Are counselling and psychotherapy practices safe for face to face work after the pandemic?

The current pandemic has impacted various areas of our lives including how and where we access counselling. Although initially, the majority of sessions moved to the online domain, clients and therapists are more often considering restarting face to face sessions. This guide is an outcome of a study that Kensington Counselling Rooms along with Pimlico Counsellors and Psychotherapists did to ensure our practices offer the highest standard of virus control.

In preparation, we have reviewed the governmental requirements, Counselling and Psychotherapy Union guidelines, undertaken the coronavirus risk assessment, and spoken to our colleagues in Italy and Poland that are already working face to face.

Is it safe to see a counsellor face to face?

We are confident that following these guidelines, the risk of passing the coronavirus in the counselling practices will be low. However, there are specific steps that each private practice needs to take to enable working in the same physical space. Please check with the practice management if there is a coronavirus risk assessment in place. Even though the infection may be minimised within the counselling practice, a higher risk may appear on the way to get there. Clients and counsellors should consider their own safety before deciding to work face to face.

When to start working face to face?

The government has not explicitly prohibited offering face to face therapy, and in fact, some of the most emotionally vulnerable clients were seen face to face during the lockdown. Even though most of the shops and hair salons are now operational, each therapist and client will need to make an individual decision based on the risk. Therapists and clients who are in more vulnerable groups or who cannot easily access the practice may carry on working online for longer.

To make sure that a private practice is ready for working offline, it needs to have rigorous procedures in place including a specific cleaning schedule.

How to increase the safety of a counselling practice during the coronavirus epidemic?

Each counselling practice will have to go through a rigorous assessment of what needs to be changed to enable safer working during the epidemic.

Below are the most frequent considerations:

  1. Waiting areas may need to be closed. Waiting areas used to be meditative for some clients while for others offered nothing more than a rain shelter, now they may need to remain closed and clients may be requested to come on time of their appointment.
  2. If working in a larger practice, therapists may be requested to change the time of their appointments to make sure that clients arrive at different times.
  3. If possible, a one-way system should be developed to enable clients to stay away from each other and use different doors for accessing and leaving the practice.
  4. Hand sanitisers should be available at the entrances and exits, and clients and staff should be encouraged to use them.
  5. Reception and other areas where staff work on a regular basis may need to be protected by screens or temporary walls.
  6. Therapists should have discussions with their clients about what to do if either of them is diagnosed. The government was not able to deliver the application that could have made the tracing clearer for our clients. Since contact application cannot be used, we need to discuss if, how and when can we disclose the client’s names and contact details to the infection contact tracers or our will executor. I think that calling our clients when having high fever and covid anxiety should be out of the question, so I suggest you get in touch with you will executor to make sure you have a procedure for when this happens.
  7. Clients and therapists must have procedures in place to quickly move sessions online if any of them develops symptoms. I would suggest that each therapist carries with them a charged device ready for online work even though they scheduled a face to face meeting. E.g. our coronavirus poster encourages clients to check their temperature before leaving for the appointment (see poster below).
  8. Cleaning rotas and schedules. Therapists may be requested to ventilate the space and use an antiviral wipe or spray to clean surfaces after each client. Furthermore, each private practice needs a cleaning rota for common areas that include door handles, bathrooms, etc. How often the practice is cleaned should be determined by the number of clients and therapists using the practice.
  9. If a therapy room does not offer a comfortable two-meter distance or appropriate ventilation, it may not be suitable for face to face counselling and should be dedicated to teleconferencing only.
  10. Each practice should identify the procedure for appointing a professional antiviral cleaning company if required.
  11. Rubbish should be removed more frequently during the crisis.
  12. Some facilities, e.g. water cooler may not be available.
  13. Practices need a good stock of single used gloves, aprons, antiviral sprays, wipes, and paper towels.
  14. Soft furnishing would need either to be protected (we used cat scratch plastic covers on the arms) or regularly disinfected using a spray that can be applied to soft furnishing, e.g. Dettol All-in-one.
  15. Communication with clients and therapists will be crucial during this time. Practices may use posters, stickers, emails and telephone to prepare both therapists and clients for the new normal. We have designed our own floor stickers showing 2-meter distance and a poster with info for clients (see below). Feel free to download the poster and send it to your clients.

COVID-19 poster for clients

Implementing the above steps require consultations and training. Each counsellor and staff working at the practice must be aware and have agreed to these changes. With the influx of counselling clients that are expected after the coronavirus pandemic, counselling and psychotherapy practices must have procedures in place to minimise the possibility of infections.

If you are looking for a counselling room to rent that is coronavirus ready, please find more info here.

Marketing for counsellors: How writing counselling profiles may be similar to tinder?

Marketing for counsellors is an underexplored subject within our profession and even less explored when it comes to advertising online. Most of us search for services online, and even though there are more differences than similarities between buying services and using social media, this article is a playful invitation to compare dating apps to writing professional profiles for self-employed professionals. As controversial as this comparison may sound, both professionals and users of dating apps look for a match through building a profile that includes text and photographs. They hope that the algorithm (mechanism working behind the scenes of an app or directory) will link them to people who are looking for similar things.
For this purpose, let’s imagine James, who is going through a break-up and does not feel good about this. He looks for support in various places, but he also wants to boost his self-confidence, so he decided to start dating. He signed up to Tinder and made his profile from carefully selected pictures writing a rather honest description of himself. It turns out he has absolutely no interest in his profile and have not been liked back in any of the apps for a good few weeks. Why?
In Tinder or online marketing for psychotherapists, there are three factors that one needs to consider: algorithm, profile and readiness of the subject (e.g. psychotherapist to see clients or James to date someone new).

How do directories work?

The algorithm is how the application connects you with the other person (be it your love on Tinder or a client on Google). Tinder has an algorithm that is also based on a geographical location. Is James seen by the application in the right areas i.e. was his profile adequate to these areas? Is James more Chelsea or Peckham? This is an important consideration in advertising. Who is a certain application or directory made for? Is the application attracting the right audience? Is this an app for people who are looking for a long-term relationship, one-night stand or anything else? Which one does James want at this stage? By algorithm, I mean all the aspects that are related to the medium that we chose to use for advertising. Similarily in the marketing for counsellors, we need to make sure that a directory we are considering has the best potential to attract the clients we are looking for. An easy way to do it is to google phrases that we hope to be found at and see where that directory appears in the search results.

How to write a profile?

The profile is the main way we communicate. Our pictures and text provide a message on which people need to make an important decision. Nobody likes to waste their time and money either or dates or counselling. Returning to dating, since James is looking for a long term relationship, his profile must show him both as someone confident and approachable. Showing own strong points could be an attractor but may scare people who do not look for perfectionism in their lives. Would a picture of him playing with a child show that he wants to have a family or that he is co-parenting? Is it worth to put an airbrushed photo on the profile, knowing that it may attract people who don’t like him in the real-life and only add to the frustration?

Does a therapist has a capacity for clients?

Having supported about a hundred therapists starting their private practice and miserably failing on Tinder, I have realised that one of the most important and either overstated or understated issues is own readiness. According to the field theory, all of our situations are interconnected. Wheeler (1997) writes that clients do not select us accidentally, so why would people on the dating sites? Is James ready for a relationship or just to build his self-confidence by having some likes and movement in the area love? In my experience of working with counsellors and psychotherapists at the different stages of their career, I believe the readiness or capacity (a term that I prefer) is the most crucial part in attracting clients to our practices. No matter they invest in marketing their counselling practices, their capacity will be the decisive factor.

The self-belief that we can make it

Apart from the algorithm, profile and readiness, although closely linked with readiness is our shame. Am I not handsome enough to have a date? Am I not interesting or do not know how to present myself? Perhaps I am not made for a relationship, or there is something intrinsically wrong with me that will doom me for eternal loneliness? Not only when we start being therapists, but also when we get more experienced, we may be asking similar questions about our ability to do this profession. Although these questions are necessary for self-development and ability to be critical towards the work that we do, I think that the intensity and viciousness with which we may be asking them to ourselves may be related to lack of support, connection or sensitivity to our feelings.
In other posts in this blog, I will share my thoughts and experience of online marketing for counsellors focusing on the algorithm, profiles, capacity (readiness), shame and contracts. I discuss how the algorithm works for Google search engines, directories and other forms of marketing for counsellors including offline, I make some suggestions about how to write own profiles and contain often difficult feelings that arise in this process. I focus on the capacity as our readiness for seeing clients is usually not binary (yes or no), but involves capacity – for example at this time of my life, I have the capacity for five clients. Shame will come in a separate section to describe how we may undermine ourselves in this process after which I will explore various strategies and mistakes beginning counsellor and psychotherapists do when negotiating or not negotiating contracts with clients.
Of course, James had some more work to do. His dating history showed him that he needs to wait and grieve first. His dating app gave very different results a few months later.

What is Psychoanalysis?

Modern misconceptions of psychoanalysis

It’s a shame the father of psychoanalysis Sigmund Freud, has become somewhat of a mockery in popular culture. The Freud cartoons are often very funny, but serve to add ridicule to his ideas; those very ideas that have profoundly influenced and changed our society. Language and concepts that run right through our lives, the unconscious, the meaning of dreams and the idea our behaviour is affected by our past and not just our brains. His thinking and writing were brave, creative and off beam. But perhaps there’s something quite uncomfortable about being reminded we’re not always as in control of our behaviour as we like to think we are. To a certain extent, society survives and operates by denying this fact.

Perhaps similarly, the popular view of psychoanalysis has served to simplify and caricature it as static, an out-dated body of knowledge formulated over a hundred years ago, by a patriarchal figure that believed the root of mental disturbance was unconscious sexual conflict. The reality couldn’t be further from the truth. Psychoanalysis continues to grow and develop organically, being made up of a number of different and related strands of ideas about the human personality, largely generated from and in response to clinical work. It’s neither dogmatic and unchanging, nor possible to define neatly.

What is psychoanalysis?

As a psychological treatment, psychoanalysis is a method of psychotherapy that can be very useful for people who are struggling with longstanding difficulties in the way they think and feel about themselves, the world, and their relationships with others. Shorter-term approaches to therapy may be useful in helping clients find ways to cope with recent manifestations of states like anxiety or depression. It may be easier to identify a trigger in such cases, specific events or life stressors such as a relationship breakdown, or loss of employment. But for challenging psychological and emotional aspects of a person’s life that have been around for longer and may have their beginnings earlier in life, an approach that takes time and endeavours to understand the bigger picture is necessary.

If you were to stop and take a few minutes to reflect on the hour or so leading up to reading this article, noting any thoughts, feelings and sensations, what you’d notice would undoubtedly give a glimpse into the very individual way you have of viewing the world. You’d probably also realise that such an opportunity to stop, reflect and think about how you experience life is extremely rare in our busy modern day society. A psychoanalytic psychotherapist is trained to create a space and a type of engagement that encourages such internal reflection. They carefully observe and listen to you and overtime gradually build up a picture of the way you view yourself, your relationships with others and how your thinking and behaviour influence your experience of the world. They will gradually feed this evolving understanding back to you in ways that are manageable and in which you can talk and think about together. It sounds simple, but it's incredibly important and what many of us may be missing. Having someone to think with us about things can really help us to think about things.

What is the unconscious?

In a recent social situation, I found myself struggling to make a case for perhaps Freud’s most influential concept. Choosing to ignore what we don’t like or feel comfortable with? The retort was yes perhaps, but everyone does that, it doesn’t mean there’s an unconscious. The metaphor of the iceberg is nicely illustrative, what we choose to show on the surface is only the tip, whilst so much remains hidden beneath the surface. Repeating patterns of behaviour even when we don’t want to and they don’t serve us well? Comes close perhaps and something we can all relate to.

The royal road to the unconscious, of course, became the analysis of dreams, but Freud believed there were moments for all of us in which we’re made aware of our unconscious, through what he termed ‘bungled actions’; what’ve become known as Freudian slips. The moment of truth in the conflict between conscious and unconscious, when we trip ourselves up and say what we really mean, without the filter of the conscious mind to censor. We’re probably all able to recall our own often-humorous slips, trips, and bungles. When Radio 4's Today referred recently to the BBC'S "new spanking building" instead of "spanking new building", listeners responded to the unconscious innuendo with gleeful letters.

Moments like this provide us with fleeting glimpses of the thoughts, feelings and desires that have been repressed, relegated and held out of awareness for fear of causing conflict with a part of us deemed more acceptable. The therapeutic setting provides us with conditions for greater unconscious access, the safety and reliability provided by meeting in the same room at the same time for 50 minutes. In traditional analysis, the client lies on a couch, the therapist sitting behind out of view to facilitate the free association that frees the client from censor. Many psychoanalysts still operate this way and require frequent attendance, between 3 – 5 times weekly. Such frequency keeps the link between the unconscious and conscious alive from one day to the next and enables overcoming the resistance that repression creates. Melanie Klein adapted this approach to children, using play as symbolic expression and a kind of pre-verbal free association, giving insight into childhood unconscious conflicts.

Modern developments

Psychoanalysis had always been interested in early child development. Work with children led to the development of new strands, attachment theory, the British school of object relations and inter-subjective and relational approaches. Whilst concepts of the unconscious and repression remain at the core of psychoanalysis, we now know much more about the importance of our earliest relationships. A combination of nature and the nurture we receive from our environment, an interaction between a new-borns temperament, their adjustment to the world and the emotional development and capacity of parents influence our physical and emotional development both early on and into adult life.

Advances in child development research have provided evidence for the importance of our early bonds via neurodevelopmental findings. We’re born with innate capacities to relate, being drawn to eyes, faces, voices and smells and preferring those that are familiar. We imitate our caregiver’s expressions and movements; new-borns stick their tongues out in response to an adult (with quite a lot of effort!). Infants respond physically and physiologically to touch and being held, distress and heartbeats are calmed. From our earliest moments, even in the womb, we respond to the conditions that facilitate our growth and adapt to circumstances when those conditions aren’t present. Foetus’s exposed to chronic stress develop a stress response of their own, perhaps anticipating the world they’ll be born into.

It seems surprising today to think that pre-1950’s, much of the troubles of infancy and childhood, the tantrums, rage and inability to bear frustration had been passed off as unimportant, or simply attributed to physical factors. Psychoanalysis has painted a vivid picture of the primitive anxieties experienced by infants born in a state of total dependency. Even for the immature child, the world can seem completely overwhelming. If we have a parent that’s able to tolerate, think about and in some way make our distress manageable, by 1 year we begin to develop the capacity ourselves. If we’re fortunate enough to have parents that respond to our emotional needs consistently and reliably, we learn its safe to express ourselves and expect to be met; crucial for developing healthy relationships in and outside of the family later on.

When parents aren’t available enough or capable to provide a facilitating environment, perhaps due to anxiety or depression, we know this translates into difficulties in emotional and psychological development and behavioural adjustment during childhood and adolescence. Neural pathways are laid down from our earliest experiences, but continue to be created throughout life. When things haven’t been ideal, the relationship with a psychoanalytic psychotherapist offers a chance to think about these early experiences again, and through thinking and re-experiencing, the opportunity for something reparative and different from before to occur.

Psychological Resilience – why it’s important and ways to build it

I find human beings ability to change and grow fascinating! I became interested in the topic having had my own reserves tested through a particularly challenging time, so I started researching ways in which I could cope better the next time I hit a life roadblock. Inevitability, we all have the odd bad day, but what I am interested in is ones mental attitude to metaphorically dusting ourselves off, getting back up and keeping on going, essentially recognising the incident as a blip, not a constant. This led me to neuro-scientific research on how the wiring in our brains affects our ability to deal with adversity, which is dependent on many variables and impacts on our day to day mental health.
The proof that our brains are capable of repairing (known as neuro-plasticity), enabling us to re-wire our neural pathways or thinking patterns to fortify ourselves in the face of adversity, is such a positive message I am keen to share!”

As corporate life can impose an additional level of stress and pressure on us and in turn, our relationships and day to day living, which can drain our energy and resilience and make life tougher than it should be. Recognising the triggers in advance and learning tips/tools to combat this can be hugely beneficial.

Here we explore more on this important topic, the ways in which our reserves can be challenged and how we can make some lifestyle adjustments to improve our psychological resilience and lead more fulfilling lives.

What is Psychological Resilience?

Psychological Resilience is ones ability to bounce back after a set back or an adverse situation or to put it very simply, to get back up when one stumbles or falls and keep on going. On a word, bouncebackability!
It also links to one’s attitude to life; research has shown that having a positive outlook or disposition can help with building ones psychological resilience.

How might my Resilience be tested?

Modern life places demands on us that can test our reserves - being “always on”, excessive working hours or screen time. Equally, lack of sleep, poor diet and lack of exercise can all contribute to challenging our spirit and energy levels and the knock on affect impacts on our Resilience.

Are there any specific times in life that might impact on our ability to bounce back?

It could be one or any number of things, however times of change or disruption may provide a trigger, e.g. change of career or job, divorce or relationship breakdown, experiencing anxiety and or depression, eating disorders, bereavement, any adverse situation we are struggling with or simply, life!
As we approach Winter, with the limited daylight and decrease in temperature leads to a more sedentary lifestyle where we tend to eat and drink more and typically, exercise less. Whilst there is nothing “wrong” with that per-se, being mindful about having a balanced lifestyle will help to keep energy levels topped up.

What traits do resilient people typically have?

• They have a positive outlook and attitude towards the future
• They do not catastrophise, i.e. they see an adverse incident for what it is, a blip or a one off, not a way of being
• They have solid acheiveable goals and a desire/plan to achieve them
• They celebrate their successes
• They are unafraid of failure, recognising that through failure, we learn (we get back up…)
• They are empathetic and compassionate, however they don’t waste energy worrying about what others think. This is important as is recognising anxious “noise” v what we should be paying attention to
• They maintain healthy, boundaried relationships, they do not bow to peer pressure
• They focus on what they can control and do not see themselves as victims

How can I build my resilience muscle?

The good news is that we all have the ability to develop our Resilience and Reserves! As with tackling any life issue, there is no silver bullet that will “fix”, however adopting a holistic approach will help in abundance. Remembering our mind and body’s are intrinsically connected and therefore looking after one, will in turn, benefit the other.

Some tips for building Psychological Resilience include:

Energy creates energy so think about where you get yours as we are all different. Some tips that have been proven to build our resilience are:

• Move: Do more exercise, if you struggle to do this on your own, find a buddy and commit to certain times to increase motivation. Try different types if you are starting out. In winter, being out in daylight for 40 minutes+ is proven to have positive benefits on our wellbeing. It doesn’t have to be extreme, as long as it gets the endorphins moving and the blood flowing! The ideal would be some cardio mixed with yoga, as long as you feel the benefit.

• Sleep: Getting regular, quality sleep is essential to a healthy outlook. If your sleep is problematic, consider why. Is it the environment, mattress, excessive eating or drinking before bed, or spending too long on screens perhaps - it could be all of the above, by tackling one or all will have pretty instant impact on your sleep. Do not underestimate how lack of sleep impairs our day to day functionality and can make us feel “other”, which is not conducive to a healthy attitude to life.

• Meditation: A personal choice and one I have found useful during particularly stressful periods. There are plenty of app’s to help, many are free. Essentially this encourages a brain reboot and slows down busy minds, temporarily, which can increase energy levels. Research has shown that long term meditation has benefits on a cellular level and combating signs of dementia. However, we recommend you try meditating offline with the help of our Transcendental Meditation teachers.

• Connect: As human beings, we are programmed to connect with others. However in times of stress, we may not feel we have the time or energy to arrange or plan for “fun”. By being around friends and family who appreciate you and just enjoying the connection will have significant benefit on our mental health. Personally, I relate to the old adage of “laughter is the best medicine” - laughter is in addition to a physical release, creates endorphins which lead to a feeling of wellbeing and greater connectivity with those around us.

• Goals: Make plans and goals that reward and give energy, be it physical, educational or something completely different! Consider balance, if your occupation is cerebral, think about something physical or exercise based and if in a more physical job, perhaps an evening class or ways in which to tap into some of the resources you do not use on a day to day basis. This fires up the neural pathways and builds confidence which in turn builds resilience. The important thing is that they should not be arduous or punishing, this is about reinforcing positive and achievable targets.

• Rewards: I cannot stress the importance of recognising your achievements and progress, however small they may seem. By reaching ones goals, and providing a reward structure fires up the neural pathways and builds confidence which builds resilience.

• Supplements: Consider supporting your immune system with acupuncture, supplements, Magnesium Citrate (sleep/mood) Vit D in Winter should the lack of daylight be a thing for you, as it is for me. Everyone needs additional support at different times of life so explore what gives you a boost.

• Therapy: It might be helpful to seek professional support during acutely testing times. This can be particularly helpful in developing your own resilience tool-kit to combat and deal with your own needs.

• Kindness: Simple mantra to live by, be kind to yourself and others! In giving, may we recieve.

If you would like to connect with Katrina to discuss anything in this article, please feel free to do so on kat@welistentherapy.co.uk

How to calculate counselling fees? A guide for counsellors.

Ways of calculating counselling fees

There are various ways businesses decide what the price should be. Some companies check the competition to see how much others charge, some calculate their counselling fees by costs and add a profit margin on the top, some like many big businesses nowadays are prepared to offer services and products for less than it costs to produce them as they want to grow before they start making a profit. The lack of discussion on calculating counselling fees led to a vacuum filled by own attitudes to money, generational gap and a fixed idea that if you have graduated you should charge around £45 per session.

The minimal discussion on the financial matters in psychotherapy may be rooted in our uncertainty and shame of talking about money. Some of us may feel uneasy charging for our services as helping others may feel natural. The generational divide is between generations of therapists who were trained during a more supporting housing situation, they usually own home and often work from it, while the new generation has to pay the high fees for therapeutic room rental and marketing that does not concern most established psychotherapists and supervisors.

This article is an invitation to a more robust discussion on psychotherapeutic financial matters and includes an alternative to calculating the counselling fees psychotherapists may charge. It is an invitation to rethink various aspects of our work that contribute to how we set our prices. All of the questions are based on personal beliefs and decisions; no two therapists should come with the same outcome.

In this article, I will ask you four questions and then propose a calculator with a formula that may be a way to calculate your counselling fees. I suggest you note down an answer to each question on a sheet of paper.

What is a decent salary for the work you do?

Let’s start with a question what a decent salary for the counselling or psychotherapy is? We are looking here for a full-time salary of psychotherapists or counsellor in the NHS or other organisations plus-minus what you believe you should earn? We are coming from different social and economic backgrounds, and at different times of our lives we may value ourselves or the therapy differently, so after you research the salary in the NHS in your area, check if you feel comfortable with this as your salary? Please note down that salary per annum with all taxes as you will need it for the counselling fees formula calculator below.

What are annual expenses in a psychotherapeutic private practice?

Having found the salary, let’s move to consider the annual expenses. If you are a seasoned therapist you can check your last year self-assessment or limited company statement, but please do remember that we are calculating the full-time salary, so for example, if you only work three days make sure that you increase your expenses to a five-day simulation.

For people who need to figure out their counselling fees for the first time, I have prepared a prompt list of some possible expenses people

  • Expenses:
    • Room rental – this is probably the most significant expense if you work in a large city such as London, the final price depends on how many clients you plan to see as a full time professional (see below)
    • Continuous professional development – with a minimum of fifty hours (UKCP standards) and the reality that most of us completes even more hours each year this is usually the second biggest expense. Please add here the cost of travel to the workshops and conferences, hotels and food if permitted by your accountant
    • Clinical supervision including travel to and from the destination of your supervisor
    • Personal therapy including travel (see above) – as most of the guidelines for psychotherapists suggests that we should be in personal therapy, I have included this as a business rather than a personal cost
    • Books and subscriptions
    • Registrations, insurance and other professional costs
    • Advertising (website, directories – e.g. Counselling Directory or Psychology Today, Google Ads, business cards, ads, etc.) – this expense will differ if you work long term or short term as in general short term therapists need to invest more in advertising
    • Accounting and banking
    • Mobile phone, emails, etc. (consider that the percentage of your mobile phone use if you don’t own a separate phone for your business purposes
    • Stationery
    • Equipment, e.g. computer, printer, scanner, shredder (you will not buy them each year, so consider how often you plan to exchange)

How many hours a week is full time for a psychotherapist?

This is a personal question and in order to provide a diversity of opinions. While the United Kingdom Council for Psychotherapists suggests that full time for psychotherapists is anything more than 20 hours, I have asked three senior therapists from our practices in Kensington and Pimlico to share their experience. Please note the number of hours that you think constitute the full time for you. This number may change as depends on our capacity for clients, support and work-life balance.

Cristina Durigon:

That’s an interesting question and of course, this can vary from practitioner to practitioner. In my personal experience, a full-time psychotherapist would be seeing a range between 18 and 22 clients or supervisees per week. This would mean offering more or less 4 to 5 hours of clinical contacts per day. The rest of the day would be dedicated to writing notes, attending supervision or undertaking other administrative tasks. Of course, this varies depending on a number of situations such as time of the year and workload, so, therefore, these are not fixed number. I hope this helps to give you an idea of what a typical week for a full-time psychotherapist would look like.

Gilead Yeffett:

My experience of a full-time practice is working five days a week, my average week includes 26-28 clinical hours.  I predominantly work with couples and parents-children; two- or three-person sessions last an hour and a half so I plan each day to cover no more than six and a half clinical hours.  I find the work highly rewarding and find that with the right weekly supervision I can maintain a solid and viable psychotherapy business.

Emily Cavendish:

What constitutes full-time is not just about clinical hours, it is also about how you manage your resources and the extent to which your work with clients can expand to fit the time and the space you have available. I did not set out to see 30 clients a week and, in truth, I would prefer a slightly smaller caseload. However, as for so many professionals who are self-employed, there can be a ‘feast or famine’ aspect to setting up a business. I am very familiar both with intense anxiety about how I can possibly see everyone and give them the attention they deserve, as well as a gut-churning fear of all my clients abruptly ending therapy and no new referrals coming in. This unpredictably is one of the features of private practice which makes it hardly to regulate the number of clients you take on. Perhaps one answer to the question of ‘what constitutes a full-time clinical practice?’ is that it is the number of hours you can work and simultaneously honour the needs of your clients alongside your own. This is a tricky balance to strike and one that must be subject to ongoing review.

How many weeks will you work on average with a client in a year?

To understand the salary of a psychotherapist over a year, therapists need to be clear how many times in a year they may see a client. Although this can be a simple question based on therapists availability, it includes essential considerations about holiday plans, time saved for sick leave, continuous professional development as well as the therapeutic boundaries. Does your contract with your clients protect you and the therapy from them taking too many holidays? For example, a therapist may plan 4 weeks of holidays, include time for 2 weeks of sick leave, 1 week conference and offer up to 5 cancellations for their clients – this equals to 40 working weeks in a year. Another example would be a therapist who expect to be paid during all of the clients' absences, travelling once for a conference, not working over 4 weeks in August and 2 weeks of Christmas and allowing only one week off due to sickness – their working year is 44 weeks. I am suggesting here only models where therapists charge for missed clients sessions with a short notice such as sickness, train cancellations, etc.

Counselling fees formula:

In the above paragraphs, you were guided through ways of figuring different amounts that now can be put into the calculator below:

 

The counselling fee that you calculated above is an average fee for a session, but you may consider increasing your price to offer some charitable work.

Social responsibility and offering discounts

A lot of my supervisees, especially those who just begun, offer discounts to clients almost automatically. As we (therapist) often had helping roles in our families, the offer of help and work for little money may seem natural to us. Others may feel that they have not qualified enough yet, so their counselling is not worth the full fee anyway. Both of the above reasons are unfortunately related to therapists own lives and have little to do with the reality of the client’s situation; they also may not support therapists in their long term relationship with their clients. A therapeutic relationship lasts for years and it is vital that the therapists prevent a situation when they may feel resentful towards clients, especially if they think they don’t value the work.

If it comes to the requests for discounts, it is important to consider if the client is not devaluing a therapy as they may devalue their own emotions and psychological health. Some of the clients may come from affluent backgrounds where money has always been a point of negotiations; they may bring these skills to the therapy too, expecting that the price we offer is a starting price of negotiations.

Having warned about all ways how it may be wrong, I think that therapy should be and isn’t at the moment accessible, and would encourage therapists to offer part of their time to people who cannot afford it. This can be done on a fixed fee basis where therapists increase their average fee (see above) by the amount they want to reinvest supporting low-cost clients or a sliding scale basis. If you choose to make it on a fixed fee basis, you need to find a discreet way of informing your clients about the low-cost places for example by writing on your website that you offer a small number of concessionary places. The sliding scale system is described below.

Sliding scale

The sliding scale system is a fair and transparent way of offering prices relevant to clients incomes. Therapists prepare the sliding scale considering the average calculated above and link it with the average salary in the area or of the group of clients that they already have in their practice. When clients come to the first session or even in the discussion over the phone, the therapist presents the scale. In most of the cases, clients are asked to self-identify the place on the scale, and we would not usually ask for evidence of their salary.

The problem is that your practice may become an attractive option to the people on low income only and you may need at some point not to accept clients who earn below a certain amount as you will earn below the calculated average.

I hope that the above system and counselling fees calculator will stimulate some discussion on how to calculate fees for psychotherapists and counsellors.