Managing Sliding Scale Appointments in Private Practice
I’m going to tell you exactly how I manage sliding scale appointments in my therapy private practice. But I have to tell you, every single time I post about therapy fees, I get some gnarly hate comments. Sliding scale appointments are one of those topics that spark a lot of strong opinions, even among therapists.
If you’re starting a private practice as a therapist, figuring out how to structure sliding scale spots is one of those behind-the-scenes details that can make or break your sustainability. I want to walk you through exactly how I do it, why I do it, and the boundaries that help me keep my business healthy while still making therapy accessible.
My Early Mistakes with Sliding Scale Fees
When I first started working in private practice, I slid my fee all over the place. I wasn’t confident in what my therapy session fee was, and I was nervous about changing it. If a client even gave the tiniest “Oh…” or slight pause or display of discomfort, I would immediately lower my fee.
Now I’ve learned that’s not the best approach. Clients sometimes react to a price the same way they might if they were going to see a massage therapist, a dentist, or a chiropractor. That little moment of discomfort is normal, but it doesn’t automatically mean they need a lower rate.
Deciding Who Qualifies for a Sliding Scale Spot
When I thought about my own practice, I had to pause and ask myself two questions:
Why do I want to offer a sliding scale?
Who will it be available to?
For me, my “why” was clear; I wanted to offer sliding scale therapy spots for clients who made at or below minimum wage in my community. And I wanted them to pay what they earned for one hour of work.
For example, if a client earns $16/hour, that’s what they pay for a session. Considering my full fee in Southern California is $250/session, you can imagine how different that is. I had to make sure my private practice business model could handle it without hurting my income goals.
Doing the Math for a Sustainable Private Practice
This is the step a lot of therapists skip; you have to run the numbers before setting a sliding scale policy.
When I’m working full-time in my therapy practice (for me, that’s 15–25 clients a week), I can offer 3–4 sliding scale spots and still meet my income goals.
When I’m part-time, like after maternity leave with my two little boys, or during slower seasons when I’m under 15 clients a week, I can only afford 1–2 sliding scale spots.
Doing the math meant I could get excited about offering these spots because I knew they were sustainable. But the only way I can keep them is by holding my boundaries with full-fee sessions.
Exactly How I Talk to Clients About Sliding Scale
Clients will sometimes ask, “Do you have any wiggle room on your fee?” or “Do you offer sliding scale appointments?” And let me be clear, there’s nothing wrong with them asking, I’m glad when they do.
Here’s exactly what I say in return:
“Thank you so much for asking! I keep [number] sliding scale spots in my practice at any given time for clients who make at or below minimum wage. Do you make at or below minimum wage?”
If they say yes, I explain:
“I charge what you earn for one hour of work. So if you earn $17 an hour, that’s what you would pay for therapy.”
If they say no, I’ll say:
“I’m so sorry. I save these spots for clients who make at or below minimum wage. But I can refer you to someone who takes your insurance, a lower-fee clinic, or Open Path Collective, they’re great for finding sliding scale therapists.”
That way, I’m honoring my sliding scale policy and still helping them find affordable care.
Why I Don’t Offer “Small Discounts”
Some therapists will shave $10–$20 off their rate for clients who don’t meet their sliding scale criteria. I don’t. If I did that often, I couldn’t afford to keep my lowest-fee spots available for the people they’re designed for.
You might choose a different structure, and that’s okay. The important thing is that your private practice fee policy aligns with your “why,” your math, and your boundaries.
Put Your Policy in Writing
If you’re starting a therapy private practice or updating your systems, make sure your sliding scale policy is in your intake paperwork alongside your full fee and cancellation policy.
Boundaries aren’t about being rigid, they’re about building a therapy business that’s sustainable for the next 30 or 40 years.
Final Thoughts
If you’re figuring out your sliding scale approach, here’s what I recommend:
Know your why before you set a sliding scale.
Do the math so it’s financially sustainable.
Communicate your policy clearly with clients.
Put it in writing in your intake forms.
Hold your boundaries so your practice stays healthy long-term.
If you want help setting your therapy fee or figuring out how to raise it, I have a free guide you can grab here.
And now I’m curious, what’s your sliding scale policy? Tell me in the comments or send me a message. If you’re wondering how to make it work in your practice, you’re not alone and you can make it happen.
Until next time.
