Why I Do Not Take Credit Card Payments for Psychotherapy
by Carol Campbell, MFT
Every once in a while someone asks if I take credit card payments for my work as a marriage and family therapist in private practice. The benefits seem obvious: Credit cards are ubiquitous and easy to use. Just swipe your iPhone these days, and someone else can keep track of all the information for you. If a patient fails to make an appointment, I could just charge them for the missed visit without even having to mention it. The patient would have the advantage of not having to carry a checkbook or cash, or worry about how much is in the bank account. Simple, right?
Not to a therapist who works from a psychodynamic perspective. The disadvantages to the therapy far outweigh the convenience factors. Here is why:
- One of my most important functions is to help my patients learn to accept reality. Reality involves facing unpleasantness — not masking it, denying it, obfuscating it, or soft pedaling it. In my book, having to pay for therapy is very unpleasant. It is costly, it takes money away from how it might otherwise be spent, and it reminds the patient that he/she needs something badly enough that he/she is paying someone else to get it. Therefore, the last thing I want to do as a therapist is to rob the patient of the important task of facing the reality of paying me my fee. Reality is far better served by having to write out a check to me and hand it to me, than by handing me a piece of plastic and having me process payment through electronic equipment.
- Many of my patients pay me with one check at the end of the month. That way they see a large number on the line for the amount paid. This facilitates another aspect of facing reality, which is that reality causes difficult feelings to emerge. By having my patients hand me the check at the beginning of the last session of the month, I am available to help them use their session time to talk about the anger, resentment, fear, shame, guilt, loss, and other difficult feelings that naturally accompany having to pay my fee. There is also room for pride, excitement, relief, contentment, and other positive feelings that arise when one has the courage to face reality. When the day arrives, as it inevitably does, that the patient forgets to bring the check, we have a fine opportunity to explore the dynamics between us that created the forgetting. That learning will make more of an impression if it is not immediately corrected by pulling out a credit card. To say nothing of the lost opportunities if the therapist just automatically charges for services and the transaction never comes up for discussion, let alone regularly.
- I am not particularly interested in making it easy for someone to be in therapy, any more than I would be interested in making it difficult for them. So why should I think it a good idea to make payment easy? Everything that happens between a patient and me is potentially part of the therapy process. We have agreed upon an exchange of my time and expertise for their money. To me there is something distancing about bringing in a credit card. Handing me a check on which the patient has written my name and my fee feels more intimate and therefore more facilitative of our work together.
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Calls regarding appointments are welcome at my private voicemail: 650-325-2576.
Carol L. Campbell, MFT, is a licensed marriage and family therapist providing psychotherapy and psychoanalysis for individual adults and couples in Palo Alto, California. She has degrees from Brown University and Santa Clara University and has been licensed since 1991. Carol is a graduate of the Palo Alto Psychoanalytic Psychotherapy Training Program sponsored at Stanford by the San Francisco Center for Psychoanalysis and was a candidate at the Psychoanalytic Institute of Northern California in San Francisco from 2010-2011. She is also a clinical member of the California Association of Marriage and Family Therapists and the Northern California Society for Psychoanalytic Psychology.
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