Avoiding Liability Bulletin – January 2006

… Therapists and counselors who manage their own practices are periodically faced with the issue of raising their fees. One of the fundamental questions asked is whether or not it is appropriate to raise fees with respect to patients who are continuing in therapy and who have previously agreed with the practitioner on the fee to be charged. Among the questions that I routinely ask therapists who desire to raise fees on continuing clients is whether or not the patient was informed, either orally or in writing, of the possibility that fees might be raised during the course of the therapy, and if so, was the patient informed about how often this might occur, how much prior notice would be given, and by what percentage would the fee increase.

Usually, the answer is that the patient was not fully informed, prior to the commencement of therapy, of the fact that the fee may be raised from time to time. Even if the law or applicable ethical standards would allow the therapist to raise the fee by giving reasonable notice, I have often counseled against raising the fee. Patients can feel exploited or squeezed and the relationship can quickly deteriorate if fees are raised “midstream.” If one wanted to preserve the right to raise fees with existing clients, assuming that doing so is both legal and ethical, it would be wise to cover this subject matter in the written disclosures that are made to the patient at the outset of treatment.

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Richard Leslie

Richard S. Leslie is an attorney and acknowledged expert on the interrelationship between law and the practice of marriage and family therapy and psychotherapy. Most recently, he was a consultant to the American Association for Marriage and Family Therapy (AAMFT) and has written articles regarding legal and ethical issues for their Family Therapy Magazine. Prior to his work with AAMFT, Richard was Legal Counsel to the California Association of Marriage and Family Therapists (CAMFT) for approximately twenty-two years. While there, he also served as their director of Government Relations and tirelessly advocated for due process and fairness for licensees and applicants.

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