Fee practices of different psychotherapeutic orientations.

Abstract

As part of a larger study on the relationship between therapists' and their patients' attitudes toward money (Sitkowski, 1989), descriptive data were gathered on fee practices for three theoretical orientations. This is of interest because fee surveys do not customarily perform an analysis by theoretical orientation. In this case there were 45 therapists, 15 psychodynamic, 15 behavioral, and 15 eclectic. The categories were based on concurrence between self-designation and scores on the Therapeutic Attitudes, Skills, and Techniques Scale (Wogan & Norcross, 1985). To qualify for the sample all therapists had to be licensed psychologists with at least five years in private practice, spend at least 10 hours per week in practice, and work primarily with adults in individual theraov. . , The eclectic therapists had the most experience (21 yr) compared to 13 For psychodynamic and 12 for behavioral therapists, while the time spent in private practice per week was approximately the same, between 22 and 24 hours. The standard fee was quite similar For psychodynamic ($86) and eclectic ($88) therapists, and somewhat lower for behavioral therapists ($81). AU psychodynamic and 14 of the eclectic therapists used a sliding scale, while 10 of the behavioral group did. Of the behaviorists who used the sliding fee scale, they had the largest average range, $56, with the lowest ($35) and highest ($91) average fees relative to the other groups. Eclectics had an average range of $50, from $49489, while psychodynamic therapists had the smallest average range of $35, from $55-$90. The major difference in fee practices was charging for missed sessions, practiced routinely by 73% of psychodynamic therapists, but by none of the other groups. The sample was small, 15 in each orientation, and more representative of men than women, 12 to 3, in the behavioral and eclectic orientations. Respondents were also from the New York Metropolitan Area, and therapists as well as their patients appeared to be middle to uppet-middle class. The only policy that seemed tied to theoretical orientation was charging for missed sessions. The more general policies, as the standard fee and use of a sliding scale, seemed determined by socioeconomic variables and the discipline involved, namely, psychology as opposed to psychiatry or social work. The potential for producing income in private practice does not seem related to the theoretical orientation of the therapist, although these were experienced and well-established therapists as compared to beginners. It is certainly possible that market conditions may favor one approach over another, as short-term compared to long-term, but orientations may anticipate such change, as for example, the recent development of shortterm psychodynamic therapies.