SPEAK EVEN IF YOUR VOICE SHAKES.

July 1, 2023

It’s our anniversary…

Esteemed clients,

Last month marked another year since I opened my private practice in Asheville, and another year of clinical expertise and development! I’m now more than 19 years in –and still in love with being a therapist. With every year, I grow, you grow… and so do the cost of living and the cost of doing business. And so, I am writing you the type of letter I dread sending to my clients.

Money, despite being a concern for most of us, is very hard to talk about. Yet, it’s nothing compared to some of the conversations we get into in therapy about trauma, family, drugs & alcohol, sex, relationships, religion… So, I’m confident we can do this.

Since the mid-eighties, with the exception of the Great Recession, the Cost of Living Adjustment, determined by the federal government, has hovered around 2-4% yearly. Last year’s was a whopping 8.6%. This year it’s only between 2.7 and 3.1! I’ll split the difference with you. So from now on, private-pay session fees will be 2.9% higher.

As a therapist, I hate the idea of raising my –already high –rates. As a Small Business Owner (SBO), I recognize that it is not up to me. So, I’m going to go ahead and place the blame on Santosha’s CPA. (Sorry, MG!)

I want it to be clear that in raising therapy rates to keep up with inflation, I am not giving myself a raise, (or rather, I’m not asking you for one, since I actually work for you). I won’t be making any more money or increasing my net profit; the bottom line will remain the same. If I didn’t raise my rates in accordance with the Consumer Price Index and the US Bureau of Labor Statistics, I would in essence be reducing my fee. Charging a fair market price, on the other hand, makes it easier for me to prevent burnout and continue to give my all to my clients.

When you pay a therapist’s fee, the rate does not only reflect the time you’re spending with them –and their years of education and training. Therapists spend a lot of time outside of the ‘therapy hour’ doing ancillary work such as research and treatment planning; communication with clients; paperwork; coordination of care and/or consultation with other professionals; billing and bookkeeping; workshops and seminars; advertising, promotion and networking events, etc. Your therapist must also charge enough to cover the costs of confidential communication platforms, electronic health record systems, credit card processing fees, licensing, trainings and continuing education, malpractice insurance, advertising, etc.

As someone with a genuine and embedded commitment to racial, social, and economic justice, I strive to be accessible to all. As such, I provide the majority of my services either completely pro bono or for less than 25% of a full fee. It feels right to do this. And it’s really hard to sustain a business that way. Particularly for a SBO who is both female and a Person of Color.

My unique fee schedule doesn’t place the responsibility of subsidizing my made-marginalized clients’ therapy on my better-situated clients, however. I actively fundraise to finance my provision of these discounted services, by offering trainings, courses, workshops and consultations, as well as trauma-informed yoga, and something I call Social Justice Yoga. I also welcome community contributions. I do additional equity work as an unpaid volunteer.

Dear White Therapists

Or how to be an antiracist therapist, colleague, and human

The Honest Therapist on Patreon

Psychology, justice, community… and yoga

Help me help.

Community fund for therapy for minoritized folx

As someone with a fair amount of privilege, I choose to use it in the service of others, and in a way that maximizes my impact beyond offering free or discounted therapy to a handful of folks. In addition, with both my time and my wallet, and on a regular basis, I support BLM, local LGBTQ+ youth, orphaned children, policymakers, countries devastated by natural disasters (likely due to climate change), and those not eligible for stimulus checks and other Covid-relief measures.

People spend money on what they deem important. In budgeting, my wish is that everyone would prioritize mental health over oftentimes frivolous expenses. Too, psychotherapy as a profession has historically been undervalued, and the narrative that therapists are “not in it for the money” perpetuates this toxic practice. Therapists have bills just like everyone else, and it’s not like costs are lowered for us if we mention we’re a therapist. I get charged just as much as an investment banker does.

What helps me break from this harmful myth that therapists should be overworked and underpaid, and allows me to acknowledge the worth of the work we do, are your statements regarding the change and growth you, my clients, are experiencing. (If you are not finding value in our work together, we must talk about this asap. I don’t want to continue to charge you a penny; I want to help you find a therapist who might be a better fit.) I also want to model a healthy relationship with money and with the notion of abundance. The universe is infinite, and so are its resources. (There is more than enough to go around in this world; we just have a distribution problem, as a few hog what should rightfully be available to everyone.) It may be that this here presents us with an opportunity to explore your relationship with money and any financial wounds, trauma, or limiting beliefs you may be holding. I want you to –I’ll go with the overused phrases –not merely survive but thrive, to live your best life! I want you and me both to be able to make life choices in alignment with our values, not out of fear or need or scarcity, not based on feeling forced or trapped or seeing no other option. I want you to move through life how you want, not how you feel you need to.

If you are unable to pay this new rate, I understand that you may need to seek other options and I invite you to visit the Open Path Collective for alternatives.

Do please let me know if you have any questions, concerns, comments, insults, or jokes. I respect and appreciate our therapeutic relationship; it is strong and can handle all manner of difficult conversations. And I trust that we will both approach the conversation from a place of fairness and as much generosity as each of our limited amounts of money and time can allow.

Please take good care of yourself,

Dr. Á