Episode #670: Insurance vs Private Pay

Summary

Abundant Practice Podcast: Episode #670 – Insurance vs Private Pay

Host: Allison Puryear
Guest: Laura
Release Date: July 23, 2025
Duration: Approximately 26 minutes

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Introduction

In Episode #670 of the Abundant Practice Podcast, host Allison Puryear engages in a candid conversation with Laura, a therapist navigating the complexities of running a private practice. The episode delves deep into the dilemmas therapists face when deciding between insurance-based billing and private pay, exploring the emotional and practical implications of each choice.

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Laura’s Journey and Current Challenges

Starting the Practice: Laura began her private practice eight years ago while still employed at an agency. Over time, significant life events, including the pandemic and the birth of her two children, influenced her professional trajectory. This period allowed her the flexibility to be present with her young family but also led to a slower-growing practice primarily sustained through word-of-mouth referrals.

Feelings of Conflict: Laura expresses a profound internal conflict regarding the idea of accepting insurance. She shares:

Laura [02:27]: "I just feel like a failure if I take insurance. It feels like I've... I didn't make it... I wasn't enough on my own."

This sentiment underscores a common struggle among therapists who prefer maintaining autonomy and quality of client care over the perceived compromises of insurance involvement.

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Exploring Insurance as an Option

Potential Benefits: A psych nurse practitioner in Laura’s network offers to fill her caseload with vetted clients if she opts to take insurance, presenting a tempting solution to her slow practice growth.

Allison’s Reframing: Allison addresses Laura’s feelings of failure by reframing the decision as an active choice rather than a fallback or a measure of success:

Allison [04:43]: "You're not failing. You're making an active choice, period."

This perspective helps Laura see the option of taking insurance not as a personal shortcoming but as a strategic business decision.

Practical Considerations: Allison provides practical advice on navigating insurance complexities:

• Credentialing Process: It typically takes about three months to get credentialed.

Allison [07:25]: "A lot of insurance companies won't tell you what you're going to be paid until you've already signed a contract."

• Clawbacks: While relatively rare, clawbacks are a concern and require meticulous documentation and adherence to insurance requirements.

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Overcoming Bureaucratic Hurdles

Navigating Big Companies: Laura expresses skepticism about large insurance companies like Alma, citing negative experiences and concerns about their intentions.

Allison [11:13]: "I don’t believe any of these companies have our best interest at heart... it's a weird, mean, bad loophole."

Alternative Strategies: Allison suggests:

• Hiring Assistance: Employing someone to handle credentialing and paperwork.
• Utilizing TherapyNotes: Leveraging platforms that simplify insurance-related tasks.

Preparedness: Allison recommends having credentialing information ready in CAQH to streamline the process when needed.

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Reframing Financial Conversations

Changing Money Mindsets: The discussion shifts to the uncomfortable nature of discussing money within therapy practices. Laura shares her anxiety over raising rates and communicating these changes to clients.

Laura [22:34]: "In eight years I've successfully raised my rates one time by $10. I raised them again recently so I was like, this is a ridiculously low rate."

Allison’s Encouragement: Allison encourages Laura to confidently adjust her rates, emphasizing that increasing fees is a valid and necessary step for sustaining her practice and personal well-being.

Allison [22:58]: "You could have a really small practice at a premium rate and take care of your family."

Practical Steps:

• Incremental Increases: Gradually raising rates for new clients to test comfort levels.
• Communication Practices: Practicing phone calls and discussions about rate changes in therapy to build confidence.

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Defining the Ideal Client

Shifting Niches: Laura reflects on her evolving ideal client, transitioning from working with teens and young adults to focusing more on new mothers. Allison validates this natural shift:

Allison [17:57]: "It almost always is... it's okay that that shifts."

Flexibility in Practice: Emphasizing that niches can evolve over time, Allison reassures Laura that adapting to new client demographics does not compromise her practice’s integrity or success.

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Key Takeaways and Insights

1. Active Choice vs. Failure: Deciding to take insurance should be viewed as a strategic business decision rather than a personal failure.

2. Practical Preparedness: Streamlining credentialing processes and utilizing supportive platforms can mitigate the administrative burdens of insurance billing.

3. Reframing Money Conversations: Therapists need to overcome discomfort around financial discussions to ensure their practices are sustainable and fulfilling.

4. Evolving Niches: It's natural for a therapist’s ideal client profile to change over time, reflecting personal growth and shifting interests.

5. Support Systems: Leveraging professional networks and seeking external support can provide the necessary guidance and confidence to implement significant changes.

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Notable Quotes

• Laura [02:27]: "I just feel like a failure if I take insurance. It feels like I've... I didn't make it... I wasn't enough on my own."

• Allison [04:43]: "You're not failing. You're making an active choice, period."

• Allison [11:13]: "I don’t believe any of these companies have our best interest at heart... it's a weird, mean, bad loophole."

• Allison [22:58]: "You could have a really small practice at a premium rate and take care of your family."

• Allison [17:57]: "It almost always is... it's okay that that shifts."

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Conclusion

Episode #670 of the Abundant Practice Podcast offers a heartfelt exploration of the internal and external factors influencing a therapist’s decision to accept insurance. Through empathetic dialogue and practical advice, Allison Puryear helps listeners navigate the often complex landscape of private practice management, emphasizing the importance of making choices that align with personal values and professional goals. This episode serves as a valuable resource for therapists seeking to balance financial sustainability with the desire to provide meaningful, quality care to their clients.

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Resources Mentioned:

• Abundance Practice Building: abundancepracticebuilding.com
• Alma: Alma Platform
• TherapyNotes Offer: Use promo code Abundant at therapynotes.com for two months free.

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Join the Conversation:
If you're grappling with similar challenges in your practice, consider reaching out to the Abundance Practice Building team for personalized support at [e-mail].

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This summary encapsulates the key discussions and insights from Episode #670, providing a comprehensive overview for those who have yet to listen.

Transcript

[Laura]

Foreign.

[Alison]

Hi, welcome to the Abundant Practice Podcast. I'm Alison from Abundance Practice Building. I have a nearly diagnosable obsession with helping therapists build sustainable, joy filled private practices. Just like I've done for tens of thousands of therapists across the world. I'm excited to help you too. If you want to fill your practice with ideal clients, we have loads of free resources and paid support. Go to abundance practice building.com Links all right, onto the show. So I've talked about therapy notes on here for years. I could talk about the features and the benefits in my sleep. But there are a couple things I want you to know about therapy notes that doesn't typically make it into an ad script. First is that they actually care if you like their platform. They don't only make themselves available on the phone to troubleshoot so you don't pull your hair out when you get stuck. They also take member suggestions and implement those that there's client demand for. Like Therapy Search, an included listing service that helps clients find you internal and external secure messaging. Clinical outcome measures to keep an eye on how your clients are progressing. A super smooth, super bill process. Real time eligibility to check on your client's insurance. In my conversations with the employees there at all levels, they all really believe in their product and they want you to love it too. Second, they are proudly independently owned. Why should you care about that? Because as soon as venture capital becomes involved, the focus shifts from making customers happy to making investors happy. Prices go way up. Innovation plateaus. Making more money with as little output as possible becomes the number one focus. With over 100,000 therapists using their platform, they've been able to stay incredibly successful and they don't have to sacrifice your experience to stay there. You can try two months [e-mail] with the coupon code Abundant. Hey Laura, how you doing?

[Laura]

I'm good. How are you?

[Alison]

I'm good, I'm good. What would be helpful today?

[Laura]

All right, so I feel like if you don't mind, I'm going to start talking about like a little bit about my practice and how it started and kind of where it is now and like kind of the pathway that I'm seeing for myself. Yeah, so I started this practice like maybe eight years ago while I was working at an agency and since then I don't know if you heard about like the pandemic happened, you know.

[Alison]

Oh yeah, I heard about that. Yeah.

[Laura]

Then I also had two kids and so I kind of eased off the throttle a little bit with all that. And luckily my Partner makes enough for us to be comfortable. Like, we're fine. We're content. Like, we're not, like, crazy, but, like, you know, we're comfortable, we're fine. So that kind of allowed me the flexibility while the kids are young, to be home with them as much as possible. Another good part about that is I hate networking and marketing. I would rather die.

[Alison]

Okay.

[Laura]

So kind of nice. It's like. It's just like, word of mouth and, you know, people who know me or like, you know, that kind of referrals have been coming in. I'm just not good at it. I don't like it. But as a result of completely my own doing, my practice is slow. I don't take insurance. I never have, and I've never really thought about it until now. I live in Maryland, so right now, things in this area feel very unstable. And with my partner's job, we don't really know what's going to happen. Right. And so whereas this is a very new thing for us. And so we've been talking about, what's our next plan? If something were to happen, we need to have a plan in place, and that plan would be me taking insurance.

[Alison]

Okay.

[Laura]

And I just feel like a failure if I take insurance. It feels like I've. I didn't make it. Like, I just didn't cut it right. Like, I wasn't enough on my own, when really you have to, like, do the work. And I didn't do it because I don't like it.

[Alison]

Right.

[Laura]

And another piece that's kind of important in this is I have a really good relationship with a psych nurse practitioner, and she was like, laura, if you take insurance, I can fill your caseload tomorrow with people that you want to see, and then I've already vetted, and they would be a good fit for you.

[Alison]

Okay.

[Laura]

And so it seems like a good deal, but I don't know that I. I'm having a hard time working past this idea that insurance means failure.

[Alison]

Okay. So here's what I want to introduce is the idea of you're not failing. You're making an active choice, period. The choice is, do you want to network and market or do you want to take insurance? And you sound so clear.

[Laura]

Yeah, I don't want to do it.

[Alison]

So, Laura, that's honoring what you want and need in your life.

[Laura]

Okay?

[Alison]

Not taking insurance and networking and marketing when you don't want to. That's chasing somebody else's goals and dreams and wants for themselves. And you don't want to do that.

[Laura]

Shit I'm just not good at. Like, if that's my skill set, like, that's just not me. And I also feel like since my practice has been slower, I don't know if this is actually true. I don't think it's actually true. But my mind is saying, well, you haven't had any, like, really tough cases. Like, maybe your skills aren't what they were. So how can you go around and being like, I can solve all your problems, and here's what I'm so good at. Even though I know my skills, I know I'm good at what I do. But, like, there's, like, blockage that's like, you've been taking it easy.

[Alison]

Well, I think there's also, like, I was having a conversation with a good friend not long ago who was like, been doing it long enough. Therapy's easy. She's like, I'm. It's easy for me to attend to my clients. It doesn't take the same kind of work it used to. To be present, to be mindful, to conceptualize. Like, it's a muscle that I flex so much that it feels easy. And, like, maybe you're there.

[Laura]

Yeah, maybe that's what it is. I'm just not used to it being like, oh, yeah, I can do that. Because, like, that's. That's a good point. That it doesn't feel the same as when I started 10 years ago, because it's not like.

[Alison]

Right. And it may be that you have easier clients now than you had back then. It could be like, a combo. But that doesn't mean you need to start taking on really hard clients.

[Laura]

Yeah, right.

[Alison]

Just because you take insurance doesn't mean you're going to take on a bunch of hard clients. Yeah, it's okay to stick with the ones that feel, like, smooth and easy. I think there's this, like, therapist martyrdom thing that happens. Right. Where we feel like we're supposed to. Because we work with struggle, we feel like we, too, have to struggle. And I think that our clients are best served when we're not struggling so hard in our business or our lives. Like, it's inevitable that that will happen sometimes, but we don't need to manufacture.

[Laura]

It, you know, need to create these problems for myself.

[Alison]

Right. It sounds like taking marketing and networking creates that struggle for you, whereas having somebody already vetting the clients, ready to hand them to you, somebody that you trust and like and know, I mean, that's a pretty sweet deal, right?

[Laura]

Am I okay? I'm not, like, overly Missing something. I'm not.

[Alison]

I mean, I think the only thing that I'm speaking to that I would probably need to know to say everything I'm saying most accurately is, like, if the insurance company is a pain in the ass or they don't pay much and probably they pay less than your full fee. But, like, is it a reasonable amount? Is it something you can live comfortably on?

[Laura]

Yeah, that's. And I think since I haven't ever taken insurance, and obviously when I was at an agency forever ago, I never had to deal with any of that. I think I'm so afraid of breaking a rule. Like, I met with a company called Alma. Have you heard of that? So I met with them and they gave me their rates, But I'm a little leery of signing on with a big company like that because I use therapy notes, and my own therapist uses therapy notes, and she takes insurance. And she was like, it's the easiest thing in the world.

[Alison]

Yeah, just click a couple buttons.

[Laura]

Yeah, yeah. And so I. I need to look into if I can fill out that whole, like, is it the CAQ thing, See if I can find out what my rates would be as a solo. I don't know if that's allowed because they've already been given rates through Alma and what they could pay me. So I need to look into if that's okay, that I can kind of contrast and compare, but it seems like that, yeah. Would be fine.

[Alison]

Well, a lot of the insurance companies won't tell you what you're going to be paid until you've already signed a contract to work with them. And therapists are not supposed to disclose to one another what they get paid, but they do all the time. So I would find a therapist in your zip code who has the same degree you do, the same license you do, and just who takes it. And ask them, isn't that, like, not.

[Laura]

Okay, that we're just expected to just, like, sign on and be like, oh, a dollar an hour. Cool.

[Alison]

Yeah.

[Laura]

So much.

[Alison]

Ridiculous. It's like they'll say it in the contract, but it's like an equation that doesn't, like, nobody knows how to do. You could probably enter it into ChatGPT these days or something. But I remember getting my contract a million years ago when I was, you know, I didn't really know what I was doing, and I was like, oh, yeah, sure. I don't know what this is going to equal when it's like, whatever Medicaid pays times this thing or plus this thing that. But it was not just a straight up number, but a person in your zip code with the same license as you will be able to tell you.

[Laura]

Okay, so, yeah, that seems obnoxious.

[Alison]

And there are things like that with insurance that are obnoxious and that's another part of what you're signing up for. So in terms of breaking rules, I would make sure that you keep your notes done, like buttoned up. Medical necessities in everyone. Like, you're hitting the main points that insurance wants to see if and when they audit you so they don't pull clawbacks. And we talk about clawbacks a lot. I hear about clawbacks a fair amount. But when you think about the. I mean, I work with tens of thousands of therapists and it's only like a few that I hear from every year that got clawed back, you know, like maybe 20. So that's not awful percentage wise. I think they are happening more often. So I would just get really clear. The insurance is going to be very opaque when you're like, what do you need in your notes? They're not going to tell you.

[Laura]

Okay.

[Alison]

But medical necessities in there and there are some like, paperwork experts who can kind of walk you through.

[Laura]

Okay. It just, it feels all so overwhelming and that's why it's always just been easier not to. And to be honest, if my husband's job wasn't the way that it is right now, I probably wouldn't be having this conversation. Yeah, right. Like, it just wouldn't. I would just keep doing what I've been doing and everything's been fine. But I'm wondering now as I'm talking to you if this really should be just a plan B in case anything happens.

[Alison]

It can be a plan B, but it might take about three months to get credentialed.

[Laura]

That would be. So we can, we can make that work.

[Alison]

Okay.

[Laura]

Not ideal, but it's. That would be okay. Do you have strong thoughts about big companies like Alma? Because for some reason I'm very cautious about signing out with them.

[Alison]

Yeah, I feel like all those big companies do not have our best interest at heart. It's so interesting. I just was talking literally the 30 minute slot before yours, we were talking about. Alma hasn't sent this person anybody since January and she's paying the $125 a month or whatever and it's like stressful. But I really don't believe any of these companies have our best interest at heart or our cl. Best interest at heart. I mean, I don't think insurance does either. But to have two companies that don't.

[Laura]

Have anybody's best interest at heart working against us.

[Alison]

Yes, actively. There's all this interesting stuff about how some of them are being bought or partially bought by insurance companies. And so what happens is these insurance companies will be like, yeah, yeah, because we own part of this company, we will pay you more per session and Than people that are credentialed with us in other ways. And it gives them this loophole, because insurance has to. Basically, a certain amount of their money that insurance companies make has to go towards medical costs. And so they can buy these companies, which is going towards a medical cost, and then they can pay more. So it's kind of like this weird, mean, bad loophole. Instead of them just, like, taking care.

[Laura]

Of people, wouldn't that be fucking cool? Like, can you. Can we just all be cool? Just all be normal? Be insane?

[Alison]

Yeah. So I don't like these middleman companies, and I know some of them have, like, reduced rates on people kind of seemingly out of nowhere. And so it just feels. It just feels less stable to me.

[Laura]

Yeah, something was just kind of holding you back that I was like, I just don't know. Like. And part of it, honestly, was just I had to switch. I went from simple practice to therapy notes. Now I have to use their stuff. Like, oh, but you don't have to. But everything's on there. I'm like, then why am I paying both therapy notes and Alma for nehr? It doesn't make sense.

[Alison]

Yeah.

[Laura]

But then I was talking to that nurse practitioner, and she was like, I mean, good luck. Like, taking journals. Like, we've tried and it's been awful, but also they're a huge practice and they were doing, like, primary care, like, not mental health stuff. They were everything. And she was like, oh, it was just a nightmare. But that's way different than what I would be doing on my own.

[Alison]

100. Yeah. The insurance side, like, in terms of filing and all that, with something like TherapyNotes, is super easy. Really? Like, you just click buttons. And I can do that? Yeah, you can click buttons. So that. That part's a lot less intimidating. But what I might do is I might suggest you get, like, all your CAQH stuff in to CAQH and just let it sit there.

[Laura]

Okay.

[Alison]

So that if you do need to, like, go for it, you can just click the button. And it's not like, oh, no, I need to gather this stuff. And now instead of three months, it's taking me like, three and a half months because I Had to gather stuff for two weeks. So just having that, like, plan B ready to go.

[Laura]

I didn't realize I could do that and then not immediately sign on, I believe.

[Alison]

So I think you can, like, save, like, your info.

[Laura]

Perfect. Yeah. I got, like, halfway through it with Alma, and then I was so mad that I just stopped. So I was like, this is why I didn't want to do this. I hate doing it.

[Alison]

It's a lot of bureaucracy. You could also consider hiring somebody to do it. There are people out there who will get you credentialed. Ultimately, you're kind of doing the same thing because you're still going to have to get them a bunch of information.

[Laura]

To get it all.

[Alison]

Yeah, yeah. So it's kind of like hiring somebody to do your billing when all you have to do is push two buttons.

[Laura]

Okay. See, I like the reframe of, like, this is just a choice that I'm making for my own sanity because I genuinely don't like marketing, and I know there are some, like, inner work that I need to be doing and have been doing in my own therapy of, like, why do you hate this? It's because you hate putting yourself out there and saying, like, hey, I'm good at this and you should hire me. Which is apparently a really uncomfortable thing to do. And it's also hard when you do send out emails and you don't hear anything back. And it's like, do I just keep pestering these people? Do I just keep, like, doing the same thing? But I can't go. I just can't, like, go up to my local high school and be like, hey, I want to meet with a counselor. Like, I can't. I can't do that.

[Alison]

Yeah. So, I mean, I think, yeah, working on the fear of being seen in therapy and the, like, owning that you're good at something and all of that. And not only are you good, it's easy now.

[Laura]

That's right.

[Alison]

Working on that is great. And I would work on that just for the sake of working on it. Not necessarily to get to a point where you're like, yeah, I want to have my own YouTube show. You know, like, if you decide to go that route later, amazing. But I would keep that maybe divorced from how you actually run your practice if. If it's a heavy lift, you know, like, I want you to just be able to work on being seen without your income depending on it.

[Laura]

Yeah, I'm sure that would be very. And yeah, I'm doing that within my own personal life. And I. Yeah, we can start kind of transitioning into, like, all aspects of life. Like, it's okay to know what you want and know what you're good at. And I remember, um, one of my supervisors in grad school was like, you need to know what you're good at.

[Alison]

Mm.

[Laura]

This is. Okay. It's not bragging. And I was like, oh, that's. She's like, yeah, how else are you going to do this job? I was like, I don't know. I just thought I'd just show up.

[Alison]

Just show up and do whatever job I did and hope it's good. Yeah.

[Laura]

Fingers crossed. Okay. Okay.

[Alison]

Yeah. You're making an active, educated choice about what works best for your life and your family.

[Laura]

And I also can't feel pressured to make a decision because someone else has clients that need to be served. I think that's another piece of it, too. I feel bad, like, there's people that want to be seen, and if I don't take insurance and I can't see them. But that's a choice I need to make for myself and for my family and how we're running right now.

[Alison]

Yeah. Because there are lots of people with schizophrenia that you could see right now. But I don't think that's your niche. You know, like, there are lots of people who are not interested in being in therapy but need it, and they're not your people either.

[Laura]

Yeah.

[Alison]

And so it's like, if we start to put pressure on ourselves of, like, we have to take care of people, then when you start expanding it to you have to take care of all people, you start realizing how, like, ultimately ridiculous it is. Right. You need to take care of the people that it works for you to take care of.

[Laura]

When I was thinking about my ideal client, because I've worked through some of this stuff in abundance and, like, trying to pinpoint it. Is it normal to feel like this is gonna sound so silly? My ideal client is who I was five to 10 years ago. I feel like it keeps shifting and I, like, keep getting like. Before, I loved working with teens and, like, more young adults. Now it's more like newer moms. I'm like, I feel like it's just who I was a little bit.

[Alison]

Yeah, it almost always is. I would say, like, probably, like, 90 something percent of the time, our niches, like a younger version of us. And, yeah, I used to love working with college students, and it was like, oh, they're just it, you know? And then I got older and I was like, oh, God, so tired.

[Laura]

I don't know what you're. I don't know what the words you're using.

[Alison]

Yeah. Can I get a translation, please? Yeah. And it's okay that that shifts.

[Laura]

Okay.

[Alison]

You know, and now my whole entire niche, not just the demographic, but my entire niche, has shifted. And that's great.

[Laura]

You know, I wasn't sure if it was something that should be, like, set in stone and, like, focused on and that's what other people did was like, this is who I work with. And, like, that's that.

[Alison]

Yeah. I mean, I think ultimately, yes, for an extended period of time, but not forever.

[Laura]

Okay.

[Alison]

And you will get people who are not your ideal clients but are very similar to them in different ways, you know, so, like, my eating disorder clients that I love, I ended up getting a bunch of people on my caseload who are business owner, perfectionist driven types. There's a lot of overlap in, like, the compulsion. But they didn't have any food and body stuff. They were just trying to make shit work with their businesses. And so whatever. Even though my whole website is like, eating disorders. Eating disorders, you know, and that's just. They were attracted to the other pieces of what I was saying.

[Laura]

Okay. It's funny when, like, you know something like, I know that to be true, but hearing someone, like, reassure that is very helpful.

[Alison]

Yeah. Yeah.

[Laura]

Because I feel like when I do and I know this is true, like, when I was working through it, I'm like, it's okay if it's not. Like, other people will come. Like, they will still resonate with what you're saying. Yeah. I just feel like this was the first. This past school year was the first one where both of my kids were in school most of the time. Not all day. The most I've ever. The most freedom I've ever had.

[Alison]

Yeah.

[Laura]

And so I was like, just like, take a year and just, like, see what you want to do. Like, it's okay to just take some time and, like, get yourself figured out. And then now that the summer is coming, I'm like, oh, I should have gotten a lot more figured out.

[Alison]

I mean, you probably needed the rest that you got, and you can't. Like, what I am learning as I get older is you can't force the knowing of anything. You could have sat there and meditated every day and, like, journaled every day, and you wouldn't be any closer to knowing what you want than you do right now. Like, if you're leaving space for it, even if it's not hours and hours, it'll show up, you Know, as long as you're questioning.

[Laura]

Yeah. So now maybe next school year is where things will shift. Maybe like I said, like we just don't know what's going to happen. And so I think at least having a game plan of like it's okay to take insurance. Maybe not with a big company if there's some like there's something within me that's like I don't think I want to work with them. Even if it means taking less money through a direct insurance company. Company. I don't think that it's worth it enough. But yeah, I'm not a failure if I take insurance. That'll be.

[Alison]

Not at all. No. Just like you don't think anybody else is a failure if they take insurance, you know. Yeah.

[Laura]

These like crazy double standards that we put on ourselves. Like it's okay for you to take a break. No, you take a nap. If I take a nap, I'm disgusting. I'm the worst. Right. Totally do that. Yeah, that's helpful.

[Alison]

Good. I'm glad. I'm glad.

[Laura]

Yeah. Just these money messages can be confusing and I'm glad people are starting to talk more about money. But it's a very like viscerally uncomfortable situation sometimes. Right. Especially when we're being told we can't talk about it.

[Alison]

Right. I know, it's so. Yeah, it's ridiculous. It's ridiculous. And I think just in general the way we talk about money as therapists with each other but also with our clients, like the, the number of questions and things like that I would ask clients earlier on around like sex that I was so much more comfortable asking them those questions then like how do you feel about your financial situation? You know, where do you feel shame around money? You know, like those kinds of things I didn't bring up because I hadn't done any of that work myself. And so there's such opportunity for us therapists to like do that work and to be able to like take care of this whole entire side of our clients lives that is such an important part of their well being. Yeah, we just like don't touch with a 10 foot pole.

[Laura]

In eight years I've successfully raised my rates one time by $10. I raised them again recently so I was like, this is a ridiculously low rate. Like you've got to stop. But now anytime someone reaches out, I'm like, oh, it's this. But I can also do this if that's fine. Whatever you want is fine.

[Alison]

I mean Laura, I'd start there because it could be you could have a really small practice at a premium rate and take care of your family.

[Laura]

Yeah. Okay.

[Alison]

Even if you just took people on, like, only the new people were at a higher rate. I mean, in Maryland, you know, like, if you're anywhere near D.C. then, you know, 250 is not unheard of.

[Laura]

I charge 125, and I just raise it to 155, but no one is at that 155 because. Because it's me. Because I'm like, oh, 125 is fine. Don't worry about it. It's fine. It's fine.

[Alison]

Yeah. And how, like, what an interesting experience it would be if every time somebody new called and you change it on your website, but every time somebody new called, you said, like, sessions are $200, and you shut up.

[Laura]

There's the key piece.

[Alison]

Mm.

[Laura]

I. I think I just go back to it, but I. I don't know that I could afford 200, so, like, how dare I ask someone else to do that?

[Alison]

Laura, you just told me that your husband can float you guys financially. You can afford 200. It might not be your priority.

[Laura]

Yeah. Yeah, we could. Okay. That's fair. Checkmate. We honestly have been doing this a long time.

[Alison]

Yeah.

[Laura]

I also. There's concern about, like, raising new people, because it's like. Do I want to remind you that you pay me every week? Like, we talk about, like, me raising rates, and then you remember that, because right now, like, the card just gets charged, and we don't ever talk about it. But what if we talk about it?

[Alison]

Yeah. What if you do? What if you do?

[Laura]

So scary.

[Alison]

Because they know they're getting charged.

[Laura]

Yeah.

[Alison]

You know, they're not in fantasy land. They probably don't even remember how much it is unless they're people who are on top of their bank accounts, and they are, like, you know, looking at their budgeting, which most Americans don't do.

[Laura]

I tried, and by the end of the week, I was like, no, this is awful. I can't. Can't do it. Yeah. What if I just charge more? Yeah, I do that.

[Alison]

And if you start with new people that you don't even know.

[Laura]

Yeah.

[Alison]

It's easier for new people than established people. And if you make it 200 and.

[Laura]

Then I stop talking.

[Alison]

And then you stop talking.

[Laura]

Yeah. Yeah. That would definitely make us more comfortable, because obviously, my income helps, but, like, it's not enough to really do anything.

[Alison]

Yeah.

[Laura]

And then I shut up. I'm gonna run right down 200 and shut up.

[Alison]

Mm.

[Laura]

I might be able to do that.

[Alison]

Okay.

[Laura]

I'm gonna have to practice in therapy. Like, we're gonna practice phone calls.

[Alison]

I love it. I love it. And then you've got the backup plan of insurance. Yeah. Like, should you need it, it's always there.

[Laura]

This was good. Thank you so much. That's amazing. I don't know why I didn't think of, like, just asking people to pay me more. Because I can charge more. Because I've done this a long time, and I might be okay at it. I might be good at it.

[Alison]

Yeah. And can we just make that language a little stronger, please?

[Laura]

I'll work on it. No guarantee today. I have therapy tomorrow, so we will work.

[Alison]

Here we go.

[Laura]

Love it. Love it. So maybe this is a good, like, refresh to, like, look at the website again. We can. We can do this.

[Alison]

Yeah, absolutely. Awesome.

[Laura]

This is very helpful.

[Alison]

I'm so glad. I'm so glad.

[Laura]

Awesome.

[Alison]

I'll talk to you later.

[Laura]

All right, thank you. Bye.

[Alison]

Bye. If you're ready for a much easier practice, TherapyNotes is the way to go. Go to therapynotes.com and use the promo code abundant for two months. Free. If you're listening, you probably need some support building your practice. If you're a super newbie, grab our free checklist using the link in the show notes. I'd love for you to follow rate and review, but I really, really want you to share this episode with a therapist friend. Let's help all our colleagues build what they want.