Recently I had a call from a prospective client looking for a therapist. He and I had one or two phone exchanges, discussing my approach, plus logistics like schedule, insurance matters and fee. At the end of the second call, which, like the first, lasted minutes, we agreed upon an appointment time and I indicated my fee for a first session. The caller balked, saying he’d hoped for a free consultation, and adding that he’d seen numerous therapists over the years, all of whom had offered an initial free session: a “screening” he called it; a “feeling out process”, seeing if we’d “connect” he added. I was dubious about his claims.
I replied that, contrary to his personal experience, free consultations are not a norm in psychotherapy, though some, perhaps many, do offer a free session at the outset. I added, pleasantly I hope, that the assumption of a free consultation was inappropriate for various reasons, not least of all because a therapist’s time, which is actually our only reimbursable commodity, is not free. The caller gently deferred on this point, but asked to call me back as to whether he’d make an in-person appointment. I sensed that his shopping had yielded other willing participants in the free service department, and that I’d not hear from him again.
Indeed, we did not meet. So, for those who have received free consultations from therapists, or who might think them appropriate, if not a standard of the profession, I will now explain why they are not.
Firstly, returning to the earlier point, a therapist’s time is his or her only reimbursable service. Meaning, there is no commission placed upon an individual’s mental health. That said, if anything, therapists might reasonably raise fees if a person’s circumstances improve, as they may be an indicator of a person’s growth and the therapist’s good work. To put it another way: why shouldn’t therapists, like everyone else, merit a raise from time to time?
Secondly, if a therapist doesn’t receive a fee, then he or she is simply giving away their time. If a private practitioner, there is no agency, hospital or other institution that will absorb the cost of the therapist’s time; not PTO that will pay for an un-reimbursed hour, and the opportunity cost of the “free” time cannot be written off taxes.
Well, what of the ideas tabled by that caller? You might ask. What’s wrong with the idea of “feeling out a therapist” as he put it; checking to see if a “connection”, a rapport, seems apparent before making a commitment to actually engage in therapy. My answer is as follows: an opening session may be a breezy, shopping encounter for a would-be client or mental health patient, but it is not and cannot be such for any mental health professional. From the outset of an episode, even during an initial telephone exchange, therapists incur responsibilities, legal and ethical–what’s called fiduciary terms–which are rivaled by few other professions. Take confidentiality, for example. That responsibility, to keep client material private, kicks in before therapists even meet their clients, when they are speaking by phone. Why? Because if I receive a later phone call from that caller’s girlfriend, for example, who wants to give background for a prospective therapy, contribute to the intake process, it’s not as though I can exchange information with that person. In a first session, in which a client may be deciding if there is a connection, a therapist must make certain assessments: is the person in danger? Is psychotherapy even appropriate for them? Are they suicidal, a danger to others, and what are the recommendations for other treatments that will best serve them? This is not a feeling out process. It is work; it requires years of education and training, and it’s not free.
Free consultations, a kind of coupon therapy, does occur in our business, and a therapist may ethically choose to work for a significantly low fee with someone of especially low means, or pro bono with someone who cannot pay at the outset of an episode. But, of course, we can’t do this with many people, and with most the practice is inappropriate, especially if done for business reasons: a teaser of free service, designed to entice customers; ideas borrowed from retail culture. Such gestures can contaminate therapy, creating tacit dependencies that likely undermine therapeutic goals, enabling false understandings as to the nature of therapist-client relationships.
Graeme Daniels Psychewriter 