Money Boundaries: Handling Late Payments, Sliding Scale, and Payment Policies (Without Feeling Like a Terrible Human Being)
Most therapists would rather chew glass than talk about money. Heck, Marina never even got paid for her first private practice session!
We will process your childhood trauma, existential dread, mother-in-law problems, vaginal dryness…
But ask us to enforce a no-show fee?
Suddenly we’re like, “Oh my god, what if they think I’m greedy?! What if they hate me?! Also, awkward!”
Let’s all take a collective breath.
Because here’s the truth:
You cannot have a sustainable, ethical, life-giving private practice if you don’t have healthy money boundaries.
Period.
And this is not just a business thing; it’s a clinical care thing.
When you don’t have clear boundaries, resentment grows, exhaustion creeps in, and clients end up being treated by a therapist who’s stressed, underpaid, and over their limit. (See our blogs Surviving the MH Industry, Part 1 and Part 2)
So today we’re diving into three areas where money boundaries get messy:
Late payments
Sliding scale
Payment & cancellation policies
Let’s clean it up so you can stop worrying so much about money boundaries.
Why Money Boundaries Are Clinical Boundaries
Before we get into the practical stuff, let me normalize something:
It is extremely common for therapists to feel squeamish about money. We were trained to be helpers, caretakers, emotional doulas. Nobody pulled us aside in grad school and said:
“Welcome to Professional Boundaries 101: If your client ghosts your invoice, that’s both a therapeutic issue AND a business issue.”
You were taught to prioritize the client’s needs above all else. And (ick incoming) a lot of us internalized awful money messages from our families of origin.
In grad school, you weren’t taught to prioritize the health of the therapeutic container.
Money is part of that container.
And here’s the kicker:
Clients actually feel safer when your boundaries are clear.
It signals consistency, stability, and professionalism — all things that help them relax into the work. Predictability often = safety.
So even though it might make you want to yak, we’re gonna talk about it.
1. Let’s Talk About Late Payments (and Why They Drive You Up the Wall)
Picture it:
You gave a great session. You held space like a boss. You grounded, you connected, you validated.
And then… the payment “doesn’t go through.”
Or worse: “I’ll pay next week, I promise!” which turns into three weeks, four excuses, and a pit of dread in your stomach.
Here’s the thing:
You’re not a loan officer.
You’re not a debt collector.
You’re a therapist and business owner/CEO.
How to Handle Late Payments Gracefully (But Firmly)
1. Have a card on file.
Having a credit/debit card on file cannot be optional. It’s OK to make a first appointment without one, because the client hasn’t even done the paperwork yet. But a second appointment cannot be scheduled without a card on file.
Also, if you’re not using autopay, please fix that. Today. Right now.
It’s 2025, and we’re not chasing people like it’s 1997.
2. State your expectations clearly, starting before the first session.
This goes in:
Your intake paperwork
Your consent forms
Your first session script
Something like:
“All payments are processed at the end of each session using the card on file. If a payment fails, we’ll resolve it before scheduling the next appointment.”
3. Don’t continue scheduling until the balance is paid. IN FULL.
I know. I KNOW.
But this is a boundary that protects you AND the therapeutic relationship. It harms clients if we teach them that walking all over their therapist is acceptable.
Real talk: if they are trying to take advantage of their therapist, they are likely doing it in other relationships. Meaning, it’s a therapeutic issue!
4. Keep it neutral, not emotional.
Late payments don’t require shame or big energy.
You can say:
“It looks like the card didn’t go through. Let’s update that so we can move forward.”
That’s it. Short. Kind. Boundaried.
2. Sliding Scale: The Emotional Minefield
Here’s a sentence that might sting (in a good way):
You cannot save the world by undercharging.
A sliding scale is a kindness… until it becomes self-abandonment.
I’ve seen therapists offer sliding scale rates out of guilt, fear of losing clients, or the chronic caretaker reflex. Sadly, lots of therapists are codependent.
But the truth is: You can absolutely offer affordable options without draining your energy, time, or bank account.
Example: about 35% of Marina’s practice is (combined) EAP clients, reduced fee clients, and pro bono clients. And she’s still clearing multiple six-figures annually.
Healthy Sliding Scale Boundaries
1. Have a limited number of sliding scale spots.
Not “I’ll figure it out as I go.”
Not “I’ll take whoever asks.”
A number.
Two spots? Five? One?
Pick it before someone asks. So when they ask, you can say, “My reduced fee spots are currently full. Would you like me to contact you when one opens up?”
2. Decide your lowest rate in advance.
This prevents the “Uhhh… what can you afford?” conversation that leads to awkwardness or resentment.
Whatever your minimum is…DO NOT accept less.
3. Reevaluate sliding scale clients every 6 months.
People’s circumstances change.
It’s okay — and appropriate — to revisit their rate.
You can say:
“I reassess all sliding scale arrangements every 6 months. Let’s take a look at where things are now.”
4. Have clients requesting a reduced rate fill out a form.
Marina’s form includes the following information:
Contact info (duh)
Total annual income (combined if married)
Fees are per hour, $275 for individual therapy, $450 for couples. Please let me know what rate you can afford
Have they verified if insurance will cover a portion of the fee? (for out-of-network reimbursement)
If insurance covers some of the fee, what is that percentage or amount?
Please provide any other information that should be considered
5. If you offer a reduced fee, make it time-limited.
Such as:
“I’m happy to offer you a reduced fee of X for six months”
6. Consider seeing reduced fee clients less frequently.
As long as it’s clinically appropriate, there is nothing wrong with that.
7. Offer alternatives that don’t involve you personally discounting your work.
Like:
Local training clinics
Nonprofit agencies
Group therapy
Low-cost community programs
Telehealth platforms with reduced rates
This lets you support accessible care without compromising your livelihood. And remember: if you decline to take a client, it’s always advised to give them a couple of referrals.
3. Payment Policies: How to Set Them, Say Them, and Stick to Them
Money policies aren’t just paperwork — they are the backbone of your practice structure.
Your practice can’t run on vibes. It runs on policies.
Here are the essentials your policy should cover:
✓ Payment timing
At the time of service? End of session? Automatically billed? [We’re fans of the automatic billing option]
✓ Accepted payment methods
Cards only? HSA? No checks? No cash? Say it clearly.
✓ No-show fees
If you don’t have a late cancellation policy that you follow, you will resent your clients who cancel late or no show.
That resentment will leak into the work.
A standard policy is charging the full fee for cancellations under 24 or 48 hours.
Feel free to steal Marina’s:
To avoid being charged for the session, clients must cancel any Sunday appointments at least 48 hours in advance of the start of the session. For sessions Monday - Thursday, clients must cancel appointments at least 24 hours prior to the appointment start time. Shortening the length of the session is considered a partial cancellation and needs to be done within the timelines specified above. By signing this form, you are acknowledging that you understand and agree to this policy.
REPLYING TO THE EMAIL AND/OR TEXT REMINDER DOES NOT COUNT AS A CANCELLATION (the reply goes nowhere). You must contact Marina Blake directly through email, text, or voicemail.
The above cancellation policy is part of the standard intake paperwork, and includes the title “Cancellation Policy: PLEASE READ.” All clients must sign acknowledgement that they are aware of the policy.
✓ Good-faith estimates
This is required by law for cash-pay clients. Make it part of your onboarding flow.
Learn more about the No Surprises Act here.
✓ Insurance realities
If you’re not paneled, your paperwork needs to say that clearly.
If you are paneled, your paperwork needs to outline deductibles, copays, denied claims, etc.
✓ Enforcement
If you wouldn’t enforce it 10 times in a row, don’t put it in writing.
This doesn’t mean you never make an exception, but that they are rare.
Scripts to Make This Easier (Because We Love a Script)
Here are a few you can steal immediately:
When a card declines:
“Looks like the payment didn’t go through. Let’s update that now before we schedule our next session.”
When someone asks for a sliding scale you don't have available:
“I don’t have any sliding scale spots open at the moment, but I can share some lower-fee referrals if that would be helpful.”
When someone cancels too late:
“I appreciate you letting me know. Per our agreement, the full session fee applies for cancellations under 24 hours.”
Short, simple, not an apology in sight.
Why These Boundaries Matter (A Pep Talk)
Money boundaries don’t make you:
Greedy
Harsh
Capitalistic
“Less compassionate”
They make you:
Sustainable
Grounded
Available
Ethically consistent
Professional
Able to continue doing this work for many years
You can’t pour from an empty cup.
And two more things
If you have a cancellation/no show policy that works, clients are WAAAAY less likely to cancel or no show (‘cuz who wants to pay for something they’re not getting, amiright?)
The clients who are late cancelling or no showing take spots away from other clients. Meaning: you’re actually helping less people.
A Gentle Assignment for You
Take 15 minutes and ask yourself:
What policy do I avoid enforcing because I’m afraid it’ll upset someone?
Where am I undercharging to soothe my own discomfort?
What ONE boundary could I fix this week that would reduce my stress by 30%?
Pick one.
Implement it.
Your future self will thank you.
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