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March 24, 2025 21 mins

I’m looking for 3 therapists who are ready to break free from the low fee trap. Find me on Instagram @leaninmakebank and DM me the word “POWER."

 

When therapists talk to me about needing to give back and be accessible, I often think about my own experience as a sliding scale client.

I know what it feels like to pay a sliding scale fee. I know what it means to need help and not be able to afford it.

But being a sliding scale client has its dark sides.

 

Resources Mentioned: 

Fun with Fees Calculator

DM Tiffany on Instagram

Send Tiffany an Email

 

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Transcript

Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
When I was in grad school, I was down and out.
I had so little money.
I was working part time for a nonprofit, which some of you may know this is a nonprofit where I had, maybe 2 years before, 1.5 years before been punched out by a, not punched out, I didn't go unconscious, but I was punched in the head about 7 times by a 250 pound schizophrenic youth male, And then I had to stay overnight because I was on the list for the overnight, so nobody sent me home.

(00:37):
Nobody said, you should probably go get that checked out.
I quit that place, not right away, by the way, a little high to high tolerance for trauma.
, but I eventually quit, but then I went back because I was in grad school and I needed the money, so I was working part time in a different position, but you know, man, you know that work.

(00:58):
So I was in grad school, I was making so little money.
I was living with a partner at the time who I'm still living with actually, almost 17 years later, he had a good job.
He also has good jobs and then loses good jobs, right, so it wasn't consistent, but I didn't want to be relying on his financial resources.

(01:20):
I'm very independent, but I was in grad school down and out working for maybe, maybe I was making literally $14.50 an hour at that time.
And I really needed help.
I really needed a therapist.
So I had to figure out how am I gonna get the help I need when I'm making no money.
By the way, my name is Tiffany McLean.

(01:42):
I'm the founder of Lean In, Make Bank.
Speaking of no money, and this is, this is why the story is important.
My whole life's purpose, this entire business I have built and run for the past 7 years, helped tens of thousands of therapists in private practice, mental health clinicians with actually earning more in their practice, Raising fees, getting off insurance panels, charging premium fees cash, and this is why, you know, some of you are like, what about the people who can't afford it?

(02:14):
I was that person who couldn't afford it.
It's not like I don't know what it feels like to not be able to afford therapy.
I did not grow up rich, right?
I, I did not have a silver spoon in my mouth, and yet I'm advocating for clinicians to charge more and this story, is gonna help you understand a little bit more about why that is.
I don't know if I've ever told this story publicly.

(02:35):
, I've certainly talked to my students about it, but I was down and out.
My relationship wasn't going well.
I was in grad school.
My old, you know, symptoms were coming back, symptoms.
Basically I was having a very hard time, so I'm like I have to get help.
So the first thing I did was, I think I'm in San Francisco, there was some kind of free therapist thing.

(02:57):
I went to that guy for a couple of years, not very good.
I eventually called.
I found psychoanalysis, love psychoanalysis, psychoanalytic thinking.
I love the depth work and these clinicians' willingness to understand the unconscious patterns, or unconscious repetitions.
There were two analytic, training institutes in San Francisco, who offered sliding scale spots for people who were willing to see a therapist in training, and analyst in training.

(03:25):
So these were therapists who'd been licensed many, many years.
They had gone back for analytic training, and they were looking for Analytic cases that means you know they would be willing to slide their fee if you'd be willing to go 3 times a week because they need people who can come 3 to 4 times a week as part of their training.
So I'm like, I will do that.
I'll find a way even if it's $30 you know, to be honest, if it's $30 and I have to come 3 times a week, that's like $90.

(03:50):
That's hard.: That was hard for me to pay at the time, but I was like, I, I, I'm gonna try to find a way.
So I called this one of the analytic institutes.
I called both, one did not have any spots, the other one.
I spoke with the intake coordinator and he said, I'll look.
, he calls me back, maybe like a few days later.
This is, this is, look, real, real talk.
He calls me back on the phone and he says, we don't have anyone who can take you at that fee, at what I could pay.

(04:19):
I was sitting, I literally remember I was in my bedroom, sitting on my bed, talking on my phone.
He said they don't have anyone for me.
And I like, I broke down.
I'm sure you could hear it in my voice and I said, I'm getting, actually, wow, emotional, I'm getting teary even remembering this.
That's interesting.
, I started, like said thank you very much, and I had to get off the phone fast because I was starting to cry and I hung up the phone and I was like crying silently to myself.

(04:46):
I don't like to cry in front of people.
So I was sitting there crying, just feeling so despondent, like I need help so bad, I can't afford it, and even this sliding scale, analytic Training Institute doesn't have anyone for me.
So I was sitting there about to break down and my phone rings again.
And it's the intake coordinator again, and he says, I can take you.

(05:14):
I'm like, what?
And he said, I can take you.
I can take you.
he wasn't even in training anymore.
He was an analyst who volunteered at the institute as an intake coordinator, and he came back and said, I'll take you on.
And I just felt like the sky is opening, you know, all the stuff as patients, right?
I think as therapists, most of us are also clients or patients, but we often forget what it's like on the other side of things when we have been doing it for a while.

(05:39):
At that time it was just like the skies parted and I felt like I was worth it, right?
I didn't even, I don't think I was conscious of this at the time, but I had been feeling like I'm not even good enough to get like the poorest of poor sliding skill.
, race came into it.
Certainly class came into it, and then this man calls back.
Gender comes into it, obviously, and he's willing to take me.
I'm good enough.

(06:00):
I, he heard the pain in my voice.
I was so broken, so sad that he came back and made the sacrifice to see me, right?
This was all tied up in my work with this analyst.
We'll call him Jim.
We'll call him Jim because that's his name.
His name is Jim.
So I started working with him.
I worked with him for 2 years.

(06:21):
I was paying $40 per session at first.
I went, I think initially once a week and then I worked my way up to twice a week.
He eventually, well, with anxiety, raised my fee at $50 per session.
And, I, I, I feel a little, maybe because I said his name.
There's a lot of gyms in the world.

(06:43):
the work was rich.
And also it was so much about this enactment, this unspoken, unconscious racial dynamic.
Jim was white, Jimmy is white, a white man who took on a black poor, a woman who needed his help.

(07:06):
I don't know how conscious I was, I became conscious of that throughout our work, but I knew that I had to be pleasing.
I knew that I came into that clinical situation as someone who.
Was undeserving and I better do good work.
I had to be the best patient.
I had to be pleasing.

(07:27):
I had to be funny.
I had to be, I had to praise him.
I was aware, I was aware that I had to do a good job.
I had to be a good client for him because I was getting it for cheap.
So for those of you out there, I want you to already start thinking about what does it mean to be a sliding scale client.
When you are saying I have to keep my fees low to give back, I have to keep my fees low to be accessible, and you are not talking about, let's even go back to talking about if you're not conscious of the setup in that clinical arrangement as the therapist, as a clinician, if you are not.

(08:05):
, talking about or thinking about in your own ongoing clinical consultation, the dynamics of that, the ramifications of that, especially when we bring in race, class, gender, then you are missing out on a rich work and you are also likely repeating.
, systemic racism, classism, All kinds of dynamics that are problematic.

(08:30):
So this was what was going on with Jim.
I was being pleasing and there were things that irritated the fuck out of me.
About Jim, he drank Diet Coke.
Sorry, those of you out there who drink Diet Coke.
Look, we all have our things, but I would just watch him in our sessions drink that Diet Coke, and I would think, is he, I've never told him this because he didn't want to hear it.
Is he like falling asleep because I'm so boring, he needs Diet Coke, and who even drinks soda anymore?

(08:54):
You're just sitting around and like I just, there was, I had contempt for certain things about Jim.
But I had to bury it.
I had to like not know, put it away, like come in and be good, pleasing, patient, this one on for, like I said, years.
I would talk about everyone else, oh, this person I'm irritated with, that person I'm irritated with, this person's not good enough, right?

(09:16):
Whatever people talk about in therapy.
I was talking about Jim, right?
This is the transference.
But, but he couldn't know and I couldn't know.
I couldn't bring it in there again, this is unconscious work we're talking about rich unconscious work.
So Jim would help me talk about this person and that person outside of the clinical situation outside of the therapy room, but the material could not come into the therapy room because he was giving me a deal, because it was my job to be thankful.

(09:45):
And I was aware that I was the white man's burden.
Again, unconscious.
It became conscious later, but unconsciously, I felt like the white man's burden.
Who was I to be angry or be frustrated or express anything about the treatment that wasn't working for me?
Because I owed him.
Think about this when you're going to offer your sliding skill.

(10:06):
Think about this when you're resentful of your clients or sacrificing yourself for them.
It is not one way, my friend.
So here's what happened.
My partner ended up getting a job, remember I told you he was out of work for a long time.
He got a job at a, you know, some kind of corporate company that had out of network PPO insurance.
What that means is, I could get reimbursed for.

(10:31):
My therapy sessions.
So then suddenly, oh my God, money became real sticky, my friend.
I haven't thought about this in years.
I actually forgot about this thing until right now.
Suddenly money became this tension between Jim and I.
Something shifted in me and something shifted in him, and guess who was talking about it.

(10:54):
Nobody.
Nobody.: It was just played out.
The moment I could pay it out, I could pay his full fee, which was 185, which by the way, is a very low fee for somebody in San Francisco who's an analyst who's probably been in the field for 30 years.
185.
And I suddenly felt like I could bring my whole self.
I wasn't a charity case anymore.

(11:17):
I was like a full-fledged human being who could pay full fee for a session, so I would pay full fee cash.
He would give me a a super bill.
I think initially he reimbursed it on my behalf, which was weird, and then I ultimately reimbursed it, so I got paid back.
But suddenly there was like he, he, I don't remember all the details, but there was some, I remember tense, angry feelings having to do something with this fee when the when the insurance wasn't paying back quickly enough, something like that, but nobody talked about it.

(11:46):
But here's what I started to do.
My friend, I was no longer the white man's burden.
I fully deserved to be in that space.
Again, all unconscious.
I'm paying him full fee and guess what started to come out, my dear friend.
My aggression.
For those of you who know me, you know me, you know me, Tiffany.
I don't fuck around, and, and, you know, I was still doing a lot of people pleasing back then, but the parts of me that wanted to take up space, the parts of me that had something to say, the parts of me that didn't appreciate Diet Coke in the middle of the afternoon because what does that mean?

(12:20):
He was late one time.
Because he'd fallen asleep, I forgot about that, right?
Back when I was paying $40 a session, I didn't say anything about that.
It's OK, you know, we all make mistakes.
This Tiffany, again, she wasn't a full bore Tiffany.
This was a decade ago, but I started making little comments about maybe his clothing or the things he did.

(12:42):
And guess what, my dear?
He didn't like that.
He didn't like Tiffany's aggression.
He didn't like these parts of me, these parts of me that needed to be understood, articulated, able to show up fully because they're playing out in my relationships whether I'm bringing them forward or not.
They needed to be able to play out in the transference within the therapy session so they could be understood, articulated, and worked with so that I could become the Tiffany of lean and make bank that I am today.

(13:14):
There was no room for any of that.
I won't go into all of the details, but I can tell you what, once I was paying full fee.
, that, that therapy quickly devolved and I left and I didn't leave in a way, as you can tell, that was therapeutic, that felt good, that helped me trust others to be able to handle my aggression or my assertiveness or my direct self, my anger, my passion.

(13:44):
I learned that there was no space for that, but here's what I also learned.
I could see how when I was paying a low fee I felt like I didn't deserve to be there.
I better be nice.: There were so many parts of myself, parts that I love, parts that I need, parts that have allowed me to build a business and take care of people and and protect my children.
Those parts had no space in that therapy session at $40 per session, in that therapy space at $40 per session.

(14:09):
They started to emerge when I was paying more, and there was nowhere for them to go, and I think to myself, Well, what if I had had a therapist?
I and I do now, by the way, who is phenomenal.
I pay $325 per session two times a week.
What if I had had a therapist at that time?
What if Jim could handle my aggression?
What if he could speak to the unconscious dynamics?
What if he could talk about, 0 $40?

(14:30):
What does that mean between us?
$185.
What does that mean between us?
He had not done his money work.
He couldn't handle the unconscious process and so.
I want to talk to you, those of you right now, I actually just you, I wanna talk to just you.
Who you're keeping your fees low.
Maybe you're on insurance, but I'm even talking about your cash pay clients, right?

(14:54):
You, even if you're charging a good fee, maybe you're charging $150 maybe you're charging $180.
But you know that you are not raising your fees out of fear.
You know that you actually need to earn more to be able to show up fully.
To be able to be present for your kids, to be able to take vacations without fear.

(15:15):
You are not enforcing your cancellation policies consistently because you're afraid.
You're not doing the significant fee raises that you need to.
Maybe you're taking new people at $200 per session or $250 per session, but you have long standing clients who you've never touched their fee, or maybe you've raised it by $5 or $10 because you are afraid.

(15:37):
There's a secondary gain.
When you keep your fees low, right?
You don't have to contend with those unconscious feelings that are actually currently present in your sessions, aggression, abandonment, fear, greed, loss, You, you're, you're actually doing your client a disservice.

(16:02):
I wanna talk to you about.
What it means when you are avoiding making changes because of fear.
Now there are some of you who are like, I'm not afraid.
I'm just gonna do it because I want to help people to be accessible, fine, I'm not talking to you.
You've missed the point of what I'm talking about here today.
Keep listening to the money sessions, maybe you'll catch up.
But those of you who know.

(16:23):
You know that you're not raising your fees out of fear.
You know that there's some aspect of your clinical work that you're avoiding and that the fee raises, it's gonna bring it up.
And you know you're better than that.
You know that you are better than that.
And this has been one area of your practice and also I will say your life that you've been avoiding this dark corner that you haven't wanted to touch.

(16:48):
But you know you're better than that.
I'm looking for 3 therapists.
Three therapists who have been avoiding the fee raise with existing clients because of your own fear.
Who are ready to step out of that paradigm, who are ready to not only earn more money because yay for more money, yay for you taking care of yourself.

(17:10):
But who are ready to do it because you understand clinically, you're not doing your best work.
Clinically, you're not serving your client by keeping them at $40 sliding scale or $125 when you need to be making $200.
You're ready to do something different.
You're ready to fully show up.
You're ready to lean into the challenging work, but you need help.
I've been on both sides.

(17:31):
I just described what it felt like to be the sliding scale client and how empowering it was when I stepped into paying full fees and how amazing it would have been if Jim had actually helped me into that realization by raising his own fee with me.
How transformational it would have been to have a therapist who could go there with me.
And I do now, and let me tell you, I would pay this woman more.

(17:57):
I mean 325.
She gets what, 76, 650 a week.
That's pretty good.
I pay more.
Because of the transformational work she does with me.
If you are ready to do transformational work, get on Instagram, find me at lean and Make Bank, send me a DM.
Say Power.
Just send me power.
I'll know what you're talking about.
If you're ready to get out of fear, start actually doing transformational clinical work, I invite.

(18:21):
I'm looking only for 3 of you.
I invite you to send me the word power in my DMs on Instagram.
Let's fucking step it up.
Let's step it up.
You know you're better than this.
You know you've been wanting to make this change, but it's very hard to do it alone.
And look, this is an analyst I was working with who's probably been in the field for 30 years, and he couldn't help me with this.

(18:42):
It feels very lonely, it feels very isolating, but you actually don't have to be alone.
You don't have to be isolated.
This is what I have spent the past 7 years of my life dedicated to this work, this work, these conversations, and the money and the clinical expertise, the craft that results on the other side of doing this work, I invite you.

(19:05):
To DM me.
Let's do this together.
I, I, I cannot wait.
I cannot wait.
To go on this journey with you.
It's something I needed at that time that I couldn't get and it was a huge loss, but also for me it was.
An opportunity to understand, to truly understand from the inside out, the importance.

(19:32):
The importance of doing your money work so you can show up fully as a therapist who can help your clients go through this fire, hold their own aggression, take up space, protect themselves in a world that's asking them to sacrifice.
We're gonna do the same.
Together, you and I, we're gonna do this work with you as well, OK?

(19:54):
I'm gonna do this work with you as well.
Help you understand what it means to protect yourself, take up space in the world, stand for the value that you provide, stand for the value.
Inside of you.
In a world that tells you you're worth very little, in a world that tells you you don't deserve it, in a world that tells you.

(20:15):
You're the white man's burden.
And you're lucky that you even get into the space.
Fuck that, fuck that.
Send me a DM Power.
We'll talk.
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