Every therapist I’ve ever personally seen has required me to bring my checkbook. When I first started in private practice in San Francisco, I did the same thing: I only accepted check or cash. After all, accepting credit card or another form of electronic payment would have cost me, right? I’d have to eat those credit cards fees with every swipe—and they really add up, right?
But after a couple months of being in business, a few things happened that made me change my mind:
– A client in her 20’s came to our first session with only her ID and a credit card stored in the back of her iPhone case.
She laughed at the idea of a check, and told me she’s never owned a checkbook.
– A client no-showed on his third appointment and then completely disappeared.
I had no way to collect that missed fee from him.
– I talked to some other therapists in SF and they were all accepting credit cards.
I jumped on the credit card bandwagon the next week and started by using Square. Now I use Stripe’s integrated credit card processing through my Simple Practice account, and every client puts their credit card on file before our first session. You can sign up for Simple Practice using my link here.
Here’s why you should do something similar:
1. Branding. All of your business operations and the ways in which your clients interact with your business, beyond when they’re sitting in session with you, communicate to the client (and potential clients) your brand and identity. What does it convey to the client when you only accept checks or cash? Does you come across as a therapist who’s a bonafied professional, who runs their business like other small businesses (even food trucks take credit card nowadays…), who has modern systems in place that will make for a comfortable, convenient consumer experience? Or do your systems seem antiquated, inflexible, and inconvenient?
2. Cancellations. You should start by being crystal clear about your cancellation policy in your informed consent and in your initial conversations with your clients when you first meet. My policy has always been 48 hours (except in the cases of emergencies, etc.) because 24 hours simply isn’t enough time to fill the slot, and I think people tend to take advantage of a 24 hour policy when they just don’t feel like talking about their problems that day, or are ambivalent about therapy in the first place. I clearly convey to clients that when they start working with me, they “own” their slot (they generally come the same time each week, and I only agree to work with people either weekly or biweekly) and are responsible for keeping up with it. I tell them frankly that when they don’t show up for their appointment, that slot is unfilled and it’s a loss for my business. It’s the same way that many other professional services offices (like a doctor’s office, etc.) operate, but we tend to get stuck on our feelings of trying to always be the nice guys. I think that when you’re this clear with your clients about how important your time and policies are, they actually respect you more, take therapy more seriously, and make a greater investment in their work with you. When you’re loose about your policies, what does that convey to the client?
After I’ve clearly explained my cancellation policy to the client, I let them know that if they cancel less than 48 hours before the appointment or no show, the card on file will be charged. I’ve never had a single client have a problem with this.
For what it’s worth, you should think about what an investment like SimplePractice, or something comparable that can store credit cards, could do for your business. Let’s say in the case of that client who I mentioned before who no-showed and then disappeared, I had no way of getting that money back. That was $150 that I’d simply never see. If I had SimplePractice in place at the time (let’s say $50/month), and was able to recuperate that fee, the investment would have already paid for itself 3 times over.
3. Incentive for clients. If you’re running a private-pay practice and charging anywhere over $100 per session, clients are simply going to be incentivized if they can charge their sessions to a credit card. It’s a significant amount of money, and just like buying a new TV or booking a flight, people want the rewards points that their credit card offers. Not to mention, a lot of clients have an HSA or FSA card, or something comparable, and will ask when they first call if they can use this to pay for their sessions directly. It’s a great service, and again speaks well to your brand, when you can say confidently that you offer such a convenient payment option for your services.
4. Time. Having an integrated system saves you time in session, and this benefits both therapist and client. It gives the client more time to talk about what they’re coming to you for help with, and it gives you more time to do your job as a therapist. As a bonus, if you offer superbills to your clients for their reimbursement, having an integrated system can often take care of this for you and can even allow clients to be able to access their own superbills whenever they need to.
5. The therapy relationship. Unless you have a secretary or assistant who accepts your client fees for you, we know that money changing hands between client and therapist can be an awkward encounter and can bring up some tricky feelings for either party. On the other hand, if you’re in the practice of doing this, it might not be a big deal, or it might be something you’ve gotten better at. One of my former therapists (who only accepted cash or check) used to have a practice of intentionally looking down at and acknowledging the check I handed to him each time, as to convey to me that he honored and appreciated the investment I was making in working with him. He’s the only therapist I know that is this intentional about receiving money from clients. When you’re using an integrated system, session fees are charged automatically and there isn’t an awkward exchange between client and therapist. The charge happens at the end of the session and it’s more or less out of mind for therapist and client. As the therapist, you can move on to thinking more about how you’re going to better help this client, prepare for your next session, or take a relaxing walk around the block.
Hopefully I’ve given you more than enough reason to accept credit cards in your business and set up a streamlined client payment system. You should be allocating a certain percentage of your gross income to your business expenses anyway, so that’s one way of looking at it and making it easier to stomach. You should also remember that the credit card fees are of course tax-deductible. The most important reason, above all, is to provide a high-end consumer experience to your clients and convey a really strong sense of professionalism and value. Good luck!
John Clarke, MA, EdS, NCC, LPC is a licensed psychotherapist and a private practice expert. He has built thriving practices from the ground up in San Francisco, CA and Charlotte, NC. In building his current practice, he had 6 private-pay clients booked for the first day that his doors were open.
Get in touch today for a free initial consultation to learn how private practice consulting can help you take your business to the next level
