Episode Overview

Title: Episode 160: The Three Money Realms of Private Practice
Hosts: Dr. Kate Campbell & Katie Lemieux
Guest: Deb Lehman, LCSW, Therapist, Clinical Supervisor & Consultant
Date: November 2, 2019

In this episode, Kate and Katie sit down with Deb Lehman, an experienced therapist and clinical supervisor from Oakland, CA, to unpack the tricky topic of money in private practice. Responding to popular demand, they explore Deb’s signature framework—the three realms of money in private practice: business, clinical, and personal. Through candid storytelling and practical advice, Deb encourages therapists to examine their own money stories and learn how personal beliefs, clinical dynamics, and business realities intersect to shape private practices. The conversation includes advice on setting fees, confronting personal money narratives, and having honest money conversations with clients.

Key Discussion Points & Insights

1. Deb’s Journey and the Origin of Her Money Mindset

• From Scarcity to Ownership:
  Deb describes starting her private practice just as the Great Recession hit, which amplified her pre-existing scarcity mentality. She explains how fear-based messages around money led her to set fees emotionally rather than logically (03:50-05:15).

  • Quote: “When I set my fee initially...I was like, okay, let me look on Psychology Today and see what everybody else is charging. Let me see what my supervisor is charging...and try and land on something that won't upset anybody. Right. So not the way to do it. Like, there was no math involved in that at all. Right. It was completely emotional.” – Deb Lehman (04:00-04:53)

• Learning through Supervision:
  Supervising newer clinicians, Deb noticed how pervasive fear and confusion around money were in the field, motivating her to share what she learned the hard way.

2. Demystifying Fee Setting: “You Have to Do the Math”

• Reverse-Engineering Your Practice:
  Deb emphasizes a systematic approach: tally up business and personal expenses, factor in taxes and desired time off, and divide by the number of sessions to find your average required fee.

  • Quote: “That's got to be your average fee, right?...If you're going to slide at all, if you're going to take insurance...you need your full fee in quotes to compensate for that.” – Deb Lehman (05:22-06:14)

• Emotional Response to Fees:
  Recognizing that “the fee number is almost always emotionally charged,” Kate and Deb discuss the importance of acknowledging reactions to the “math fee,” not just the number itself.

  • Quote: “For a lot of people, it's oh, crap, right? Or oh, no, I can't dare charge that...But inevitably there's an emotional response to that.” – Deb Lehman (06:15-06:27)

3. Introducing the Three Money Realms

• The Business Realm:
  Practical systems, including tracking income and expenses, deciding on billing practices, and setting policies. Deb references the Profit First system as a helpful model.

• The Clinical Realm:
  The symbolic meaning of money in therapy—how both client and therapist bring money-related emotions, histories, and meanings into the clinical space.

  • Quote: “There's all of that going on, the symbolic, and then there's the personal. Our own money stories, all of what we're bringing to it, all of our own biases, all of our own fears.” – Deb Lehman (08:24-10:38)

• The Personal Realm:
  Deep dives into therapists’ personal money stories—family of origin, gender roles, cultural and societal messages, financial trauma, and core beliefs about worth and work.

• Bonus: The Cultural Context:
  Deb adds that all these conversations are happening within a broader cultural and socioeconomic context—economic downturns, inequality, geographic realities, and more.

  (12:19-13:13)

4. Examining Your Money Story

• Reflection Questions:
  Deb urges therapists to explore their upbringing, gendered expectations, class background, and family incidents involving money.

  • Prompt: “What messages did you receive? If you grew up socialized female about money and your capacity to earn? What based on your social location, your class background, what messages did you receive about money?” – Deb Lehman (13:23-14:06)

• Host Reflections:
  Both Kate and Katie share their own family money narratives—one learned “you have to work hard to make money,” the other had a history of spending tied to “I work hard, I deserve this.”

  • Quote: “I've always been like a spender historically. And the belief underlying that is, I work hard, I deserve this.” – Katie Lemieux (14:47-15:25)

5. The Clinical Tensions of Therapy Fees

• The Client’s Perspective:
  The hosts discuss how clients might experience paying for therapy, sometimes resenting the need to pay for something—especially when rooted in childhood lack.

  • Quote: “...so many people come in, they don't want to have to be paying for therapy. They wanted things to have gone differently early on so that they wouldn't be needing therapy in the first place.” – Deb Lehman (17:11-18:14)

• The Therapist’s Dilemma:
  Deb explores the tension that “most people are paying too much for therapy, and all therapists are getting underpaid at the same time,” underscoring the challenge of separating clinical value from the fee amount (16:57-17:39).

6. Navigating the Overlap: The “Sweet Spot” of the Three Realms

• Holding the Tension:
  The key is finding balance—not over-indexing on business (“the fee is the fee, take it or leave it”), nor being overly accommodating on the clinical side to the detriment of the business.

  • Quote: “Being in that sweet spot is being able to hold the tension...If we can hold the anxiety about that a little bit and get really curious and compassionate, I think that can deepen so much.” – Deb Lehman (20:19-23:03)

• Case Examples:
  Deb and the hosts share tangible examples: managing resentment with sliding scale clients, setting clear boundaries, and openly discussing money with clients.

  • “If you do, don't do it. Don't do it. It's really, really bad for the therapy.” – Deb Lehman, on agreeing to a fee that breeds therapist resentment (23:54-24:01)

• Script for First Calls:
  Katie shares her approach of asking, “Was that what you were expecting?” when quoting fees to new inquiries, making the money conversation a natural part of client selection (24:16-25:37).

7. Why Facing Money Conversations Deepens Clinical Work

• Personal Growth and Professional Success:
  Tackling the money topic leads to a more robust business and richer therapeutic work by opening up new arenas for self-reflection and client engagement.
  • Quote: “Not only will ultimately you be able to have a more successful business because you’ll feel more comfortable having those money conversations, but your clinical work is also going to really deepen because there’s going to be this whole realm that is so, so meaningful...” – Deb Lehman (27:36-28:41)

Notable Quotes & Moments

| Timestamp | Speaker | Quote / Moment | |-----------|---------------|-------------------------| | 04:00 | Deb Lehman | “Let me try and land on something that won't upset anybody. Right. So not the way to do it. Like, there was no math involved in that at all. Right. It was completely emotional.” | | 05:22 | Deb Lehman | “You have to do the math. You have to figure out what your expenses are...and then divide that number...to get the number that you need to gross, and then divide that by the number of sessions you're planning on doing.” | | 10:38 | Deb Lehman | “It gets overwhelming, it gets super complicated to think about all those things. Nice.” | | 14:06 | Kate Campbell | “I know that my biggest money tape is you have to work hard to make money. And that definitely came from there. Always had to be some type of exchange to make money, and that's really not true.” | | 17:37 | Deb Lehman | “We’re all worth getting well compensated for the work that we do…It really has nothing to do in some ways with what you’re ultimately going to charge.” | | 20:19 | Deb Lehman | “Being in that sweet spot is being able to hold the tension...There’s a reality that the therapist has their own needs and at the same time, this is meaningful in both concrete and symbolic ways for the clients.” | | 24:00 | Deb Lehman | “If you do, don't do it. Don't do it. It's really, really bad for the therapy.” (on agreeing to a fee you’ll resent) | | 27:36 | Deb Lehman | “This is an area that can be so intimidating for so many people, but that when you really start to explore and get into it…your clinical work is also going to really deepen...” |

Timestamps for Key Segments

• [02:35] – Deb’s early struggles with money and scarcity in private practice
• [05:22] – How to reverse-engineer your fee and “do the math”
• [08:24] – Introduction of the Three Realms: Business, Clinical, Personal (and the extra “cultural” context)
• [13:23] – Self-inquiry questions about money history
• [16:57] – The inherent contradiction in therapy finance (“clients pay too much, therapists earn too little”)
• [17:37] – The feelings clients bring to paying for therapy
• [20:19] – How to find the “sweet spot” and balance all three realms
• [24:16] – Scripts and strategies for handling money conversations with prospective clients
• [27:36] – What Deb hopes listeners will take away about confidence and depth in clinical work

Resources Mentioned

• Book Recommendation: “The Energy of Money” by Maria Nemeth
• Private Practice Calculator Worksheet: A tool from the podcast hosts for fee planning (28:41)
• Deb’s Free Download: “5 Questions You Need to Ask Yourself Before Talking About Fees with Clients” (29:13)

Summary Takeaway

“When you really start to explore and get into [money], not only will you be able to have a more successful business because you’ll feel more comfortable having those money conversations, but your clinical work is also going to really deepen.” – Deb Lehman (27:36)

This episode offers private practitioners a powerful invitation: examine your money stories, embrace business savvy, and don’t shy away from candid money conversations. By integrating business realities, clinical nuance, and personal exploration, therapists can set sustainable fees, foster honest client relationships, and ultimately enrich both practice and therapeutic outcomes.