Pro bono, Free, Reduced Fee
Last week I wrote the “Money Issue.” This week I’m discussing a closely related topic – pro bono, free and/or reduced fee services.
Counseling ethical codes encourage counselors to provide some services for free or reduced cost. I believe that for the most part, our collective challenge is quite the opposite. The system of payment for services is set to pay us for the direct service hour; or 1/2 hour; or 43-45 minute (hour) with the patient, client or “consumer” (my least favorite phrase for the people we serve).
This single session fee is intended to cover all of the other work tasks and time spent on that case from the note to the treatment planning to time spent billing as well as time spent staffing and consulting on cases etc…
All combined, those fees are intended to cover all of our costs for practice and then cover our payroll, contracted services, and payment to oneself etc… So clearly, the margins are close and without careful attention to efficiency or multiple streams of income, it can be very challenging to bolster a practice based solely on one-on-one services unless you are private pay (and full fee).
So Why Do We Give Services Away?
On any given day I believe most practitioners are practicing at a financial deficit (all things considered). So when it comes to a decision to give services away or at a reduced cost…it often feels like a natural transition for therapists…an easy “yes!”
It is a “yes” because we are accustomed to long challenging hours with capped compensation. Free or reduced services are often in alignment with helping professionals who may have inner conflicts about being paid to help others.
Additionally people feel quite comfortable asking us for free or reduced fee services and some of us struggle with saying “no,” either because of feelings of guilt about turning someone away or even worse…over identifying with the client who seems to believe he or she is not making a livable wage or who simply does not believe the service provided is worth that rate.
Tithing and Volunteering
While it is certainly true that the circulation of money, including practices like tithing or volunteering one’s time, is vital to both the self and one’s community when it comes to wealth and principles of both financial, social and emotional riches and abundance. I still believe in service marketing and providing some services for a reduced fee.
However, when I meet with colleagues regarding practice development or for case consultation, they are often challenged by an underfunded (under capitalized) business and a business model that does not incorporate a plan to address these issues. This failure to plan can lead to all types of poor decisions from a competency and treatment perspective.
Therapists who are giving service to others from a place of financial depletion are risking burnout!
Additionally, when paid opportunities come along (like new therapy clients or speaking/training opportunities), they may be inclined to say yes to cases or opportunities that are beyond their scope of practice because “they need the money.”
So How Do We Combat These Challenges?
Decide on your annual plan – your target number for pro bono, reduced fee therapy, speaking or facilitation services etc…Including the criteria for saying “Yes” (like your target audience or non-profits). If you don’t have an annual plan start one now. Let this be month #1!
Then notice how quickly (or slowly) into the year these services are depleted or conversely how long you hold onto those hours.
During a licensure renewal year, I get many requests to present on a variety of topics. What I’ve learned is that it is better for my life to not say “yes” to every paid opportunity. First I must determine if it is mine to do. Below is a list of questions that run through my mind when I am presented with an opportunity.
- Does this request align with services that I already provide? If not, do I want to provide this service?
- If I do want to provide it, am I competent to provide it?
- If I am not competent, how long would it take for me to develop this competency?
- Should I work toward developing that competency so that I can say “yes” to this type of opportunity in the future?
If the answers are “No;” or “No, not right now;” or “No, never,” then of course the answer is “No.” I then refer the request to another colleague.
Knowing what I will provide for free and how often and to what audience allows me to follow a road map. Just like the map I have for paid services.
After all, the stakes are the same. We have liability, ethics, legal and standards/best practices etc…that all attach to free and paid services. Don’t treat free services as consequence free services. You have a professional responsibility but also personal responsibilities to yourself.
How Does this Apply to You?
Depending upon where you are in your career (for example early or late) it may be part of your annual plan to accept more free service requests because either you want to gain more experience or increase your name recognition. Those further along in their careers may be in a “generativity” phase and eager to do more giving back regardless of compensation, hopefully with a healthy retirement nest egg in place.
Just know that people generally don’t respect or value free “one-on-one” services as it relates to health care. Never forget that via licensure you are first and foremost a healthcare professional. When we devalue mental health care, we are colluding with others who devalue it.
Copyright © 2016 Ruby Blow. All rights reserved.
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