If you have been a therapist in private practice, you have likely had the idea to provide free or pro bono sessions. This is likely because there have been times when a potential Client could not pay, or a Client you were seeing could no longer afford your services. As therapists, we want to help people and often have a strong desire to do so. When we see someone who cannot afford us, we feel bad, as we feel we are in a position where we can help. Compassion is a great thing, and can help many. Unfortunately, however, providing free therapy will likely pose problems in the future for you and your Clients.
Therapy Has Value
You may be wondering, how providing free therapy could be bad for a Client? After all, with therapy being free, the stress of the financial arrangement is removed. Less stress is good, right? The problem is that over time, with no cost and no sacrifice, the value of therapy will decline. As humans, we place value on how much something costs. Ask yourself this: if you had cancer, would you want to see the doctor who was $400.00 an hour, or one who is $50.00? You would assume that the $ 400.00-an-hour doctor was better, more qualified, and more able to help. You would listen more to this doctor, as that cost point would make them an expert. Would you listen as much, or do as much, for the doctor who charged $50.00 an hour? You would be happy with the cost, but over time, you would devalue his opinion due to its low price point. Therapy is no different. Over time, Clients will begin to dismiss you, since it costs nothing to see you, and requires no sacrifice.
Therapy Requires Sacrifice
Therapy is the process of change. True therapy involves helping the Client identify problems in their life, problems they want to address, and then assisting them in finding solutions to resolve their issues. Therapy can be challenging in the long run, as it often requires overcoming resistance to change. To take advantage of therapy, sacrifice is required, which for most is financial. If you, as a Client, are paying someone to help you change, then you will likely put more effort into it, as it has a recurring cost. You will want to listen to and work with the therapist, as the cost adds up over time. What happens then if there is no cost? For many Clients, they will lose any sense of urgency and fall back into past patterns of behavior. Since therapy is free, there is no sense of urgency. Many Clients will view it this way: “Since therapy has no cost, I can see the therapist forever if I wish. Therefore, I can take my time and do this at a comfortable, slow pace”. This is the mentality for many who receive free therapy. How do I know? I saw Clients pro bono for many years, and this was a pattern I saw for many.
Free Therapy = Stagnation
At first, things will likely go well. The Client will be pleased and view you in a very positive light. As the therapist, you will enjoy this feeling, as you will feel like a good person and that you are “helping”. For the first few weeks or months, things will go well. The Client will listen and work with you. However, as time passes, the thankful and positive feelings will fade, and therapy will become routine. The Client will begin to miss sessions, fail to complete homework assignments, and overall start to ignore you. Worse, they will see you as someone they can “dump” on, vomiting all their problems and issues on, but not willing to put in the hard work to change them. Over time, you will notice this and challenge them, which may work for a week or two, but then, this pattern of stagnation will continue. As a therapist, you can challenge this stagnation, and for a time, you may be able to defeat it. However, it will be your enemy until the relationship ends.
The Therapist’s Guilt
Over time, the therapist will see a lack of progress and the pattern of stagnation. They will work to combat it, but it will likely return repeatedly. The therapist will begin to think in terms of ethics. Providing therapy over time that is ineffective is unethical. Thus, you will start to think of terminating the relationship. However, because Clients who accept pro bono therapy are financially disadvantaged, you wonder if they will be able to find another therapist who will see them for pro bono. Most therapists will not. Or, as a therapist, you have a rare specialty, and wonder if you can find another therapist with that specialization who can provide pro bono therapy. Chances are, you can not. As the therapist, you will begin to feel guilt and think that you need to change your approach or need to do something different. You will put more work than your Client, and will likely not see any lasting results. Your thinking can become distorted, where you think you are the only one who can help. If the Client does not put the work in, you cannot help, and it is not your responsibility! It is easy for therapists to get messed up in this, especially if they have seen someone for a long time.
The Therapist’s Stress
Many Clients who require low-cost or pro bono therapy have stressful lives. This is often due to family issues, relationship issues, and trauma. They will be high-stress Clients, who will put much pressure and demand on the therapist. These are the Clients who will call you on a Saturday at 8:00 PM about a crisis, which at times may become so volatile that they may require hospitalization. Any time the phone rings, anxiety will appear, with a worry about your Clients, and whether you will need to provide damage control. For over ten years, I lived this life. There was a time when 25% of my caseload consisted of pro bono work.
This stress is real and never-ending. Suicide is your greatest enemy, as many Clients will struggle with it. You will become their lifeline, and at times, it will be on the back of your mind, even on days off. I experienced this stress for over ten years, always worried when an unknown number called my phone, wondering if I would need to defuse a situation. For me, around 90% of my Clients with this stress were pro bono. As therapists, we all agree to work with Clients who are stressed and have these issues; however, over time, it can affect you, especially if you are not gaining financially from it. You can discuss boundaries, teach your Clients how to manage their own stress, but many will still call you and expect you to handle it, because you are “my therapist”.
Is it Ever a Good Idea to See a Client Pro Bono?
In my opinion, with sixteen years of experience as a therapist, I would say no. For me now, it would take a very special situation for me to do so. There is a better method than providing pro bono therapy. Provide a Sliding Scale. A sliding scale is a payment structure depending on your Client’s income. You set the cost per income point. This way, their financial situation determines how much they pay, not you. It allows Clients who cannot afford your full rate a chance to see you, while providing financial compensation for you and a sacrifice for them, so they take the therapeutic relationship seriously. To see an example of a Sliding Scale, Click Here. It is one I have used for years. For each Client who takes advantage of your Sliding Scale, make sure to get a copy of their income, a tax return, or pay stubs for the past three months’ work; this way, you know they are telling the truth.
As a Therapist, You Deserve to be Paid
If you are a beginning or new therapist, please take note of this. You spent at least six years in college, likely have over $100,000 in student loan debt, and need to be paid. You cannot afford to give your services away or to low-ball your rate. You need to value yourself and your services. I made this mistake when I was a beginning therapist. I set a low rate and accepted pro bono Clients. I was poor and worked 80 hours a week to survive. It does not work! You cannot provide life-changing therapy if you are stressed or burned out. It took me over 10 years to finally learn this and stop accepting new pro bono Clients. My overall stress levels are extremely low because I have established proper boundaries and expectations with my Clients.
I can recall pro bono Clients whom I helped who did well, and were able to change their lives. It does happen. I am glad I was there to help them. However, now that I am in a better position to help, I can provide more effective therapy, as I am less stressed. If you are a therapist, consider what I have said today. We all want to help people, but sometimes, what we think of as help can harm if we are not careful.
You can reach me at my website or call me directly at 832-559-3520 if you have any questions. Thank You!
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