Help! The Client Likes Me!

An updated version of a classic blog post for you. Enjoy! Originally Published 4/8/11

Q: What do I do if a client expresses attraction to me in session?

First, don't freak out. I know that's the temptation. In fact, that's what I did the first time this happened to me. I stammered a little, and I think I said "thank you", which wasn't the best thing I could have done. But it was awkward. It was really, really awkward.

I have a philosophy that every feeling we (the counselors) have in a counseling session means something. This situation, trust me, will cause you to have feelings, so I ask you, what could your feelings in this situation mean? First, here are some common feelings you might find yourself having:

• Awkwardness
• Concern about ethical issues
• Reciprocal attraction
• Fear/Vulnerability
• "Stuck" (What do I do next?)

That's a lot of feelings! And any one of those makes it really hard to think of what to do in the moment. That's why it so good that this question came up. It's one of those that's really best to address ahead of time if you can.

Of course, with so many different directions, it's hard to declare just one definite answer. So don't try. Just think through as much as you can. A rule of thumb: if you have any reciprocal attraction, hear warning bells. You need to immediately refer and consult with a colleague to work through those feelings. You'll be getting yourself in dangerous territory if you do not! 

If it's not a mutual attraction, realize getting you to refer to someone else might be the point of expressing the attraction. The first time this happened to me, it was on the first session with a guy who was a serial adulterer and didn't have a lot of respect for women. His wife wanted him to come to counseling, and he had no use for it. It is my belief that he knew he would fluster me by bringing that up. He wanted to get off of the topic at hand, which was his problems. Unfortunately, it worked. But now, at least, I know better than to have it happen again.

Everything that the client does is a clue...

Changing the relationship dynamic is a way that clients can try to manipulate you or change the power dynamic in an unhealthy way. Remember that the power dynamic should be different but balanced - you should not feel victimized by the client any more than they should by you. 

As with all client-counselor interest conflicts, you can get through this by remembering that you are in charge. You're the counselor, and you have the capability to deal with anything that comes your way. (Even if it might take a little fumbling....) You are the professional, and you will get through this in a professional manner. In the moment, ask yourself "why?" and remind yourself that you can handle it. Even though it seems so scary, attraction to the counselor, in the end, is just another symptom for you to explore. 

Have you ever had a client express attraction to you? If so, how did you deal with it? (PLEASE REMEMBER  - DO NOT SHARE specific details about a client or a counseling situation such that the client could possibly recognize themselves. That is not ethical and it leaves you legally liable.)

7 Ways To Practice Confidence With Your First Clients - Even When You Don't Feel It Yourself

The first time that you meet with a client is a heady mix of thrill and terror. It will probably seem both like it came too quickly and you've been waiting way too long for it. 

And one of the biggest things on your mind during those first few meetings? 

"How can I inspire trust in my clients so that they can open up and get the help they need?" 

One of the most effective ways of inspiring trust is displaying confidence in your own ability to help your clients. When you trust yourself, your clients will trust you. But how can you display confidence in your abilities when you're struggling to feel it yourself? 

Though I dislike the connotation of the maxim, "fake it till you make it," I have to admit the principle applies here! The more you practice self-confidence, the more you will feel it - and conversely, the less you practice self-confidence the more likely you are to get stuck in a cycle of feeling like a failure. You practice self-confidence by identifying the anxieties in your mind that are attacking your faith in yourself, and creating a new framework of understanding to operate from going forward. 

7 Ways To Practice Confidence With Your First Clients - Even When You Don't Feel It Yourself

1. Instead of worrying over what you don't know, take stock of what you DO know. What do you do well? What did your professors praise you for in class exercises? Try to come up with at least 5 things that you can pull out in situations in which confidence is hard to to find.
2. Check their expectations - which are probably not what YOU think they think. We can pretty easily work ourselves up wondering if this client is thinking we're messing things up, or that we're no good at what we do. But really, how likely is it that that condemning US is what's most on their mind right now? Practice telling yourself that they have other things to worry about then our abilities, such as the reasons they are coming in to get help from a counselor. 
3. Get a yay-sayer in your life. Everybody needs someone encouraging around them on a regular basis! For many of you that will be your clinical supervisor, but if not, connect with a fellow counseling student or layperson friend who can tell you that the small things you are agonizing over really aren't that big of a deal.
4. Pre-settle the "experience" question. A lot of us in the student stage get ensnared by the experience question, i.e. "How can you know what I'm going through? Do you have (fill in the blank) kids/husband/wife/traumatic experience/death of a loved one. You're never going to "win" by a direct yes or no answer to this question, because there will always be some experience you have not shared. Plan on how to deal with it using a version of these two responses: 1) Getting at the real question: "Why does it matter to you if I've been through that? Your experience is what matters." And 2) Getting clear on the fundamentals: "I may or may not have been through _______ but I've felt pain before, and pain is pain no matter where it comes from." 
5. Don't be afraid to say that you don't know. You might think the worst possible thing you can say for inspiring trust is "I don't know." But you can't possibly know everything! It's all in the attitude. If you calmly and evenly say, "You know what? I don't know the answer to that right now, but it's important to me and I will look into it before our next session" it will both inspire trust and provide excellent client care.
6. Remember the "get-to-know-you" gap. When you first meet a new client, it honestly takes a minimum of 1 1/2 sessions to start to get a handle on the person...at least it does for me! Before then, we may have some idea, but we don't have enough information to move forward. So don't pressure yourself to know everything right away. No one does!
7. LISTEN. Sometimes, you don't have to have the answers to inspire trust. Sometimes, you just have to be willing to listen. 

When you struggle with self-confidence in beginning counselor training, what do you do or say to yourself to remind yourself of what you have to offer? 

Who Else Wants to Measure Client Success?

Ever wonder if your efforts with clients are getting anywhere? Are you making the difference you hope to with your interventions and techniques, or are they falling flat? 

How do you know if you’re being effective in your client work?

This time in your life (practicum & internship) is all about trying new things. You’re supposed to be experimenting and finding your own personal style. But in order to do that, you need to measure the results of the new things you’re trying.

You can test the effect of your interventions on client’s stated goals by looking for these key signals as a sign that something is happening. You might not know what it means yet, but you will be able to identify that there is a reaction that means something.

The client asks specific questions about your intervention. Example: “How long do we take a time-out? What should I say to my partner when I need a break, so that they don’t feel abandoned?” This means they are engaged with the logic of what you’re suggesting and seriously considering putting it into play. The real test, of course, is to see if they…

Come back and tell you about trying it. Example: “We did this and it really worked! We were able to communicate so much better afterwards.” This is one of the most straightforward and welcome ways for you to recognize the benefits of your work…it helps your confidence a great deal when a client can specifically tell you about what worked and didn’t work. If they do not do this on their own, I encourage you to come right out and ask! It will show them you care and help you monitor your progress as well as theirs.

The client is super-quiet, even still. Example: You suggest something they could try to alleviate a symptom of their problem. A normally chatty, even bubbly person, may become quiet and not move. He/She may look at the wall or their hands. This is a sign of contemplation, obviously, but at another level like a kind of shock, indicating you may have shared with them an idea that is new to them and needs to absorb. When the client does this, consider simply mirroring them until they speak again – if it is quiet for a long while, you might also reflect the situation back to them. “It seems like you got really quiet there. Did something about that hit a nerve?”

The client starts making jokes. Example: You say, “Have you thought about telling your family you’re taking medication now?” They say, “Oh, sure, I’ll can’t wait to tell them I’m on drugs!” While a little dark humor can actually be a healthy way to process (seriously, they’ve done research) it can also be a way to deflect from feelings of fear or confusion. The fact that they want to deflect is a sign you’ve hit on something that matters, so follow up on it with them.

The client gets angry or belligerent. Example: When you suggest something, they say, “That seems like a terrible idea. It doesn’t make any sense. Why would you waste my time?” etc. Like inappropriate humor or sarcasm, this is a way to push you away and get you to focus on something else rather than what you suggested. This aggressive behavior could be physical, verbal, manipulative (passive-aggression) or sexual (flirting or come-ons) but the point of it all is the same. You got to something they want to protect. If at all possible, it’s important to not react and stay focused on the problem they’re covering up. Stay safe, but if you can, try to connect with them before they lead you off the track. 

These are signs that you are making progress in counseling. The ultimate sign of progress, of course, is when you run out of things to talk about. You know they’re not holding back, they’re simply done with their goals. That’s when you can begin to ease them back into a more independent process of self-exploration. But until that point, these clues above can help you know you’re on the right track.

What signs do you look for to measure client successes? Comment below!  

And join me on Sept. 2 for a

Free Private Practice Webinar

Who are you? Q & A

Marketing yourself. We've been discussing how it build confidence, why you want to do it, and how to put it into practice. But some questions can't be addressed on a general basis. That's why I asked you to share with me your biggest questions on marketing as a newbie counselor. 

Q: Do you have any suggestions on how to present or market oneself as an intern counselor to a potential supervisor? Specifically, in a cover letter/resume format and in the case of someone waiting on their license to come through. 

• My first suggestion with any kind of marketing is "don't start with you." The cover letter or resume that states your objective, in my opinion, misses the mark. Even the kindest person sifting through a bunch of resumes doesn't care about your needs at that exact moment - they are looking to fill their sometimes desperate need. Start instead with a question or a statement about their needs and then tie your skills and desires into it. 
• If you have something that is lacking, approach it a different way. In this person's scenario, you might say: "Although I won't take my NCE until _____, I am actively seeking a supervisor and further client experience starting immediately." There are some legal restrictions you will have to overcome to work with clients after graduation, but before an official start to your internship. If these exist in your state, you might propose a compromise that is legal, for some people, volunteering hours and/or getting temporary liability insurance that covers you under another umbrella.
• Follow up. Most people don't. Snail mail is very inconvenient to respond to. The person receiving the message may mean to respond, but put it in their "to-do" pile indefinitely. You can follow up with a simple phrase like, "I wanted to see if you received my cover letter and resume." [If yes] "Do you think that my skills might be a good match for your needs?"
• Research them. If you can say why you like their organization, it will go a lot farther for you. Make sure your counseling theories match, and that the job isn't "too good to be true." Sadly, an internship that promises major $$$ may be a scam because that kind of money just isn't there at the intern level. 

Q: Why don't you take Medicaid...(or another specific insurance panel they want covered)? 

My answer to this question when I first started was stupid. "Because I have to be licensed such-and-such amount of time to get on this panel...because there are too many people on-panel in this area..." I would end up redirecting the clients to other providers rather than offering them a solution that would work for them.

When a client says, "Why don't you take..." they aren't really asking why. They're communicating that they have some level of interest in your services and are frustrated that you don't offer their insurance panel. But they're still talking to you, which means they're not convinced they want to go with someone else. So here's what you can do instead. 

Affirm that you support whatever they choose to do next, but you have options for people who have insurance you don't take. That might be sliding scale, out-of-network benefits, group therapy, coming less often, etc. Ask them to try it out and see if they like it. If it doesn't suit them, they don't have to keep coming, but it might be the right fit for them. Remind them that there are privacy compromises and limitations on service with insurance providers, and as an out-of-network provider they have more choices with you. 

If they don't want to go off-panel, they won't. They'll call around till they find another provider. But if they want to talk to you enough to ask you "why?"...then they're still invested in the option of working with you. Trust in the VALUE you have to offer and give them another option to consider. 

Q: How do you make sure people are getting what you're sharing with them...and not just nodding their heads?

Ah...I see.

But do they really? Sometimes it's hard to know if you're really getting through to people. But anyone can learn to read the signals of comprehension in order to better communicate their message.

With a referral source, client or coworker, you know you're likely communicating effectively when you see a few positive body language signals, like the ones below:

• Repeating back to you a version of what you've been saying.
• Focused gaze on you or off to the side, as if they're thinking. 
• Taking notes.
• Getting closer or leaning into your space. 
• Mirroring movements. 
• Feet crossed at the ankles while sitting. 

Some signals that might indicate distrust, disinterest, or impatience are:

• Looking away at other things, shifting eyes.
• Shifting feet, tapping feet.
• Crossed arms.
• Hands on hips.
• Looking down. (Though in some people this can be thoughtfulness.)
• Squinting eyes with lowered eyebrows. 

Of course, you want to have more of the former than the latter. So if you are experiencing some negative signals from another person, you might be able to turn it around with one of these tricks:

• Asking about comprehension. "You know, I'm feeling like I might be being confusing. Am I making sense?"
• Asking for their opinion. "What do you think about what I've been saying?"
• Keeping it short. Leaving out extra topics and going over what has already been discussed once again.
• Trying an analogy or metaphor. "I like to think about it as a ship in a storm..."
• Trying a visual aid. Prepare one or two that you can keep on you or bring to meetings! 

As you try some of these strategies, watch for the other person to suddenly snap back into the present. That will tell you what to continue speaking about, and what to abandon.

That's enough questions for today, but I'm always here! If you could have any question about counseling answered, what would it be? Did the answers today help you resolve anything you were struggling with?

Who Are You? Part One.

Have you ever felt afraid that when you start your first counseling gig, that you won't have enough clients? Have you worried about your clients coming to appointments with you and then deciding your work "wasn't worth it?" 

The way I always pictured these scenarios in my head was a bit like Mean Girls. I'd be the new girl trying too hard to impress, and the clients would take one look at me, sigh in disgust, and then show me the hand as they walk out the door. 

When I sit down and spell it out like that, it seems ridiculous! But I'm betting I'm not the only one who has ever felt that way. 

The more I coach Beginning Counselors, the more I'm convinced there a single underlying issue to all Beginning Counselor concerns. Identity.

Whether it's a question of, 'how do I talk to a client who thinks I'm too young,' or 'what do I charge for sessions,' or 'how do I get on EAPs,' what you're all asking underneath that is 'what kind of a counselor am I going to be?'

Each little piece - and there's SO many of them - makes up a small bit of you the practitioner. 

Entering any new career is a point at which a reconstruction has to begin, of yourself as the individual to yourself as the professional. But what is unique to the counseling profession is the very personal nature of our work. 

When a client rejects what you have to offer, it feels like they're rejecting you. 

When they don't complete their homework, you wonder how you could have been more compelling.

When you can't answer a question, you feel like you've let them down.

This is very different from the kind of job in which you only have to communicate that "we're out of the special sauce." That's not to say those kinds of jobs aren't just as hard in a different way, but it's not something you're going to take personally. When you can't offer someone something they want from counseling, however, you take it very personally indeed. 

You feel like you've failed, because you've wrapped up so much of your identity in a multitude of things that change from day to day. How you feel that morning. How a client acts. Whether you keep things on a tight timetable, or know the right words to say. It's exhausting. If your identity as a counselor is in external results then you will be tossed around by the events of the day. 

But many counselors set themselves up this way without even realizing it...especially the new ones. When we're new, we're searching for feedback constantly on how we're doing. And because we don't have the experience yet to balance negative feedback with the bigger picture, we tend to take the worst perspective when it's presented to us.

When a client doesn't come back, we think, "Of course not. I completely screwed up when they dropped that big bombshell. Why would they come back?"

When we list our brand-new practice on Psychology Today, and don't get a single call for a few weeks, we think, "Of course not. Who would want to get help from me?"

Please tell me I'm not the only one who's ever had those dark thoughts. Though thankfully they grow more rare the longer I work in this field, I have to say I thought things like this quite frequently during my early days. 

It sucks to feel that way. This is your dream, and instead of feeling hopeful and useful, you feel like you've made a big mistake thinking you were good enough to enter this field.

Here's the thing. With time, you will see this is not the case. You will see how you were needed and meant to share what you have to offer. 

But that doesn't really help when you're feeling it right now.

Now you just think you're someone who makes idiotic mistakes and you blame yourself for everything that can possibly go wrong in a counseling session.

So how can you help yourself with these feelings right now?

The answer is the same as the problem. Identity.

 

If you don't know who you are as a counselor, you have nothing to combat the self-doubt that comes. 

When you know who you are and why you're here, though. That's when you're unstoppable. 

Fortunately, you don't have to wait several years to develop this on your own. There is something for you, right now, that helps you move from self-doubt into secure self-confidence.

You're not going to believe what it is.

Tune in next week for the answer....

In the meantime, share with us: have you ever felt doubt in your professional abilities? What did you to that helped it? 

PLANNING For Client Success

When was the last time you knew someone who followed their New Year's Resolution? If you can't think of an example, you're in the majority. A mere 8% of people successfully follow their resolutions each year. That leaves all the rest feeling discouraged and down on themselves. 

But this shouldn't be surprising news, right? We know better than anyone. Our job, after all, is change, and change is HARD.

During the course of therapy, our clients will "fail" on the path to achieving their goals in a multitude of ways. 

• Fall off the wagon.
• Speak to the destructive ex-partner.
• Overwork, overeat, or overplan. 
• Go off the grid. 
• Hide from the world.
• Explode in anger.

Or any of a dozen other vices they are in therapy to address. 

We know how hard it is to achieve change, both from our personal experience and from watching many, many clients go down the same path. There is no direct ascension in the path to success. Change is like a game of Chutes and Ladders. One spin moves you way up, and another can bring you back down again.

We know that. But our clients don't often know that. 

How many times have you had a client "apologize" to you for messing up on their therapy goals?

Or stop coming to counseling altogether, only to find out later that they did so because they were ashamed for violating a goal they discussed with you?

It is completely unrealistic to expect perfect success, without any setbacks, from anyone trying to accomplish a change in their lives. But clients often see the completely normal up-and-down path of working towards a goal as their own private failure. 

That is why I believe it's important that we go out of our way to disabuse clients of this unrealistic notion of success. Whether they're working towards a New Year's Resolution or trying to achieve another goal, it's part of our job to let them know that they are only able to affect the now.

We can do that by the simple act of believing in them. If someone has believed in us in the past, we may take the power of that belief for granted. But in reality, many people don't have that. Before they come to counseling, they have probably been struggling with this issue a long time. Their family and friends may be sick of hearing about it. Their family and friends may be part of the problem. The belief you have in their ability to change may genuinely be the only strength of belief they have in their life.

Your belief in them can be the very thing that teaches them by example how to believe in themselves. 

It opens the door to teaching them other tools to self-belief:

• Creating opportunities to prove your own strengths.
• "Flipping" the situation: if another person you trusted was facing the same odds, would you be as hard on them as you're being on yourself?
• Rehearsing self-control before a trigger and increasing your ability to avoid temptation.
• Reminding yourself that self-belief is something you can learn. 

Our job is a little like New Year's in a bottle - with every new client we're trying to set them up for success with challenges that are staggeringly difficult to achieve. But by believing in their ability to achieve their goals, we teach them that it is possible...even if there are a few bumps along the way. 

What do YOU tell clients to help encourage them success is possible? Comment below! 

[Video Post] Ways For Counselors To Reduce No-Shows (Even With Clients Who Come See You For Free)

17 Game-Changing Questions for Any Counseling Situation

A few posts back, I ran a video blog that (among other things) shared how I think that questions are powerful tools in the counseling office. Since that seemed to strike a chord with many of you, I thought I'd share with you guys my favorite, top-secret, GAME-CHANGING questions that cut through the "story" and get at the heart of the matter. 

These questions will help you turn the session around when it stagnates and show clients that you really "get" them.  If you've ever worried that you might fumble or sound unsure of yourself, memorizing a few of these key questions will help you avoid that. And since questions should always be used with caution, I've also included at the end of this article today 3 Ethical Keys to make sure you're asking questions responsibly and judicially. 

17 Game-Changing Questions For Any Counseling Situation

Background

1. When did this first start?
2. How do you see what happened/is happening?
3. How do you describe yourself? 
4. How would your family describe you?
5. What drives you?
6. What one thing makes you who you are?

Motivation

7. What was it that made you call a counselor?

8. Why is now the right time for a change?

9. What are you doing this for?

10. What possibilities will there be in your life once you no longer are burdened by this issue?

Uncovering the Problem

11. When are you free of [the problem?]

12. What do you feel like when you do not have to deal with [the problem?]

Discovering Barriers to Change

13. What would your life be like if you woke up tomorrow and no longer had [the problem?] (Miracle question.)

14. Who in your life would benefit if you no longer had [the problem?]

15. Who in your life would struggle if you solved [the problem?]

16. What have you tried before to help with [the problem?]

17. What do you think has stopped you in the past from being free of this issue?

Ethical Keys

1. Tone matters. You must never use an angry or judgmental tone when you ask questions, or it will blow up in your face.
2. Spacing matters. Don't rattle off multiple questions at a time. These questions are designed to help you uncover gold. So ask them, and sit back, and let your client lead you straight to the motherlode.
3. Follow-up matters. After you ask a difficult question, it is often helpful to come back to them and assess how it was for them. You might say something like: "Was that scary for you to answer?" "Did you feel concerned about how I would respond to your answer?" Follow-up questions allow you to assess your questions' suitability for a particular client, and to recover from any misunderstandings that might have happened. 

What's your favorite question to ask a client? Why? 

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Fear of The Follow-Up

Does this sound like you? 

You dread listening to your voicemail and having to return a new client call. 

You see outdated information on your website or your therapy profile, and you feel tired and apathetic.

You call a potential client or referral source and they don't answer, so you never try them again. 

It's a depressing way to be. You always feel like you're just "missing the boat." That no one likes you and wants your services. That you're lost. 

But it doesn't have to be that way. Once you know what you're looking at, the problem is quite solveable. 

So what are you looking at? I call it the "Fear of the Follow-Up."

Whether you're a newbie looking for hours or a private practice counselor needing financial support, we all must have clients to succeed in our business. ;) But we're unknowingly sabotaging ourselves by with this fear - a fear most of us don't even realize we have.

But this fear results in:

• Clients not booking appointments.
• Being unable to pay your bills. 
• Plummeting self-esteem

Fear of the follow-up comes from a place within most counselors - most people, in fact - that hates to "bother someone else." We're afraid of being pushy, or sales-y. We don't want to sound like we have an agenda.

Those are all excellent things to avoid. But they don't necessarily correlate with following up. 

Following up is really just checking in. 

"Hi, so-and-so, I saw that you said you were going to call me back about making an appointment with me, but I don't have one on the books yet. Were you still interested in doing that?"

There's a bunch of easy ways you can accomplish the goal of following up without being pushy. Try this simple formula, accompanied with a patient, easy tone, and tell me for yourself whether it doesn't take away some of the fear of the follow up.

To segue into a follow up, simply reference the point from which your first contact was made. This might be when they called and chatted with you briefly, requested a phone call on your website, left a message on your machine, or requested through someone else, like a family member, that you give them a call. 

Then, after catching up to speed with their situation, ask them something along these lines: "Were you ready to make that appointment we talked about?" "Did you say Tuesday was good for you?" "If you still need more time to think about it that's fine, but we could also put something on the books and you have 24 hours before to cancel it if you like." 

None of these is rude, aggressive, or takes away the client's free will. 

After all, if someone reaches out to you to set up an appointment, they're displaying interest. If you follow-up with them once, and they don't reach back, or you never follow-up with them and they don't call back, it doesn't necessarily mean they're not interested. 

Instead, it could mean they're:

• Tired.
• Distracted.
• On vacation.
• Working.
• Voicemail is full.
• Walking the dog.

You get the idea. If they don't want what you have to offer, there's nothing in calling them and gently asking them if they're ready to make an appointment that will force them to meet with you. In fact, most of them will be grateful that you cared enough to encourage them to follow through with their plan. (Sometimes, clients have fear of the follow-up too!)

I wish I remembered the exact moment when I stopped being wishy-washy and started assertively following up with potential clients. But I do remember the first difference that happened when I put the power of the follow-up into play. 

Clients started making appointments. It was that simple. And I believe that it can be the same for you. I'd love to have you try it in your own practice and tell me what you think. 

Has fear of the follow-up ever cost you in your private practice? How did you deal with it? 

This is #6 of the 9 Ways You Are Sabotaging Your Private Practice And How To Stop. Listen to it by signing up here and going to our Facebook group through Thursday at 7c/8e.

Sliding Scale Secrets [Classic Beginning Counselor]

To celebrate the new blog location for Beginning Counselor, I've collected and updated some classic blog posts for you. Enjoy! 

Have you ever been asked by clients if you could offer them a sliding scale counseling fee...and had no idea what to say? 

Yes.

No.

Maybe.

Why?

Um....

There's something about that question that makes us all feel a little wishy-washy. We want to help. But we also know we have to pay our bills, and most of all be fair to all of our clients.

Why is this so hard to do? Well, it's awkward talking to clients about money, especially when you're not used to doing so. And it's rare for other agencies to publish their own formula for creating a sliding scale, so you don't have much to go by. Sometimes your supervisor may have a specific formula for how he/she wants you to do that, but sometimes they won't. And then you're on your own.

So what do you do?  

The only thing TO do - create a system of your own that's fair to the clients but at the same time meets your needs. Sound impossible? Nope, not if you ask yourself these simple questions!

• What are the minimum and maximum fees you are comfortable charging? You don't want to make the price too low, or risk discouraging the client from taking the session seriously. You also don't want to charge as much as a licensed counselor would if you're not licensed, because you don't have the experience yet to justify it.
• What fee increments will you be using? One example is starting with a specific fee and taking $10 off per hour for each $10,000/year the client's income drops.
• What are your special exceptions, if any? Do they get a certain low rate if they are on unemployment, if they are a student, if they are on disability, if they have children they are financially responsible for, etc? 
• How do you back up their statement of income? One way is to verify self-stated income reports by using the client's check stub or income tax form.
  

Once you decide your fee structure make sure you steel yourself against being persuaded to reduce it further. When you present any fee with some flexibility to it - like sliding scale - it's a natural human instinct for clients to try to see if they can get an even better deal. (I would be tempted to try to bargain it down in that position, too!) Resist. It does not make you a bad person to stick to the boundaries you've already set, especially if you're going by fair guidelines like the ones above.

To protect yourself against this, I would suggest giving yourself at least 24 hours to think it over before you reduce a fee further than the guidelines you have already established. If you still want to change after 24 hours, than it's probably a situation you should change. I bring this up because new counselors often struggle with guilt over charging a fee for their services. Don't. Can many other people do what you do? No. You deserve to earn a fair wage for your services.

A good sliding scale fee system benefits both the counselor and the client. The client gets the help they need at an affordable rate, and the counselor knows they're helping people but still making a decent living. 

If you use a sliding scale in your counseling practice, what guidelines to you go by? How do you deal with any guilty feelings that come along with it?

Originally Published 7/15/11

Recommended Reading: Building Your Ideal Private Practice: A Guide For Therapists And Other Healing Professionals. I loved it!