Free for all?

In my previous blog I discussed payment for counselling. Why we have to charge, what the payment represents and why there is tension for us as counsellors asking for money.

exclusionAll counselling has to be paid for. Whether it’s through taxation for the NHS, voluntary donations or charges in the 3rd sector, or a personal payment to the counsellor in private practice. In private practice the amount charged needs to cover the costs of counselling as well as provide a living for the counsellor. A quick search for counsellors in the north west would suggest this amount is currently somewhere around £40 – £45 per session.

And this is where the tension lies. This is not an insignificant amount of money, especially as it is likely to be a weekly expense. So by charging this amount it seems we are restricting counselling to only those people who can find £45 per week for the privilege.

There has long been a discussion within the counselling community about how we ensure it is accessible to all. Any counsellor working ethically will strive to offer a service to anyone who needs it, regardless of gender, race, sex etc. But what about ability to pay? If I’m charging £45 am I only paying lip service to being accessible, because the reality is this is too much for many people to afford?

We are of course able to negotiate reduced fees, but this in itself can put people off even asking. Why should people have to explain their circumstances and be reliant on my “charitable” nature to access counselling? If clients are struggling with self-worth (for example) how are they going to manage the tricky process of asking for reduced fees? If a counsellor does offer reduced fees, is there a potential for the client to feel they are not getting the same level of service? And how do we manage the already complex power relationships when the client is having to ask for a reduced fee?

The 3rd sector and NHS do of course offer options for people who can’t afford private fees. But this takes away choice for the client of pursuing a preferred type of counselling, or even a specific counsellor if that is what they want. It also means clients often can’t see a counsellor in a timescale that suits them.

Individual counsellors will struggle with these questions and come up with their own solution. (reduced fees, volunteering for 3rd sector providers etc.) But the reality is most private counsellors will be working with a particular subset of our communities. If the government was genuinely committed to supporting people, they would provide funding for clients to seek out whichever counsellor they preferred. Given our current culture of public spending control this does not seem a likely solution. Words are easy. Creating a truly equal society where everyone has access to health care, education, personal well-being etc. needs more than a few sound bites on the steps of No 10.