In today’s economy many LMFTs are finding it harder and harder to make a living.

Clients are becoming scarcer due to a reduction or elimination of income. Insurance

companies are cutting costs and are either reducing reimbursement rates or not paying

altogether for services. In addition, we as professionals are facing much of the same

challenges as our clients: loss of home values, foreclosure, increase business expenses,

cuts in pay and job loss. With such dire circumstances it is easy to cut corners but we

must now more than ever make the effort to distinguish ourselves as practitioners with

high standards of ethical practice.

If you are in private practice and struggling it is easy to take shortcuts and compromise

your ethics. One of the first ways may be to bill for fraudulent services. Insurance

companies only pay for face-to-face contact time with clients so without them looking

over your shoulder it may be easy to think about billing for session with clients that were

never held or billing for longer sessions that never occurred. This of course is a legal and

ethical violation. EOBs (explanation of benefits statements) are typically sent to your

clients after services are billed. Do you really want to run the risk of either losing your

client, getting called out by them and their insurance company for fraud or worse risking

being charged with fraud?

A second shortcut that may be taken is to withhold taxes. Believe me it is no fun to pay

taxes to the government and to think about shelling out quarterly tax payments when you

barely have enough to pay for your own mortgage is a pain. However, not paying taxes

either quarterly, at tax time in April or altogether is not an option.

A third way your ethics may be compromised during this time is to have less face-to-face

time with your clients. A typical session with a client is usually 50 minutes long. You

may be tempted to fit as many clients in your schedule in 30 minutes increments but you

are doing yourself and your clients a disservice if you do so. As professionals who listen

to people for a living it can become mentally exhausting to try to distinguish one’s

client’s problems for the other. After a while, they all may seem to run together.

Sometimes my 10 hr days often feel like that. But you are not giving your clients enough

time to process their feelings with you, as well as give yourself enough time to help them

find workable solutions to their problems. Your practice should not be assembly line

like.

A fourth way you may be compromising your ethics is to reject clients who cannot pay

you. We of course all want to get paid for our services but as servants to the general

public we are called to help those in need not just those that can afford our fees.

So what are some ethical solutions for a better practice? You might first consider joining

a group practice to share costs such as rent and utilities. Seek out colleagues at your local

MFT chapter meetings and ask if they have office space they can share. Next, consult

with a financial advisor or accountant if you are behind in taxes. The IRS is often times

more than willing to give you a delayed tax re-payment schedule. Third, consider

offering a sliding fee scale to clients who either do not or who have lost insurance

coverage. Getting something is far better then getting nothing. Also, don’t rule out probono

services. Your clients will appreciate it even if it’s only 1-2 sessions per month you

can give. Remember, your clients are your best referral base and may refer other clients

to you just because they saw you as compassionate. Fourth, use creative low cost

marketing. While no one enters the MFT profession intends on a career in sales, that

component is vital to a good practice. Build a website or have someone do so for you,

start a blog, write articles for local newspapers, volunteer to speak at local MOM’s club

group, hold a free seminar once a month or quarter at your church. Put ads in

neighborhood newsletters in residential areas where your practice is close to. Do

anything to increase your profile and distinguish yourself from other mental health

professionals. Sixth, offer specialized services. Many LMFTs have decided to not take

insurance and you can do the same. What makes them successful is that they offer

services that are unique from other mental health professionals; for example, intensive

sessions, which maximizes what their clients get from paying an out-of-pocket fee. Fifth,

don’t be scared to consider getting a part-time job or use your other creative skills to

general income. Your talents as an artist or calligrapher may pay off handsomely if

people knew you could design bedroom art and murals for children. Lastly, consult,

consult, and consult. There is no need for you to feel alone out there in the world of

private practice. Talk to your colleagues; let them know about your struggles. They may

be able to give you helpful advice or refer you to services and people that can help you.

So why should LMFTs maintain such standards of practice? First, because we should

honor the public’s trust in us. Clients come to us seeking our expertise and with an

inherent respect. To dishonor that or take advantage of them in any way does a

disservice to our profession and cheapens our ability to promote second-order change.

Second, we should maintain high standers of practice to distinguish ourselves from other

psychological professionals. We are more than coaches, teachers, or mentors, social

workers or mental health counselors. We are uniquely trained to see and help the family

from a systems perspective. It is important that our clients know our paradigm

perspective. I’ve found that when I explain this to them in practice they appreciate this

viewpoint and are more willing to engage in the therapeutic process. Lastly, we are

ethically and legally bound to maintain high standards of practice in order to maintain

licensure. In AAMFT’s Code of Ethics Principle 1 states, “Marriage and family

therapists advance the welfare of families and individuals without discrimination on the

basis of race, age, ethnicity, socioeconomic status, disability, gender, health status,

religion, national origin, or sexual orientation. They respect the rights of those persons

seeking their assistance, and make reasonable efforts to ensure that their services are used

appropriately.”

As LMFTs we are all striving to make ends meet during these tough economic times. I

see many of my colleagues struggling and wish for the good old days but we cannot

dwell on the past. We have to look forward and make wise choices when it comes to

finances, our practice and our lifestyles. Maintaining a high standard of ethical practice

will serve to continue to remind us why we got into this profession in the first place, to

help individuals and families find hope, healing and lasting change