Fees In Psychotherapy and Counseling: Clinical, Ethical and Management Considerations

Developed by Ofer Zur, Ph.D.
Course materials are available as articles, and audio with transcripts.

This is an intermediate level review of the ethical, clinical and management complexities of fees in psychotherapy and counseling. Money, like time and sex, are the most focused upon concepts in our culture. Most people agree that we can know a person by simply learning about their attitude and practices regarding money, time and sex. Freud observed more than half a century ago, money is even a bigger taboo than sex. This statement rings even more true now, at the beginning of the 21st century. The relationships to money and time have been closely linked to people’s construction of meaning. Most therapists have very poor attitudes towards money. They primarily ignore the topic both in themselves and too often with their clients, especially with clients who are more financially successful then they are. Many therapists believe in the notion that care and profit are inherently incompatible. Along the same lines, therapists have been equated with prostitutes as both are paid to provide love. The obvious fact that therapists chose to go to graduate school to study psychology or counseling rather than business administration, law or economy seems to be indicative of the inclination and motivation of most psychotherapists. As a result, setting, charging and collecting fees in psychotherapy becomes a burdensome chore for many psychotherapists, which is often not handled well clinically and ethically.

This course consists of six sections, comprised of fifteen articles and two audios with transcripts. The first section includes an introductory audio, which discusses the meaning of money in our culture and identifies ways of charging clients. The second article, “A Century of Fees,” discusses therapists’ attitudes towards fees. The second set of articles discusses the complexities of handling fees issues in psychotherapy and psychoanalysis. It also explores the complexities that managed care systems have introduced in regard to fees and ‘cheap’ drug solutions. The third set reviews gender differences in attitudes towards money as it applies to clients and potentially to therapists. It also provides an extensive review of the history and practice of bartering in therapy. The fourth set explores the most common forms of insurance fraud and ways to avoid them. It also explains the complications that may arise from using collection agencies. The next set details different billing options and identifies some of the HIPAA guidelines relevant to billing, reviews the section of major professional associations codes of ethics on fees and billing, and reviews an update on California law on fees in psychotherapy. It also provides samples of the sections relevant to fees for the Office Policies form, a few questions to help therapists better understand their relationship to money, and a bibliography on the topic. Finally, the last section provides guidelines and gives a detailed summary of fees in therapy. Additional resources and references are provided for further study, but they are not part of the course.

Educational Objectives

  • List the types of fee arrangements and their applications.
  • Analyze the importance of handling money issues clinically and ethically.
  • Utilize informed consents regarding fees.
  • Summarize the ethics of fees, including California law.
  • Describe billing options and HIPAA on billing.
  • Explain ways to avoid insurance fraud.


  • Meaning and importance of money in our culture
  • Types of fee arrangements
    • Full fee
    • Sliding scale
    • No fee - Pro Bono
    • Bartering
    • Flexible fee schedule
  • Analytic/Psychodynamic view on the meaning of fees
  • Money and Psychoanalysis
  • Managed Care considerations
  • Gender differences in regard to attitudes towards money
  • Insurance fraud
    • Common forms of insurance fraud
    • Ways to avoid insurance fraud
  • Collection agencies: Complexities and concerns
  • Bartering
    • Types of bartering: goods, services, etc.
    • Ways of arranging bartering
    • Case studies & guidelines
    • California regulations on bartering
    • Ethics code on bartering
  • Informed Consent and Office Policies in regard to fees
  • California law on fees in psychotherapy
  • Therapists' attitudes towards money and fees (self-assessment)
  • Guidelines