Supervision CircleThe truth is, most therapists don't underprice because they misread the market. They underprice because asking for money feels like the opposite of the job. You spend all day making room for other people's needs, and then you're supposed to send an email that says "my fee is going up." It lands weird in your chest.
But an underpriced practice isn't generous — it's fragile. Burnout math is real: too low a rate means too many sessions, which means worse clinical work for everyone on your schedule.
The Math
Start with your number, not your feelings
Before you pick a fee, figure out what your practice actually has to produce. Work backward:
1. Target take-home
What you need to pay yourself annually. Not your dream number — your floor plus a real cushion.
2. Add the invisible costs
Self-employment tax, health insurance, retirement, EHR, liability insurance, licensure, CE, supervision or consultation, rent, and the accountant you should have. This is usually 30–40% on top.
3. Divide by realistic sessions
Not 40 weeks at 25 sessions. Use your actual attended rate after cancellations, vacation, and sick weeks. Most full-time clinicians land far lower than they estimate.
4. Compare to your market
Look at what comparably credentialed clinicians in your city charge. If you're at the bottom of that band with a full caseload and a waitlist, that's your answer.
A full caseload with a waitlist is the clearest possible signal you're priced under market. If you're booked out three weeks, the market has already voted.
The one-slot rule
You can raise your rate and still serve people who can't pay it — those two things aren't in conflict. Decide on a fixed number of reduced-fee slots (two is common), fill them intentionally, and price the rest of your practice at what it actually costs to run. Sliding scale applied by guilt in the moment always drifts toward the people who advocate loudest, not the people with the most need.
The Letter
What to send existing clients
Short, warm, specific, no apology spiral. Something like: "I want to let you know that starting March 1, my session fee will be $X. I review fees once a year. If this creates a real barrier to continuing, please tell me and we'll talk about options — I'd like to keep working together."
That's it. Three sentences. The longer the letter, the more it reads like you're negotiating with yourself, and clients feel that.
The Pushback
What to say in the room
"That feels like a lot."
"It is an increase, and I understand. Can we talk about what would make it workable — spacing sessions, or a reduced-fee slot if one's open?"
"Can you make an exception for me?"
"I hold a couple of reduced-fee spots and I'd rather be honest about whether one is available than quietly resent the arrangement later."
"I might have to stop."
Treat it clinically, not commercially. Endings raise material. Explore it the way you'd explore any other ending — and mean it.
After
Protect the decision
The week after a rate change is when nerve fails. You'll get one hard email and want to reverse everything. This is exactly the kind of thing to bring to consultation, where three colleagues can tell you they went through the same wobble and held. If marketing is the other half of this problem for you, our Reluctant Marketer group is built for people who hate promoting themselves, and consulting vs business coaching covers who to hire if you want more structured help.
I built my own practice, Shoreside Therapies, through several of these increases, and I've talked through the awkward parts on the Without the Couch podcast more than once.
FAQ
Common questions about raising therapy rates
How often should I raise my therapy rates?
Most sustainable practices review fees once a year on a set date, rather than waiting until resentment or a bad financial month forces the decision. An annual review makes the increase routine instead of personal.
How much notice should I give existing clients?
Thirty to sixty days is standard and respectful. Put it in writing, keep it short, name the effective date, and offer a conversation for anyone for whom it creates a real hardship.
Should I grandfather long-term clients at the old rate?
You can, but decide it as a policy rather than case by case. Ad hoc exceptions tend to track who is most uncomfortable to disappoint, which is not a financial strategy. Many clinicians instead hold a fixed number of reduced-fee slots.
What do I say if a client pushes back?
Validate first, then hold. Something like: 'That's a real increase and I understand it's a stretch. I want to keep working together — can we look at frequency, or at a reduced-fee slot if one is open?' You don't have to justify your fee with a spreadsheet.
Will I lose clients when I raise rates?
Usually a small number, and often the ones who were already ambivalent. Plan for a few departures, and remember the math: a modest increase across a full caseload typically outweighs the loss of one or two sessions a week.
How do I set a rate when I'm brand new?
Anchor to what comparable clinicians in your area charge rather than to what you feel worthy of. Impostor feelings are a terrible pricing consultant. Then plan your first increase for the twelve-month mark so it's already scheduled.
Practice building
Want support with the business side?
Rate changes, marketing, and the parts of practice nobody trained you for — drop your name and I'll let you know when a group opens.