The Therapist's Dilemma: Unpacking Money Mindset and Anxiety
Money can be such a taboo subject in today’s world. For therapists, the subject of money, both personally and professionally, can be really difficult to address. The intersection of therapists’ money mindset and anxiety is an area that is not always discussed, and that can bring about a lot of shame and insecurity for all involved. As mental health professionals, we are no strangers to helping others navigate the turbulent waters of their emotions, but what about our own financial well-being? This article aims to shed light on an essential aspect of a therapist's journey - the relationship between money, mindset, and anxiety, and how they are all connected. I hope this article changes not only the way that you think about money, but also how you practice as a clinician.
1. The Gender Gap in Therapy Income: Breaking Down the Numbers
Therapy has become a field in which the majority of therapists are women, and to put it succinctly, women are a marginalized community. We make, on average, 77-83 cents on the dollar to what a man does. And this gap is much larger for Black and Hispanic women. Over the course of our working lifetimes that is around $900,000. Think about that, almost a MILLION dollars is taken away from women BECAUSE we are women.
Therapists are ingrained with “you don’t go to school for therapy to make money” and we often see our co-workers/colleagues working multiple jobs in order to simply survive. In order to take care of others, you must also take care of yourself. In a world of hurting people, therapists often forget that they must first put their own oxygen mask on in order to continue to add value.
2. Money Mindset Matters: The Impact on Therapists' Well-Being
A lot of things that occur in childhood can leave a lasting footprint on the mindset we have and the money choices we make in our adulthood.
Was money talked about in your family?
Was money not talked about at all?
Was the lack of money in the household creating a lot of stress in the adults of the household?
Whatever it was, it left an imprint.
Scarcity mindset is about lack: I don’t have enough money, training, beauty, etc. In Daring Greatly Brene Brown explains that as a society, "We spend inordinate amounts of time calculating how much we have, want and don't have, and how much everyone else has, needs and wants. We are often comparing our lives, our marriages, our families, and our communities to unattainable, media-driven versions of perfection, or we're holding up our reality against our own fictional account of how great someone else has it."
How does this land for you? Have you considered that your thoughts and your relationship to money are deeply connected to the mindset that you have?
Falling into scarcity robs you of looking at the potential of life. It robs you of your joy. It creates fear, pain, and dread.
Dread isn’t helpful for your clients.
Dread doesn’t help them get unstuck from where they are.
Dreading the work can lead a therapist to burnout. Or the burnout has been there for so long they don’t recognize it anymore.
So, how do therapists become unstuck from their own shit, and stop taking it into the therapy room with their clients?
I’m so glad you asked.
By showing up in their own life.
And consistently taking that shit to their own therapy.
Because therapy is a safe place for therapists too.
And by working on their own shit, in their own therapy, and challenging their mindset they can start to let some of that go, and in return their clinical work will elevate to a whole new level.
I want to be a therapist that is excited to go to work. Excited to show up for my clients. Excited to delve into their deepest inner wounds and help them clear the pain from their minds, hearts, and bodies.
I want to hold that sacred space for them, and yet I know that if I don’t challenge this scarcity mindset every single day I won’t be able to hold that space.
I can’t take someone somewhere I have never been myself.
I want to go there.
Do you?
3. Transitioning to Private Practice: From Employment to Entrepreneurship
For a long time, I thought that private practice was the sweet spot. I had it in my mind that if a clinician is able to go full-time private practice, they’ve made it. After taking the leap to full-time in 2022, I am realizing how much effort really goes into being your own boss. I’m starting to understand that if I don’t want “just another job” but actually my own sustainable business, I am going to have to continue working on systems, strategies, and mindset.
There are so many factors to consider.
Insurance, self-pay or hybrid?
Do your own billing or outsource that?
Hire a virtual assistant or complete those tasks on your own?
Build your own website or pay for that?
Work on your own marketing or hire someone for that?
Are you noticing a trend? So many choices. Choices, choices, choices. It’s exhausting. And yet, it’s what you sign up for when you create your own private practice. For the Type-A, high-achieving, solopreneurs of the world, it may feel as though the pressure to achieve and succeed is squarely on their shoulders. One way to shift this is to delegate tasks of your choosing to others, and yet therapists starting out often choose to go at it alone as there isn’t enough money to invest in all the things that they need to do in order to be successful.
Another item to consider is paying your own health insurance premiums. As a self-employed individual, you no longer have an employer that is covering some of the cost of the premium, and so this tends to be a higher cost for full-time private practice clinicians.
Do you see how these issues can create anxiety for a clinician?
As I was beginning my private practice I chose to stay on as an employee until I had saved a certain amount of money so that when I took the leap to full-time I wasn’t completely scared out of my mind. I was able to do this at the time since there were so many people reaching out for help (during Covid-19) and I was able to live on the income from my employer. Another factor that helped me was that I got credentialed with insurances.
It is easier to attain clients when taking insurance; however, it may not always be the best decision for therapists.
Let’s explore those reasons now.
Did you know that a therapist has to give someone a diagnosis when the client is using their insurance for mental health therapy?
Insurance panels include mental health treatment under a medical model. So when you go for therapy, the clinician is required to diagnose you to establish medical necessity as to why you are seeking therapy services.
What if someone wants to go to therapy simply to understand themselves better? Of course they may be able to utilize an EAP (Employee Assistance Program) but not all therapists are paneled with EAPs due to their lower reimbursement rate.
Another factor to consider is that clinicians contracted with an insurance panel make less than their full fee on average. For example, let’s say that a clinician’s rate is $200 a session, but because they are contracted with an insurance panel, they receive $120 for that session. This means that a clinician is potentially missing out on hundreds of thousands of dollars over the course of their working lifetime because they accept insurance.
Accepting insurance means there is more legwork and administrative burden for a clinician. When claims are denied, clinicians (or those they delegate this task to) are spending a significant amount of time on the phone simply trying to get paid. This can certainly add higher levels of anxiety and stress on the clinician.
Clinicians are required at times to submit private information to insurance companies.
Insurance companies can sometimes do what is called a clawback. This means that they pay a clinician, and then end up taking the money back. In Oklahoma, this is allowed for up to 2 years from the date of service.
Clinicians that accept insurance may consider taking on a higher caseload in order to meet their own financial needs (i.e. pay off those pesky student loans, be able to retire, or maybe even take a vacation). This puts them at higher risk for burnout and can potentially impact their level of clinical work.
I have been in this boat before, and I can tell you, it’s no fun. It’s been hardwired into my system that I need to ‘utilize self-care’ and yet, in graduate school, no one really did a great job of explaining how to put this into practice. It’s taken years of delving into what self-care looks like for me to really understand where my limits are in terms of how many clients I see per week.
4. Money Talks: Having Conversations with Clients About Fees
The Lean In Make Academy (or LIMB for short) created by Tiffany McLain has been a huge part of my life for the last year. She created a program in which she teaches therapists how to challenge their money mindset and make more money in an ethical and professional way.
Before joining LIMB I was so scared when I discussed fees with potential clients, and I was not consistent with charging my cancellation fee for clients that did not cancel/reschedule within the timeframe I’ve established.
Now, I can safely say that discussing fees still scares me, and at the same time I know that I’m not alone. And that it’s normal to be afraid of something that you haven’t done before, and that’s okay. I have been able to charge my cancellation fee, in an ethical and professional way, be consistent with my boundaries, and show my clients I am going to hold them to what they agreed to.
Joining LIMB, and engaging in the process has truly transformed my mindset. It has changed how I run my business, how I view myself, and the level of clinical expertise that I bring to the therapy room with my clients.
It is truly an honor to do this work, and I want to continue as a therapist for a very long time. I know that I need to learn to take care of myself: personally, professionally, and financially, in order to continue as a therapist. For me that includes coming off of insurance panels when I am financially able to, raising my rates on a consistent basis, and consistently charging a cancellation fee.
5. Shifting Perspectives: Book Recommendations for Challenging Money Mindset
Expanding your knowledge and insight can be helpful when wanting to grow in a certain area. These are book recommendations for beginning to unpack this complicated issue.
Financial Feminist by Tori Dunlap
Mindset by Carol S. Dweck
Women Talk Money: Breaking the Taboo by Rebecca Walker
We Should All Be Millionaires by Rachel Rodgers
Secrets of Six-Figure Women by Barbara Stanny
Think Like a Breadwinner by Jennifer Barrett
The Big Leap by Gay Hendricks
Radical Healership: How to Build a Values-Driven Healing Practice in a Profit-Driven World by Laura Mae Northrup
Be a Wealthy Therapist by Casey Truffo
Remember that managing financial anxiety is an ongoing process, and it's normal to experience fluctuations in your emotions and financial situation. It's essential to be kind to yourself and seek support when needed, both personally and professionally.
6. Navigating Financial Anxiety: Strategies for Peace of Mind
Here are some strategies to consider when developing a healthier relationship and mindset in terms of money.
Create a Detailed Budget: Develop a comprehensive budget that outlines your income, expenses, and financial goals. Getting a clear picture of what is going on with your finances (personally and for your business) can lower anxiety. uncertainty
Establish an Emergency Fund: Set aside money in an emergency fund to cover unexpected expenses or income fluctuations. Having a financial safety net can provide peace of mind.
Diversify Income Sources: If possible, diversify your income sources. This might include offering workshops, online courses, or other supplementary services to complement your private practice income.
Set Realistic Financial Goals: Establish achievable financial goals that align with your values and priorities. Break them down into smaller, manageable steps to reduce feelings of overwhelm.
Seek Financial Advice: Consider consulting with a financial advisor or accountant who can provide guidance on managing your finances, making investments, and optimizing tax strategies.
Mindfulness and Self-Care: Practice mindfulness and self-care techniques to manage stress and anxiety. Regular exercise, meditation, and relaxation exercises can be beneficial.
Regularly Review Your Finances: Schedule regular check-ins with your finances to ensure you are staying on track with your goals. This can help you catch issues early and make necessary adjustments.
Consult Peers or Mentors: Engage with other peers and professionals that are in a similar mindset as you.
Manage Client Boundaries: Set clear boundaries with clients to prevent overextending yourself, which can lead to burnout. Maintain a balance between the number of clients you see and your overall well-being.
Continuing Education: Consider attending workshops or courses related to financial literacy and stress management. Expanding your knowledge in these areas can help you better manage financial anxiety.
Debt Management: Develop a strategy for managing any existing debt, such as student loans.
Regularly Review Fees: Consistently assess your fees to make sure that they are in life with your financial goals. Be willing to adjust them as needed.
Remember that managing financial anxiety is an ongoing process, and it's normal to experience fluctuations in your emotions and financial situation. It's essential to be kind to yourself and seek support when needed, both personally and professionally.
