Money-it's the last taboo, say many psychologists. Everybody needs some, but no one really wants to talk about it-whether it's in clinical work, executive coaching or business consulting.
"There's this idea that thinking about money conflicts with your goal of wanting to help people," says David Ballard, chair-elect of the American Psychological Association of Graduate Students (APAGS).
But getting comfortable charging for your expertise isn't just acceptable, says Ballard-in fact, it's mandatory (see Money and gratification). "You won't help many people if you go out of business," he explains.
Yet many graduate students don't get a lot of experience with billing issues during their internships, says Jeff Baker, PhD, a board member of the Association of Psychology Postdoctoral and Internship Centers. The leap to charging for your services individually is "a big transition and a big part of professional passage," notes Baker, also associate professor and director of the University of Texas Medical Branch psychologist training program.
So how do students get a taste of discussing what therapy will cost and how it will be billed?
The level of training for this issue varies across institutions, Baker says. "Every clinic has a different procedure." At his program, students are given an opportunity to get some exposure to managed-care claims and fees, for example. But for the most part, students don't handle billing issues. "Ours usually has a financial person who has that meeting with the client before they arrive, so that they are not totally shocked by it all."
But when there isn't a financial person or a billing clerk to take care of that-or when that doesn't happen or whatever reason-students can suddenly be thrown into learning billing first-hand, he says.
TIPS FOR TALKING MONEY
When Baker is supervising a student whose patient raises the money issue, he gives the student the opportunity to respond. At a hospital such as the University of Texas Medical Branch, there are so many health-care plans and co-pays that interns might not know the exact answer to a patient's question about billing, but it's important for students to learn to refer patients to the person who can answer their question. The process of discussing costs "takes into account [the student's] ability to respond to patient concerns," says Baker.
Certainly money practices will differ by venue, but some general tips for handling the money issue in the therapy room include:
Be direct and explicit about your fees. "Bring up what happens with missed sessions," suggests Ballard. "Do you charge? Do you charge for lengthy phone contact in between sessions?" He also suggests that this issue should be dealt with initially-as part of the informed consent process at the beginning of therapy. Danny Wedding, PhD, professor of psychiatry and director of the Missouri Institute of Mental Health, agrees: "It is an important issue for both therapists and patients, and it is a germane topic that will get in the way of the work of therapy if it is not addressed."
Listen to the patient. "Are they distressed about the [issue]? If they're scared or anxious, then the psychologist should stop right there and deal with that issue," says Baker.
Appear confident and relaxed about financial issues. "Clients will pick up on it if you're not," says Ballard. "How can you expect a client to value your services if you have a problem sharing this information?"
Know the context you're working within. Ballard suggests that involvement in a state or national organization can help early-career psychologists learn the ballpark of fees and managed-care reimbursement, and develop sliding scale fee structures.
Consult your supervisor. "Talk not only about how to bring up fees, but about any discomfort you're having and how to handle that," says Ballard.