Ethical Questions s/o from how much do you earn

amother

Bisque

Thu, Oct 31 2019, 9:58 pm

amother [ Purple ] wrote:

I disagree. Therapists that charge these rates are obviously worth these rates . Otherwise they would not have any clients. Nobody starts off charging $250 a session- you charge $250 a session when you’re an established therapist in private practice that has worked long enough and made a reputation for yourself - that people will actually feel you have value over a therapist that is charging $150. Therapists that can charge $250 a session etc are usually those with extensive knowledge and training in different areas, and they are constantly training as well.

Not necessarily. I have gone to therapists with these price tags and their competence and knowledge base were a joke. I truly find it unbelievable that so many of them have such a high view of themselves and their self worth- to charge so much. But then again, many are just looking at it from a business point of view and the patients are just income streams to them.

Jeanette

Thu, Oct 31 2019, 10:38 pm

amother [ Tan ] wrote:

I am so curious. I keep seeing the therapists write how they are so amazing and sooo specialized they can charge so much but I have not read 1 post from anyone who paid these prices and said it was worth it...
Who are these amazing highly qualified practitioners and did you get your money's worth? Were they magical miracle workers that supercede anyone else?

I wonder the same thing. I'd also like to hear from people who tried the $100/hour therapist, got nowhere, and only got helped when they started seeing the $300/hour therapist.

I did read a study once that patients did better on a drug that they were told cost $1000 compared to patients who were told the drug cost $10. Both groups of patients were given the same drug!

amother

Pearl

Thu, Oct 31 2019, 10:57 pm

So I am a therapist. I don't have a private practice right now for various reasons (including not being able to give up my day job with its low pay but security) but hope to one day have a private practice at least part time.

Many people not in my field don't know but I spent years in school. Not just a 2 year combined BA-MA joke program. (Ask where they got their degree from. Online? Ha. Frum program? Chuckle. Real schooling at REAL universities is tough with 30+ page analysis on clients, diagnoses, treatments, theories etc for EVERY COURSE.)
I worked for years UNPAID. 5+ years to get my hours for licensing. I couldn't get the required crazy number of hours otherwise. And I paid for supervision for some of that time.
I had tons of student debt and I borrowed responsibly (got scholarships for academic ability, didn't borrow to go out to eat etc).
I now work in a job that you would laugh when you hear what I get per hour. People assume I rake it in but I don't. Teachers may make more when you calculate per hour. And yes, I do tons of work after the clinical day- research, creating client worksheets, making therapy group handouts, notes... So I could spend an hour or two after your session working on things for you. I am always reading, learning etc for my client.

I won't accept insurance if I can get away with it. The paperwork is crazy. They don't pay well. They can say to stop treating at any time. I would have to diagnose and treat that issue specifically-- and no, I couldn't accept insurance for a purely couples or family counseling case.

My malpractice insurance is crazy expensive. Plus other licensing fees, mandatory CEs I need to to take, renewal fees, my field's association membership fees....Plus if I have a private practice I need slip and fall insurance, pay both sides of social security, rent, overhead, utilities, a lawyer to write up/review those contracts and intake forms etc. plus you want a comfortable office, nice lighting, decent couch. That gets expensive too.

Yes, I personally think it's insane to charge 300 a session. Unless maybe you are the only therapist in 50 miles who speaks a specific dialect and is trained in a specific niche field. But a therapist who "specializes" in everything or even a handful of subjects isn't a real niche specialist.

singleagain

Thu, Oct 31 2019, 11:17 pm

Jeanette wrote:

Isn't that called prestige pricing? Or something like that. I will in a grocery store and my manager has told me that certain products once it gets to a certain point, just round it to to the next .99 cents even if the "formula price" would make it a .29 ... Bc ppl will pay the higher price. And we need to make money to.

amother

Gray

Thu, Oct 31 2019, 11:31 pm

amother [ Tan ] wrote:

I paid $450 for 45 minutes weekly. Therapist is experienced and specialized. Non-jew. Therapist has a waiting list. After seeing 4 therapists before this one that did not help, yes, I did get my money's worth (painfull of course).

amother

Mustard

Thu, Oct 31 2019, 11:44 pm

amother [ Seagreen ] wrote:

I hear what you're saying...

At the same time, I edit papers from time to time. I don't have a set rate and charge largely based on how much advance notice I got vs. how busy I am at the time, how much work it'll take me, etc. I'm actually pretty cheap right now and I believe I'm selling myself short. But yes, I might change prices seemingly at random- not based on my mood, but based on the total picture.

For example, two people might contact me with rush jobs at different times, and I still may give them a different rate. Why? One is a science paper where I need to do a significant amount of research in order to edit and proofread well, whereas the other one is a research paper about some topic that I already understand well, and it won't take any extra work on my part.

In other words, I charge by the project based on the amount of labor I invest. That is extremely variable.

A similar situation in my field would be, charge by the hour. The more experienced you are, the higher your hourly rate BUT the fewer hours it will take you to complete the job.

amother

Seagreen

Thu, Oct 31 2019, 11:48 pm

amother [ Mustard ] wrote:

A similar situation in my field would be, charge by the hour. The more experienced you are, the higher your hourly rate BUT the fewer hours it will take you to complete the job.

Not necessarily with editing, though. I'm quick because I'm very good at it. However, I'm also very dedicated, so I'm willing to do the research. I'm a pretty knowledgeable person in general, but I don't know everything, like advanced material for a biology thesis or math research paper. That would take almost anyone time to research.

I'm pretty sure I sell myself short quite a bit with my rates, but since I don't do it as a paid thing that often, I'm okay with it.

amother

Mustard

Thu, Oct 31 2019, 11:49 pm

amother [ Pearl ] wrote:

So you have a 2 year master's degree, and then you worked for 5 years, under supervision, at no pay at all?? Is this typical? I honestly did not know this is how it's done

amother

Pearl

Fri, Nov 01 2019, 12:18 am

amother [ Mustard ] wrote:

So you have a 2 year master's degree, and then you worked for 5 years, under supervision, at no pay at all?? Is this typical? I honestly did not know this is how it's done

So mine was a 3 years masters program. Then I did 5 years of unpaid labor to get my hours to take the exams for license. I couldn't get a paid internship in my field (not lcsw) especially since I wouldn't work on Shabbos (many places required that as clinics want to be open on weekends). Where I live most of the internships are unpaid just in general...
I know not everyone has the same experience I had but when I am ready to open a private practice, I am not going to want to make $40 an hour. Even though that's more than I make now... (Yep. I make less than that with full state licensure.) Especially given the huge risks private practice has (legal requirements, liability, taxes, insurance, you don't get paid if you have no clients...).

giselle

Fri, Nov 01 2019, 12:44 am

amother [ Pearl ] wrote:

I’m confused as to why you worked for 5 years without getting paid.

amother

Pearl

Fri, Nov 01 2019, 12:59 am

giselle wrote:

I’m confused as to why you worked for 5 years without getting paid.

I couldn't find one paid. I know others who did the same thing too. Maybe not 5 years but a few years unpaid is normal where I live. You need a certain number of experience hours to get the license (plus exams, paperwork, background checks etc). If a client doesn't show that doesn't count, paperwork and client notes do not count etc.
it all depends on your internship and what kind of hours you can get. Mine gave good experience but not the "right ones" for the state.

We don't talk about working for free. Then they think we are worthless even though they see marked improvement. My clients had no idea I and the other interns worked for free. It was a low cost clinic place so their fee paid for the printer paper, electricity etc. they probably thought we got some grant or donation and were raking it in. Ha.

giselle

Fri, Nov 01 2019, 1:06 am

amother [ Purple ] wrote:

You need a certain amount of clinical hours for licensure . If you can’t find a paid internship , then you take an unpaid one - otherwise you can’t get your clinical license (which allows you to open a private practice ).

If we’re talking about a social work degree, you need two years of internship. After that you can get a job earning hours toward your clinical license. At least in NY and NJ. I’ve never heard of anyone working for free for 5 years. Once you graduate it’s no longer called an internship. Or are you talking about psychology?

amother

cornflower

Fri, Nov 01 2019, 1:24 am

I just wanted to weigh in:

I am a speech therapist in private practice. I charge $80 for a 1/2 hour session, which amounts to $160 an hour so it’s way less than a social worker in private practice, but some would consider that very expensive and think I’m ‘raking it in’.

I also have a very specific specialization and bH see a lot of hatzlacha with my clients, which is why I have a very long waiting list.

I worked for several years at very low-paying clinics to gain experience (after my 4 year bachelor’s and nearly 3 year’s Master’s, and after my CFY year where I worked also for practically nothing). I have many years’ experience and spend HOURS researching each month and collaborating with other professionals. I take courses all the time and constantly develop new programs. For every session I do, there is preparation, note-taking, other paperwork, and often speaking to parents/teachers/other therapists, etc.
The numerous extra hours are, for the most part, not reimbursed. So when you’re paying for your sessions you’re really getting much more.

Aside from that, I am in a solidly middle class position, and not eligible for government programs. With my ‘high’ salary, we often don’t make ends meet. I love how people count others’ money when they really have no clue...

There are therapists who take Medicaid and/or other insurances, and there are therapists who charge lower rates. Some might be wonderful, and some are not.

It is a free country and people can go wherever they want. No one is being forced to use my (or any other therapists’) services.

I think after my schooling (with loads of student loan debt to boot), experience, research, and dedication, I have earned the right to charge what I feel I am worth. It is up to the client to use my services or to seek cheaper services elsewhere.

It is also important to note that there are many, many overhead expenses of which your average client is simply unaware. Liability and malpractice insurance, billing system, bookkeeper, materials (and especially testing materials which I keep updating and upgrading), technology when appropriate, credit card fees, etc. The expenses cost waaay more than you could ever be aware of if you don’t run your own private practice.

With that being said, I think it is up to each and every client to be an educated consumer, whether they are seeing a psychotherapist, speech therapist, or any other kind of professional. Always ask about their training, experience, etc. and have a clear idea of the goals and why those were chosen. Question the therapist if you don’t feel you’re seeing progress.

There will always be those who are either unscrupulous or just really not aware of how mediocre their services are.

But for the most part, I find that you get what you pay for (though not always). Unless someone is seriously off the charts with regard to what they charge (as compared to similar professionals around them) I wouldn’t bash them or accuse them of price gouging. They have a right to charge it. You have a right to seek services elsewhere.

ora_43

Fri, Nov 01 2019, 2:19 am

amother [ cornflower ] wrote:

It is a free country and people can go wherever they want. No one is being forced to use my (or any other therapists’) services.

The problem is that this isn't entirely true.

If someone wants a therapist, they need a qualified therapist.

And the number of qualified therapists is artificially low. This isn't a free market where any person smart and kind enough to be a therapist can decide the salary looks good to them, and make the transition.

In Israel, they'd have to compete for one of a limited number of spots in university.

In America, they'd have to come up with a mind-boggling (to many people) amount of money to pay for not only undergrad and graduate, but years of unpaid/underpaid internships. It might not officially weed people out, but unofficially, it's not a process most people can afford.

I'm not saying that therapists don't need training, but you can't expect supply/demand to work in the same way that it does with, say, content writing, or website design, or translation, or any one of hundreds of other professions that anyone can join just by declaring themselves a member. If you want a content writer, you can choose from anywhere on the spectrum, anything from an expert with a portfolio full of beautiful work who charges accordingly, down to someone who just started advertising as a content writer on Wednesday because hey, anyone can write, right?

If you desperately need help from a psychologist, you can choose anything from a highly trained expert who charged $350 an hour, to a highly trained non-expert who charges $150/hour.

Add to that the fact that access to psychological treatment is literally a question of life or death for many people, and of course there's frustration.

ora_43

Fri, Nov 01 2019, 2:24 am

Just so it's completely clear -

the unwritten conclusion to that last post wasn't "... which is why any untrained idiot should be allowed to advertise their services as a psychologist."

But we, as a society, do need to either:

- make it much, much easier to get professional training, not necessarily in terms of hours or the effort students need to put in, but in terms of things like the test scores required to get in (a perfect grasp of English and SAT-level math is not necessary here) and tuition fees.

- recognize that supply/demand doesn't work in this profession, and find a way to close the gap.

Ideally, both.