Effect of fees on psychotherapy: What is the evidence?

Abstract

Theoretical support and previous research regarding how fees affect psychotherapy are reviewed. The two theories about fee effects, psychoanalysis and cognitive dissonance, have not been appropriately tested. The belief that some fee is necessary for effective psychotherapy has been disputed, but within the limits of brief therapy with particular samples and without the involvement of the therapist in the payment process. Fees appear to present a barrier to patients in entering or continuing therapy, and fees may be more important motivators to therapists than to patients. Currently the effect of fees on psychotherapy outcome is uncertain. There is a need for further research in which sliding-scale fees, private practice settings, and therapies of some duration are used and the role of the therapist in particular is explored.

College Students' Perceptions of the Relationship Between Fee and Counseling

“…Although it makes intuitive sense that people would be more willing to pay a higher fee as the level of distress climbs, this was not found here with this student population. This may be due to the idea that people in the United States seem to believe that they are entitled to many services for which they may be reluctant to pay (Herron & Sitkowski, 1986). The two variables, however, did have independent effects.…”

The Practice of Fee Setting and Collection: Implications for Clinical Training Programs

“…These beliefs appear to have their roots in two explanatory theories: psychoanalytic theory and cognitive dissonance theory (Herron & Sitkowski, 1986;Shipton & Spain, 1981). From the psychoanalytic perspective, fees must be paid only by the client and must be sacrificial in order to ensure the client values the analysis sufficiently and receives maximum benefit.…”

“…They concluded that there was "limited experimental evidence" (p. 72) available to support whether or not paying a fee was beneficial to therapeutic outcomes. In a later review, Herron and Sitkowski (1986) conducted a more in-depth study of the available literature that included a total of 17 studies. Although three of the reviewed studies found paying fees had a positive impact on therapy outcomes, the bulk of the reviewed studies did not, leading the authors to conclude that the weight of the evidence did not support the belief that clients who pay a fee benefit more from therapy than those who do not.…”

Common Errors in Conducting Psychodynamic Psychotherapy: Illustrative Vignettes and Alternative Strategies

“…The debate ranges from those who believe that meaningful psychotherapy is not possible without an adequate fee (Freud, 1913(Freud, /1958 to those who believe that reducing the fee can be used as a tool to reward the patient for reaching goals (Gumina, 1977). Curiously, the evidence is contradictory as to the effectiveness of fee payment on psychotherapy (Bishop & Eppolito, 1992;Herron and Sitkowski, 1986;Pope, Geller, and Wilkinson, 1975;Yoken & Berman, 1984). Most traditional therapists regard the negotiation of the fee as a contract that constitutes part of the structure of psychotherapy.…”