What I Learned About Fee Setting After Years of Getting It Wrong

I used to feel apologetic about my fees. I'd rush through pricing discussions, offer unnecessary discounts, and wonder why I felt some resentment about work I loved.

After years of building my practice - and making plenty of mistakes - I've learned that ethical fee setting isn't about choosing between caring for clients and sustaining yourself. It's about doing both well.

Here's what I wish someone had told me from the start.

Table of Contents | Jump Ahead

• Caring Doesn't Pay - or Does It?
• Other Fee Fears Therapists Face
• Integrating Fee Setting Into Your Professional Identity
• Calculate What You Actually Need (Not What Feels Nice)
• Without Racing to the Bottom
• Design Accessibility Without Self-Destruction
• The Communication That Changes Everything
• The Fee Increase Conversation That Preserves Relationships
• What Not to Do (Lessons from My Mistakes)
• The Balance That Actually Works
• References

---

Caring Doesn't Pay - or Does It?

Most therapists enter the field to help people, not to build wealth. This creates tension between altruism and business realities. Our helping-profession identity can make money feel "impure," fostering a professional blindness: the assumption that caring about money diminishes care for clients.

The "helper's dilemma" assumes that charging for emotional support compromises the therapeutic mission. Cultural messages reinforce that helping should be selfless and mixing money with care is inherently wrong.

I spent my early years undercharging, believing lower fees were more ethical. I was wrong. Unsustainable fees serve no one. When financial stress affects your presence, limits continuing education, or pushes you to take clients you're less confident with, underpricing becomes everyone's problem.

The uncomfortable truth? Charging appropriate fees protects your clients by supporting the professional competence and emotional availability they deserve.

Other Fee Fears Therapists Face

Discussing fees often triggers anxiety, especially for newer therapists. Imposter syndrome, scarcity thinking, and cultural conditioning around money can make setting fair rates feel uncomfortable - or "wrong."

The therapeutic relationship adds another layer. Therapists may fear exploiting clients, overidentify with financial struggles, or worry about awkward power dynamics, leading to avoidance or apologetic approaches to fees.

Short-term fear of losing clients often outweighs long-term sustainability, creating a false tension between fair fees and accessibility.

Training gaps and ethical uncertainty leave many unprepared for the business side of practice.

Integrating Fee Setting Into Your Professional Identity

As psychologists, we are well placed to do the necessary inner work that helps us engage with guilt and fear more consciously. In doing this, I have gradually readjusted my sense of who I am as a psychologist to find a fee that feels right - one I can charge with confidence as my experience grew. Over time, I have reached an emotional settling point that feels neither like overcharging nor undercharging. I remain mindful of the trap of misdirected guilt and fear while standing in integrity with my ethical commitment to serve the community through my expertise.

Discussions with peers and supervisors have been invaluable in helping me stay conscious and true to myself over time.

Calculate What You Actually Need (Not What Feels Nice)

Before I learned the lesson of appropriate fee setting the hard way, I set fees based on what felt comfortable rather than what was necessary. This led to periods of financial stress that I could have avoided with basic math.

It is helpful to consider actual costs (to test the reality of the situation, so to speak):

Annual Practice Costs (rent, insurance, licensing, continuing education, supervision, technology, administrative time)

+ Personal Living Expenses (housing, healthcare, basic living costs)

+ Professional Benefits (retirement savings, emergency fund, disability insurance)

+Taxes (don't forget self-employment taxes)

÷ Realistic Annual Billable Hours (factor in vacation, sick time, professional development)

= Your Minimum Sustainable Fee

You may discover, when doing this calculation honestly, that you are charging less per session than your actual costs require.

Without Racing to the Bottom

Early in my practice, I positioned myself at the lower end of competitor fees, thinking this made me more accessible. This overlooked an important reality: fees should reflect value, not just market position.

Instead of competing on price alone, focus on what sets your services apart:

• Specialised training or certifications
• Experience with specific populations
• Therapeutic outcomes and client feedback
• Unique approaches or modalities
• Professional reputation and referral patterns

You don't need to be the most expensive therapist, but you also shouldn't be the cheapest-unless your experience genuinely warrants it.

Design Accessibility Without Self-Destruction

I live in a country where many people face poverty. I do this work to be of real service, but I have learned that serving diverse populations doesn't require martyrdom. I've structured my practice to support clients across financial situations, making therapy accessible without compromising sustainability:

• Sliding Scale: A portion of my practice is reserved for clients with financial constraints, allowing access while maintaining overall viability.
• Community Partnerships: I collaborate with employee assistance programmes that fund services at fair rates, reaching those who couldn't otherwise afford private therapy.
• Pro Bono Commitment: Two slots are reserved for clients in genuine crisis, funded by the sustainability of the rest of the practice.

Another strategy is to offer payment plans to clients between sliding scale criteria and full fees.

The Communication That Changes Everything

Learning to discuss fees confidently transformed my practice relationships. I now present fees as a straightforward professional exchange, including a clear framework in my practice documentation.

Notice what's missing? Any implicit apology, justification, or suggestion that therapy should be free. Notice what's included? Clear information that helps clients make informed decisions.

For clients with cost concerns, I explain that limited sliding scale availability is offered based on financial need. When fees are not accessible, I make it my business to assist clients with referrals to other trusted and skilled therapists or low-fee services, to ensure they still receive the support they need.

The Fee Increase Conversation That Preserves Relationships

I had dreaded fee increases for years, which led to my rates stagnating below sustainability. Now I approach increases as standard business practice, and have an annual date set for increases that are clearly communicated in my practice documentation.

Most clients accept increases as a normal business practice when handled in this manner.

What Not to Do (Lessons from My Mistakes)

• Don't set fees based on guilt or what feels "nice." Base them on actual costs and professional value.
• Don't automatically match the lowest competitor rates. This creates a race to the bottom that serves no one.
• Don't offer unlimited sliding scale spots. This compromises practice sustainability and ultimately reduces your community service capacity.
• Don't avoid discussing fees. Clear pricing information upfront and early on prevents awkward surprises and helps clients plan appropriately.
• Don't let fees stagnate for years. Annual reviews ensure your compensation keeps pace with experience, expertise, and economic reality.

The Balance That Actually Works

Charging appropriately is the most ethical move: it sustains your expertise, your practice, and your ability to serve clients now and in the future. Done well, fee setting becomes an extension of your clinical values, not a compromise.

I would welcome your insights.

Want more insights on building a sustainable practice that aligns with your values? This post is part of our practical guide series for independent therapists navigating the realities of ethical practice development.

References

Beidas, R. S., Stewart, R. E., Adams, D. R., Fernandez, T., Lustbader, S., Powell, B. J., Aarons, G. A., Hoagwood, K. E., Evans, A. C., Hurford, M. O., Rubin, R., Hadley, T., Mandell, D. S., & Barg, F. K. (2016). A multi-level examination of stakeholder perspectives of implementation of evidence-based practices in a large urban publicly-funded mental health system. Administration and Policy in Mental Health and Mental Health Services Research, 43(6), 895-908. https://doi.org/10.1007/s10488-015-0705-2

Bryan-Podvin, L. (2022). The financial anxiety solution: A step-by-step workbook to stop worrying about money. Jessica Kingsley Publishers.

Green, R., Baskind, F., Mustian, B., Reed, L., & Taylor, H. (2007). Professional education and private practice: Is there a disconnect? Social Work, 52(2), 151-159. https://doi.org/10.1093/sw/52.2.151

Koocher, G. P., & Soibatian, C. (2017). Understanding fees in mental health practice. Practice Innovations, 2(3), 123–135. https://doi.org/10.1037/pri0000048

Mintz, N. L. (1971). Patient fees and psychotherapeutic transactions. Journal of Consulting and Clinical Psychology, 36(1), 1–8. https://doi.org/10.1037/h0030483

Nissen-Lie, H. A., Havik, O. E., Høglend, P. A., Monsen, J. T., & Rønnestad, M. H. (2013). The contribution of the quality of therapists' personal lives to the development of the working alliance. Journal of Counselling Psychology, 60(4), 483-495. https://doi.org/10.1037/a0033643

Rupert, P. A., & Dorociak, K. E. (2019). Self-care, stress, and well-being among practising psychologists. Professional Psychology: Research and Practice, 50(5), 343-350. https://doi.org/10.1037/pro0000251

Rupert, P. A., Miller, A. O., & Dorociak, K. E. (2015). Preventing burnout: What does the research tell us? Professional Psychology: Research and Practice, 46(2), 168-174. https://doi.org/10.1037/a0039297

Zur Institute. (n.d.). Fees in psychotherapy and counselling: Clinical ethical and management considerations (O. Zur, Ph.D., developer). https://www.zurinstitute.com/courses/fees-in-psychotherapy-counseling/overview/