delay offering a sliding scale…
Starting a business can be tough, and you’re probably not going to be rolling in the dough in the very beginning. It may be a hardship on you to be offering low fee spots in your practice when you are trying to get established.
I’m sure you’ve heard the statistic about half of all businesses failing within the first five years (and 30% within the first year). If you’re able to get full fee clients in the beginning, it may make sense to get your practice established first before offering your sliding scale. When you feel like your practice is in a good spot financially, you can make room for sliding scale spots or give back in other ways (or not – you do you).
In the end, I want you to be empowered to make the best decisions for your business, regardless of what anyone else thinks you should do (including me).