Making peace with the cost of counselling

Private counselling can be a costly affair. It can feel tricky to work out how a counsellor’s fee equates to value for money. How do therapists calculate their rate? And, as clients, how do we come to terms with the notion of paying someone to listen to us?

How I work out my fee as a counsellor

My instinct is to make my service available to anyone in need. But I must balance this impulse with earning enough for my own survival needs. Maslow reminds us that we limit our capacity for higher endeavours, such as conceptual thought and empathy, when we are preoccupied with our own security. This means addressing hard facts around the costs and restrictions of providing therapy in private practice, including:

Restrictions

• 20 clients maximum per week, as stipulated by The British Association for Counselling and Psychotherapy, with whom I’m accredited.
• 47 working weeks per year, barring illness.
• Periods of unpaid compassionate leave during life events that would impede emotional clarity.

Costs of delivering the service

• indemnity insurance
• membership fees for professional bodies
• repayment of training expenses
• directory costs
• website fees
• continuing professional development (as stipulated by professional bodies such as the BACP)
• room hire or purchase
• utilities
• mandatory monthly supervision
• personal therapy fees (personal therapy is a mandatory part of training)
• resources for creative work
• telecommunications and IT costs
• data protection fees

This provides a rough idea of the practical aspects that the fee needs to cover. Then I need to address the fee’s symbolic communication in how it:

1. Reflects my self-value in terms of experience and qualifications.

2. Informs the client’s comparison of me with other counsellors.

Self-respect

Self-respect is one of the Principles of the BACP’s Ethical Framework for Good Practice. It advocates “fostering the practitioner’s self-knowledge, integrity and care for self.” A healthy sense of self-respect is key to well-being and is also something clients seek to foster in themselves through counselling.

Our internal sense of respect for one another and for ourself is symbolised through our interactional exchanges, including through money. Respecting my own worth as a counsellor is symbolised through the fee I set; respecting the client’s ability to provide for themself and establish their own priorities is symbolised in my communicating that fee, and the client’s self-respect is symbolised in the investment they make in themselves.

Getting the session fee right is part of an ongoing awareness of self-respect and respect for my client.

Things I consider when thinking about the financial value of my own experiences and qualifications include:

• The level of my qualifications – how far have I attained beyond the minimum BACP required qualifications for practice?
• The status of my work as recognised by a professional body (e.g. a BACP member might have attained registration, accreditation or senior accreditation).
• The number of client hours I have worked with, and the depth or range of presenting issues I have benefited from experiencing through those client hours.
• The extent of continuing professional development with which I’ve engaged.
• Personal growth and life experiences that have informed my work.

Things I consider when thinking about the client’s self-valuing include:

• Research that indicates counselling is more effective for clients who pay than for those who do not.
• That being offered a concessionary or gratis session might cause a client to feel patronised, disempowered, or under-estimated. Conversely, it might falsely indicate to the client that they are special to the counsellor.
• That, in some circumstances, negotiating a fee can feel empowering for a client and can establish a more symmetrical relationship with the therapist.
• Concessions can provide a reparative experience for a client who may previously have felt like they have had to earn feeling valued by others.

The contradictions in the above list only go to show the significance of money in the therapeutic relationship; how valuable it can be to uncovering some of the issues and dynamics that might have brought a client to counselling, and how challenging it sometimes is to come to terms with paying to be heard.

Difficult feelings around paying to be heard

Counselling is sometimes referred to as talking therapy, though arguably the therapy comes as much from the being listened to as from the talking. Other professions we associate with listening, like spiritual leaders or mentors, although often funded, are associated with voluntary giving of help. Similarly, we’d consider it pitiable if we had to pay our friends or family for the privilege of talking to them.

A counselling relationship can sometimes, because of the core conditions of empathy and unconditional positive regard, have a feel of friendliness. Yet, the therapist is not our friend and, unlike our friends, does charge us for the time they spend with us.

Our brains love to categorise but, with private therapy, we are offering it a conundrum:

“I feel unconditional positive regard from my counsellor in sessions, but sessions are conditional on payment.”

Arguably, one of the ways as a culture we are attempting to square this circle is through re-categorisation. Counselling is founded on a Wellness Model i.e. it takes a holistic approach, which considers our strengths as well as our difficulties in order to develop ourself.

This model perhaps fits into a category in our minds with the pastoral relationships mentioned above, which are associated with the charitable giving of one’s skills. However, if we start to adopt the language of pathology, and think of therapy as something that 'cures' or 'corrects' us, we find ourself reconceptualising it as something that sits alongside seeing a doctor, dentist or physiotherapist - we feel more accustomed to the professionals being financially rewarded for their skills.

However, there are other cultural shifts we can adopt to come to terms with the apparent conundrum of paying for care. One of these is to challenge the conceptual link between the care of others and self-sacrifice, whereby we associate caring for others to be at the expense of the carer. This is therapeutically unhelpful in my view.

After all, we may argue as clients that we know when we’re ready to finish counselling, not because we feel secure in being cared for by our counsellor, but when we have developed sufficient beliefs and strategies to feel able to appropriately care for ourself. In this way, it is vital that the counsellor be able to model that they can balance self-care with caring for others.

This means the counsellor being confident in charging fees that are required to provide for their key survival needs, do justice to their skills, and put them in a place psychologically where they have the energy and empathy to focus on their client.

The events of 2020

The impact of Covid-19 in terms of both the disease and consequential lockdown has only created more counselling demand. With NHS services at a bare minimum during the peak of the virus and charities stretched due to lockdown, there has been an increase in distressed clients seeking urgent support from private therapists at concessionary rates.

My impulse is to help. However, I’m also conscious that our public services are accountable for the safe provision of high-need clients and, if these clients overflow into private counselling, it’s possible the therapy may put them at risk without them having wider social and medical support networks.

Black Lives Matter demonstrations have also been stirring us to address complacency over inequality of opportunity. Arguably, potential clients (perhaps particularly men from black, minority ethnicity or working-class heritages) may struggle to find themselves reflected in their counsellors, who are often middle-class females. This is because this demographic is most socially expected and most likely to accept that their services be given charitably.

To make the profession representative of all potential clients, it is important that it can provide a living wage for practitioners who have the skills and inclination for this work - whatever their heritage.

Summary

As clients considering how much we can afford and want to pay for therapy, it can be therapeutically useful for us to explore the impact of any requested or offered concession, or any agreement we make about time-limited work due to budget limitations.

If we are a client with complex needs, it may also be relevant for us to consider what publicly funded services need to be provided to offer us a network of support. And, regardless of how at ease or otherwise we feel with paying for counselling, it is useful to have a sense of what the counsellor’s fee represents both in terms of the counsellor’s experience our own investment in the process.