What is a Therapist to do When a Prospective Patient Believes They are Entitled to Care in a Self-Pay Situation?
Today I want to bring up a situation that has been going on with another person on Quora over the past few days. She is a person who states that she is suffering from OCD to the point where she can no longer run her business and is suicidal. She has called a few therapists and all have told her that the cost of treatment would be $250 to $300/session and one person told her it would take a year for her to be treated.
Let me be clear that I am surprised that no therapist would take her in just to get her hospitalized if this is her baseline. My guess is that she never told any of these people that this was the condition that she is in because they are mandated by law in the US to protect those who they know can be a harm to themselves or someone else.
Well, there are different ways that people can access care, and self-pay is not for those who are unable to pay their bills — that is just the way it is. Yet, this Quoran didn’t want to hear that feeling that she was entitled to care on a sliding fee basis but couldn’t find a person to give that to her. She went as far as to tell me that I am wrong for not caring enough to take sliding fees. Well, the fact of the matter is that if I have a college kid who earns $10-$15/hour they will indeed get a sliding fee and they will choose how much to pay during the month to pay off that fee. I am happy to report that ALL my college kid clients have paid me in full — never an issue. However, with adults — they have screwed me over a few times so I am not as likely to give them a sliding fee for that reason.
Getting back to this Quoran, I would think that if she did run a business of her own, that she would understand that there are costs to running one. Second, that no one is entitled to anything just because they find themselves in a difficult situation. Many people today are finding themselves in horrific situations that they had zero control over — losing jobs, businesses, and homes as a result.
To believe that mental health professionals only care about the money is ludicrous. This is something she stated as fact. From all the years that I have been involved in mental health, I believe the larger concern is that of a ‘need to be needed’ as I refer to it — with the belief that one only matters to the degree that one is helping another which is a terrible way to be. I don’t want my clients to need me, I want my clients to be invested in the treatment — period. It has nothing to do with me except as the facilitator of their health and wellbeing — it is up to them to do the work required to achieve it. I can’t do it for them.
Do understand that I don’t believe in exorbitant fees for the clients who are called to work with me — many have tried everything they could think of before coming to me, yet, there are costs involved and one does need to pay one’s own bills. What I do believe in is being a caring and discerning practitioner because a bad fit with a client is worse than never working with them in the first place all around.
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