tag:blogger.com,1999:blog-26666124.post6224337521551659746..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Just A Little More TimeUnknownnoreply@blogger.comBlogger42125tag:blogger.com,1999:blog-26666124.post-64554092616942612992009-02-27T06:34:00.000-05:002009-02-27T06:34:00.000-05:00Yesterday near the end of my appointment my therap...Yesterday near the end of my appointment my therapist and I started talking about an issue that was happening around town, something that we couldn't believe had happened. When I next looked up at the clock it was 5:15! <BR/><BR/>Thinking about your post, I told her that she needed to promise that she would kick me out so that she could actually leave on time. Her response? <BR/><BR/>"I think I've been doing this long enough that I can manage my own time. I know how to say 'Our time is over' but I am choosing not to."<BR/><BR/>Interesting response, I thought.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-47088028418515034312009-02-24T08:38:00.000-05:002009-02-24T08:38:00.000-05:00Hi, What an amazing blog.. I can't believe it's ta...Hi, What an amazing blog.. I can't believe it's taken so long for me to discover it!<BR/><BR/>I have to say I am something of a fan of boundaries. They should always be communicated by the practitioner to the client consistently and regularly especially if there is any chance of deviation from existing rules occurring "accidentally" - and I believe this is important no matter how long the relationship has been continuing because as long as it is a professional relationship then professional boundaries apply; one is the client and one is the service-provider.<BR/><BR/>However, I do agree that in this case the boundary should not be enforced on this occasion because clearly there has been a lapse and it is always the practitioner's responsibility to enforce and maintain boundaries. However, once the rules have been re-communicated (is that a word?) then henceforth the client should be charged.<BR/><BR/>I guess its more about *how* it is done rather than *if* it is done.<BR/><BR/>The relationship must be protected and this can be achieved with the right level of professional tact and diplomacy.<BR/><BR/>Not a shrink - just a client who likes professional behaviour.<BR/><BR/>:)<BR/><BR/>Thanks for a great post!<BR/><BR/>BTCBTChttps://www.blogger.com/profile/10121250074929671102noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-60834885239536311212009-02-21T23:48:00.000-05:002009-02-21T23:48:00.000-05:00I was reading through some old journals today and ...I was reading through some old journals today and stumbled upon an entry that stated that my psychiatrist informed me that he instituted a policy that if I was late by ## of minutes, he would charge me $$. So I turned around and said to him straight up, "so, if you're late by ## minutes, can <I> I </I> charge you $$? <BR/><BR/>Based on what I wrote, it's not exactly clear what his response was, but I'm sure he was not amused one bit.Rachel Cooper https://www.blogger.com/profile/09487957625202462927noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-16911627033325327232009-02-21T20:58:00.000-05:002009-02-21T20:58:00.000-05:00Have been on both sides of the situation, and neve...Have been on both sides of the situation, and never charged/was charged. If it was a recurrent occurrence, though,I would inform the patient and start charging.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-32448109610041659682009-02-17T00:03:00.000-05:002009-02-17T00:03:00.000-05:00OMG! I'm salaried & I stayed until 5:20PM...OMG! I'm salaried & I stayed until 5:20PM today. That's 20 minutes! 20 whole minutes of MY time for which I was not paid! I'm outraged! How dare that person come in & ask me a question at 4:59PM. They know my hours are 8:00-5:00, with an hour lunch that runs exactly 60 minutes. They must be taking advantage of me! This has happened before. OMG!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-36783249766724046702009-02-16T19:01:00.000-05:002009-02-16T19:01:00.000-05:00I am a shrink with 25 yars experience. I think it ...I am a shrink with 25 yars experience. I think it would be dirty pool to charge extra for the session without warning the patient first.<BR/><BR/>Same on phone calls. The first 5 minutes is free, after that, I say "Telephone advice is worth $XX/hr. Do you wish to continue this call at that rate or do you wish to book an appointment?"<BR/>Patients often phone for telelphone prescriptions and its the same deal "It will cost $XX for me to phone this in. Do you wish me to continue or come in and see me?"<BR/><BR/>In our system, appointments are free to the patient, but if we could charge the patient, I would say "This sounds really important but our time is up for today. Do you wish to rebook another time, or continue right now at an additional charge?"<BR/><BR/>What's the harm in doing the logical thing with money?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-11119695485614611852009-02-14T18:02:00.000-05:002009-02-14T18:02:00.000-05:00Clients pay for 50 minutes - minute 51 and beyond ...Clients pay for 50 minutes - minute 51 and beyond are your time. If you'd like to give them your time, so be it, but don't charge. If, after dozens of sessions you haven't clarified the boundaries or established a consistent routine for starting and stopping, the responsibility falls on you. You'll need to eat that fee and let the sting teach you a lesson about setting boundaries.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-70603642713638451702009-02-13T01:38:00.000-05:002009-02-13T01:38:00.000-05:00As a patient, it takes about an hour 15 to keep me...As a patient, it takes about an hour 15 to keep me composed. And as a medicare patient, i know money is not being made on me. But I do wish, if a session goes beyond a regular session, which for me is a long time - that I ask if I can have another session that day or the next.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-70583696744338935912009-02-12T19:05:00.000-05:002009-02-12T19:05:00.000-05:00Oh...I guess I need a "little more time." I am a ...Oh...I guess I need a "little more time." <BR/><BR/>I am a grad student for an MSW. I paid for crappy student health insurance, and with that I can go to the student health places for free. Student Health is near the dorms (or the med school). Anyways. I had a 15 min check with the PDoc...and then the fire alarm went off. It was not a drill (although not serious). My Doc wrote me scripts in the parking lot. It was funny as hell. It was a weird day.<BR/><BR/>I want a "guilt cookie" now...<BR/><BR/>Wait...90 days until my MSW? BLAHHHHHLadyk73https://www.blogger.com/profile/08293016397853788993noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-27776967273504648162009-02-12T18:32:00.000-05:002009-02-12T18:32:00.000-05:00The doctor is in charge of the session. No, I do...The doctor is in charge of the session. No, I don't think the doctor should charge extra for the session. If it is a continuing problem with a specific patient, you can negotiate a new fee schedule at the next session. And then schedule a longer session. <BR/><BR/>If the patient wants paperwork done, the patient can be charged an administration fee.<BR/><BR/>I am a month away from my MSW...so I am both a professional, and a patient. <BR/><BR/>If you find this is a widespread problem, you can restructure your fee schedule to reflect whatever billing codes are appopriate. <BR/><BR/>These also depends on if the patient has insurance that pays for therapy, and if you are a participating provider. <BR/><BR/>Whatever model you use, you need to ensure that every patient is subject to the same rules. (even if the insurance companies pay different rates). Technically, if you don't take medicaid or medicare, it doesn't really matter. But it is still a good practice.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-37232160498495465712009-02-12T10:51:00.000-05:002009-02-12T10:51:00.000-05:00i think all billing information should be discusse...i think all billing information should be discussed at the outset of the treatment relationship, and made available in a tri-fold brochure for both parties' future reference.<BR/><BR/>my opinion's based on an experience several years ago with a therapist who did not discuss anything but her hourly rate at the outset, and i didn't know enough to ask any followup questions. my irritation point came when she billed me for a session i canceled with less than 24 hours notice, and then later refused to compensate me for a session she canceled with less than 24 hours notice. <BR/><BR/>at the next session, i presented her with an invoice for my billable hour. after some discussion, she agreed to waive her cancellation bill "in light of the circumstances."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-30463539097571197682009-02-12T09:45:00.000-05:002009-02-12T09:45:00.000-05:00My perspective is as a Navy Psychiatrist - so I'm ...My perspective is as a Navy Psychiatrist - so I'm not getting paid by the hour, but I'm usually still a stickler for time. I agree with many of the points made above ... not everything can be wrapped up according to schedule, etc. I also agree that it's important to have a clock my patients can see, and to make sure they understand the boundaries going in. Since it's not a question of money, I'm able to focus on exploring why it is that time boundaries are being pushed ... is my patient genuinely in distress and why? Is it something that really has to be resolved prior to leaving today (or is it my anxiety that's driving it?) Why a last minute "oh by the way," or a med request (as noted above, is my patient scared to ask me, or are they being manipulative? People are more likely to say "yes" perhaps to end an uncomfortable discussion quickly ...)<BR/><BR/>But the long and the short of it is that I think the blunter the better when it comes to time and money boundaries with patients. I would also add that by being very up front about such things, eventually the discomfort can fade for both parties and proper business can take place.Williamhttps://www.blogger.com/profile/03912133587868824797noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-33406760379219609782009-02-12T09:04:00.000-05:002009-02-12T09:04:00.000-05:00I think I agree with many commenters...Don't charg...I think I agree with many commenters...<BR/><BR/>Don't charge this time because of precedent. Do communicate that time over 50 minutes in the future will be charged - new office guidelines.Bixhttps://www.blogger.com/profile/06263963508785739508noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-65129571801120782502009-02-12T08:33:00.000-05:002009-02-12T08:33:00.000-05:00Hummm.....i just started with a new Psychiatrist w...Hummm.....i just started with a new Psychiatrist who actually does therapy (yay!) a few months ago and i contstantly find myself glancing at either my watch or the clock towards the end, to see how much time i have "left". Then having to assure the doctor i am n o t hoping the time is almost over...it's atually the opposite...!tracyhttps://www.blogger.com/profile/03264215182043791934noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-24400963368993397352009-02-11T23:58:00.000-05:002009-02-11T23:58:00.000-05:00Oh, should also add that I start each session by s...Oh, should also add that I start each session by setting an 'agenda' with the patient, finding out what they want to talk about, maybe suggesting some things my self and then working with them to assign priorities so we get the important stuff done first.<BR/><BR/>However, even doing that, people can sometimes forget something until last minute or simply only get the courage to mention something as the session is ended and they feel they can escape!HPhttps://www.blogger.com/profile/09409589783052980600noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-82192173196469166732009-02-11T23:41:00.000-05:002009-02-11T23:41:00.000-05:00I often run closer to the 60 minutes and occasiona...I often run closer to the 60 minutes and occasionally over that - dependent on the circumstances. However, if something important is raised at the last minute AND the person is a repeat offender, I will reinforce boundaries and say that such important things should be brought up earlier in future sessions.HPhttps://www.blogger.com/profile/09409589783052980600noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-34464888831348576572009-02-11T19:17:00.000-05:002009-02-11T19:17:00.000-05:00This is a little off-topic, but I just went to see...This is a little off-topic, but I just went to see my pdoc, whom I've seen exclusively for med checks for the last several years. The past time I saw her, it was a long appt., and I thought later -- how nice of her to take more time to talk. I then got the bill and instead of billing me for a "med check" it was "psychotherapy" and cost several times as much... :(Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-20302210856397468692009-02-11T17:39:00.000-05:002009-02-11T17:39:00.000-05:00A follow-up question based on what Roy said: Is it...A follow-up question based on what Roy said: Is it even *possible* to schedule in an extra session back-to-back or does it always have to wait "until another time"? Why *not* do it in half-hour increments? What about people who need more time to process things? And what about the people who really have nothing to talk about at that session?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-9939105619963742602009-02-11T10:09:00.000-05:002009-02-11T10:09:00.000-05:00what tigermom said.and what Roy saidI don't unders...what tigermom said.<BR/>and what Roy said<BR/>I don't understand the question what if the doc called time but the pt kept talking and the doc became engaged. that doc has an issue then, not the pt. it wouldn't be unusual for a pt to keep talking but it is not therapeutic for a doc to be that engaged once the session is over. that is more like enmeshed, no sense of boundaries. the pt should not have to pay for that. if the doc called time and the pt refused to budge well that would be different. the doc would be late for his next pt or would late getting on with life and it was not the docs choice to become "engaged". in that case the doc is held hostage until he or she can call security or convince the to leave. i would be afraid to see a doc so engaged by me and my stories that he or she could not disentangle themselves at the end of a session. (yes, on occasion there is a little extra time but not because the doc is engaged.) that is one hell of a slipperly slope and it is the doc's job to make sure the road is salted or sanded or whatever.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-35479423155755052972009-02-11T02:25:00.000-05:002009-02-11T02:25:00.000-05:00I agree with Tigermom. How did I get seduced to ex...I agree with Tigermom. How did I get seduced to extend the session? The client knows the time. It's grist for the therapeutic mill. <BR/><BR/>But if we can't process it next session and I'm just commenting on billing - I have no answer, just another question ... Do I charge less if the patient and I wind up the session ten minutes early?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-44635151540178657872009-02-11T01:53:00.000-05:002009-02-11T01:53:00.000-05:00Good point acqua. I think for some people endings...Good point acqua. I think for some people endings are the hardest part of therapy. Sometimes you can only get to the crucial point in the last five mins, whether it's about medication or something else.<BR/><BR/>Do therapists find the ending as hard as the patients do?<BR/><BR/>This post links well to all the ones about hugs, handshakes etc if you think about it dinah...<BR/><BR/>Patient patient, or patient client.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-72796084668787152392009-02-11T01:22:00.000-05:002009-02-11T01:22:00.000-05:00oh yeah I forgot,...the reason I, as a patient, mi...oh yeah I forgot,...the reason I, as a patient, might wait until the end to ask for medication, especially one I know my pdoc isn't keen on, would be because I am scared to ask and it took me the whole session to get brave enough to make a request. This may be an opportunity for helping the patient be more assertive.Aquahttps://www.blogger.com/profile/16230285017033299419noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-31899278001904515172009-02-11T01:16:00.000-05:002009-02-11T01:16:00.000-05:00I think it is like any other business arrangement....I think it is like any other business arrangement. If you feel the pdoc feels s/he was unclear about the client paying for any extra time, then there should be no charge this time, but a reminder if the patient is seen again, and clear boundaries/times and expected payments discussed if the patient is seen again. It doesn't seem fair to charge the patient without clearly having told them there will be a charge for this kind of service at the time it was provided.<BR/>...aquaAquahttps://www.blogger.com/profile/16230285017033299419noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-34041963401601368972009-02-10T23:47:00.000-05:002009-02-10T23:47:00.000-05:00Just a patient not a proAnother perspective: once ...Just a patient not a pro<BR/><BR/>Another perspective: once I was kept waiting for 20 mins by my therapist (she's usually fairly punctual).<BR/>She saw her previous patient out and came to get me - the woman was a sobbing heap, in immense distress, bawling her way out of the waiting room - and my therapist looked quite distressed, for her. Whatever it was hadn't been resolved and I doubt it could have been no matter how much time they'd spent. She didn't mention it and neither did I but it affected the tone of our meeting obviously. <BR/><BR/>I would've preferred to wait even longer while she composed herself for 10 minutes in the bathroom instead of launching into the next session with me.<BR/><BR/>So I guess - therapy isn't jabbing people in the arm, there are all sorts of factors that mean it's not always 50 minutes and there is room for give & take.<BR/>(& clocks visible to both parties, and clearly written policies about fees)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-74945024137473379412009-02-10T22:16:00.000-05:002009-02-10T22:16:00.000-05:00If it's the patient's last session, it's over and ...If it's the patient's last session, it's over and done. Unless that person comes back, of course.<BR/><BR/>For other patients, write it into your office policies page for new patients and hand out a notice for existing patients with a short explanation (on a note attached to the paper) of why a blanket policy was needed. Give one freebie, but don't tell that in advance -- everyone screws up / has a bad day. I would suggest doing a 25% payment for anything up to ten minutes and 50% payment for anything over 10 min extra (read the section in <I>Freakonomics</I> about what happens when a daycare charges only a nominal fee for late pick-ups).<BR/><BR/>Also, it doesn't make a difference if it is the last appointment of the day because then that person is cutting into *your* time which is just as valuable as anyone's.Catherinehttps://www.blogger.com/profile/18012100875719616898noreply@blogger.com