Counsellors' Response to Fee Disputes

Title: Counsellor’s response to non-payment by paying clients

Introduction

The fees counsellors set for sessions represent a number of factors, first, most importantly, is boundary. Paying for fees and its consistency provides stable boundaries for the client (Langs, 1982). It also defines the business nature of the therapeutic relationship (Gutheil and Gabbard, 1993). It is usually when the counsellor and client meet for the first time that these aspects of the relationship are established. Therefore, agreement about fees should be done very early on during the contracting stage. It is safe to expect that fee paying is contractual, as if you were paying for a gas or electric bill whereby it states, ‘If x amount is not paid by the date stated then services will come to a halt’. There is no obligation to treat clients who cannot afford to pay or have fallen behind with payments otherwise the boundaries become unstable.

There are, and will be, incidents where clients do not pay for various reasons, but what action can counsellors take? Sending clients bills in hope that it is paid and if not then what actions are to be taken? As the payment of fees is a very important boundary issue, some may think that non-payment of fees should be pursued. However, the counsellor must be mindful for what action s/he takes as there is the very important factor of confidentiality to consider when thinking about pursuing further legal action. Perhaps this can be resolved with the initial contract where a simple statement such as ‘legal action will be pursued for non-payment of fees’. What about ensuring that no harm is done to the client as per BACP ethical code? Going ahead with legal action may cause clients anxiety and stress. This could result in a complaint being made against the counsellor with BACP.

Non-payment of fees is still a recurring issue as Balsam and Balsam (1974) identified that money issues are difficult to address and most find conversations about money an embarrassing confrontation. Freud (1913) found that money issues are treated with the same prudishness and inconsistencies as sexual issues. I prefer to pay for my therapy sessions monthly and upfront just to avoid being asked for it. The times I was not able to pay for a session I would make my counsellor aware at the beginning of session and also paid as soon as possible, usually, at the beginning of the following session. Hardly any discussions about money took place, whether it was due to discomfort from both of us and/or simply because she understood my financial circumstance. Whilst there is an appreciation that there are various reasons why a client does not pay for sessions, it is still an economic loss for the counsellor unless it is recovered. Training to be a counsellor is an expensive process There is the cost of institution fees, supervision, personal therapy and many hours of service the decision to pursue or not pursue non-payment? Has anything changed in the last few years? I hope to answer these questions with this research.

Methodology:

There are different ways that counsellors will choose to respond to client’s non-payment of sessions. Each individual counsellor will have a subjective way of responding. I believe different past and present experiences will determine how counsellors respond to non- payment, therefore hold a constructivist worldview. I have chosen to carry out this research qualitatively as I am looking at the phenomenon of how individual counsellors respond.

When looking at a phenomenon, in this case the phenomenon being counsellors’ response to non-payments, it is important to gain insight into multiple experiences and different angles (McLeod, 1999 and Cresswell, 2007). In order to do this I will be carrying out this research by interviewing a minimum of five counsellors. There will be no specific inclusion/exclusion criteria except that they are in private practice. I will use a semi-structured questionnaire incorporating Moussakas’ transcendental phenomenology (Cresswell, 2007) process. I will begin the interview with two standard interview questions. The first question requires a textual description (what happened), the second question will require a structural description (how they responded) and any subsequent questions will emerge from the participant’s response. I will allow approximately 30 minutes for the interview.

All interviews will be taped, recorded and transcribed.

As I hold a constructivist worldview, my ontological position is that there will be multiple different experiences in how counsellors respond to non-payment. There will not be a universal way in which counsellors respond to non-paying clients but it would vary amongst counsellors. There will be subjective experiences. I do not have a close relationship with this area of research as I do not charge clients for sessions. This gives me an epistemological and axiological advantage. I will approach this area of research with an open mind. The only relationship I have with this area of study is collecting voluntary donations from clients and there are no repercussions if client does not pay.

Data analysis:

One of the ways I initially considered collecting data was quantitatively. This would require a very large sample size and I would be expected to have some ideas about how counsellors respond to non-payment from clients. This approach would also require me to have a positivist-world view and that there is one set way in which counsellors chose to respond. Having read around the area, there does not appear to be a universal way that counsellors respond to non-paying clients. Reflecting on this, I have decided a qualitative approach would be more suitable. There are various ways in which I could analyse the data obtained from the interviews. A grounded theory approach to data analysis in this phenomenological research is an option. However, as I am not expecting to find a universal response to non-paying clients, it may not be appropriate. Also there are time constraints to consider. I have decided to analyse the data using Interpretative Phenomenological Analysis. The reasons why I have chosen this method are because I am familiar with the process and it allows different phenomenological angles to be explored. The disadvantages of using this method of data analysis is that it is time consuming and labour intensive.

Ethics:

Ethical approval is essential when there are participants involved. The participants will need to willingly consent to taking part in the research (Kvale, 2007). I will need to first obtain informed consent from participants (see appendix 1). There will be no deception involved in this research so all participants will be briefed and informed about the nature of the research.

All participants will remain anonymous during the analysis of the data which will remain confidential. I will also need to consider participants wanting to be acknowledged in the write-up (Kvale, 2007) and may not want to be anonymous. For the sake of fairness to those that want to remain anonymous and the sake of regularity, all participants will be anonymous. Any participants that would like acknowledgment will be mentioned at the end in section titled ‘acknowledgements’. Participants will be given a copy of the transcribed interviews so they could correct and amend anything that they feel is not an accurate representation of what they have said. As interviews will be recorded and transcribed I will ensure that they are kept in a lockable cabinet which only I have access to. Any data stored on a USB storage device will be password protected. It is important to also ensure that participants are able to contact someone after the interview is over in case they have any questions about the study or anything that they have discussed. Participants will be able to speak to someone after the interview if necessary and this information will be provided on the debrief form (see appendix 2). Fahmida KhanumId no: 000746152-6 Self-care: As I have a progressive eye disease I will need to ensure that I take regular breaks and occasionally do something that is different. I will also read books and go to the gym when I feel overwhelmed.

Discussion:

This topic has been extensively researched already. However, it is an ongoing issue that counsellors in private practice face all the time. This research hopes to explore how counsellors in this day and age respond to this issue. I hope to update previous research in this area. There are many new methods of payments such as; PayPal, bank transfers and even good old fashioned cash. There are even payment apps on mobile phones on instances where cash may have been forgotten. They may be options that counsellors have taken up to ensure payment from clients. With modern day technology, it seems almost impossible to have an excuse for not being able to pay other, than due to economic circumstance, if they are happy with the session provided. However, being unhappy with sessions, due to whatever reason (as long as it is within what has been contracted), does not excuse a client from paying for sessions. It could be argued that BACP ethical code of conduct can influence the actions that counsellors are able to take to deal with non-payment from clients. There can be a negative economic impact for counsellors due to non payment and this issue may need to be addressed by BACP on a larger scale to protect the profession.

Participant Consent Form and Information Sheet University of Greenwich

Purpose:

The title of this research is: Counsellor’s response to non-payment by paying clients.  The study is part of MSc Therapeutic Counselling final year dissertation, under the supervision of Quentin Stimpson.   The purpose of this study is to look at the experiences of counsellors who have experienced non-payment from paying clients and how they responded to it. I also will ask about what influenced the response.

Procedure:

If you agree to be in this study, you will be asked to do the following: Participate in an interview for approximately 30-60mins regarding your response to non-payment by paying clients which will be audio recorded and transcribed.

Benefits/Risks to Participant:

Due to the nature of interview you will be asked to think about some of your processes during therapeutic encounters with clients. This may result in uncovering unprocessed issues and may cause distress. Please tell the interviewer if it is experienced and/or seek personal therapy.

Voluntary Nature of the Study/Confidentiality:

Your participation in this study is entirely voluntary and you may refuse to complete the study at any point during the interview or refuse to answer any questions with which you are uncomfortable. You may also stop at any time without an explanation and without any consequence. You are free to ask the researcher any questions you may have. Your name will never be connected to your results or to your responses on the questionnaires; instead, a number will be used for identification purposes. Information that would make it possible to identify you or any other participant will never be included in any sort of report. The data will be accessible only to those working on the project. All data collected will be stored on a USB memory stick which will be password protected. You have the right to withdraw from the study for up to three weeks after the interview has taken place.

Statement of Consent:

I have been given, and read, an Information Sheet concerning this research, and any questions that I had concerning the research have been answered to my satisfaction. Initial of Participant_______________________________________ Date: __________ Initial of researcher____________________________________________ Participant Code for data query purpose:………. Thanks for your participation!

University of Greenwich

Debriefing Form for Participation in a Research Study

Thank you for your participation in this study titled ‘Counsellors’ response to non- payment by paying clients’.  Your participation is greatly appreciated.

Purpose of the Study:

The purpose of this study was to look at how counsellors respond to client’s non payment of session fees and what influenced the response. I realise that some of the questions asked may have provoked strong emotional reactions.  As a researcher, I do not provide mental health services and I will not be following up with you after the study.  However, I want to provide every participants in this study with a useful list of resources that are available, should you decide you need assistance at any time.

Confidentiality:

Your participation in this study is entirely voluntary and confidential. Your name will never be connected to your results or to your responses on the questionnaires; instead, a number will be used for identification purposes. Information that would make it possible to identify you or any other participant will never be included in any sort of report. The data will be accessible only to those working on the project. All data collected will be stored on a USB memory stick which will be password protected. You may decide that you do not want your data used in this research.  If you would like your data removed from the study and permanently deleted you can contact me on kf210@gre.ac.uk for up to 3 weeks after the interview has taken place. Your interview took place on this date…………….. The last date that you can contact me to withdraw is………….. Please quote your personal code below when contacting me.

Final Report:

If you would like to receive a copy of the final report of this study (or a summary of the findings) when it is completed, please feel free to contact me via email kf210@gre.ac.uk.

Useful Contact Information:

If you have any questions or concerns regarding this study, its purpose or procedures, if you have a research-related problem or wish to take part please feel Fahmida KhanumId no: 000746152-6 free to contact me on kf210@gre.ac.uk or my supervisor on q.stimpson@greenwich.ac.uk. If you feel upset after having completed the study or find that some questions or aspects of the study triggered distress you may wish to explore this further with your clinical supervisor or personal therapy. Your personal code is………. Please quote this when contacting us regarding your participation.