site search by freefind

Understanding and Using "Pay for Results" for Therapists
From Chapter 3 of the Subcellular Psychobiology Diagnosis Handbook (2014)
© 2014 by Dr. Grant McFetridge

Table of Contents

Subcellular front cover 250px
3.1: What is ‘Pay (Charge) for Results’?
3.2: The Rationale Behind ‘Pay (Charge) for Results’
3.3: Therapist Fears About ‘Pay for Results’
3.4: Writing the Contract - Negotiating Outcomes
3.5: Setting Fees and Estimating Treatment Time
           3.5.1: The ‘rule of three’
3.6: Duration of conventional treatment
3.7: Results Criteria and Time Duration Guarantees
3.8: Client Satisfaction and the Apex Problem
3.9: Some Situations Don’t Allow ‘Pay for Results’
3.10: Disputes with Clients
3.11: Trademarks, Logos, and Affiliate Organizations
3.12: Questions and Answers
3.13: Key Points
3.14: Suggested Reading

Appendix 2: Examples of 'Pay for Results' Contracts
Appendix 10: 'Pay for Results' - Fee Calculation Guide
Appendix 11: 'Pay for Results' - Statistical and Mathematical Modeling for Fee Calculations

To download a PDF version of this article, right click here.

    "When we talk about our work with clients or professionals, their first reaction is often “where’s the proof?”, or from academics, “where are the evidence-based studies?” When we reply that we have a ‘pay for results’ policy so there is no need for it, there is a momentary pause, eyes glaze for a second, then they usually repeat themselves as if we hadn’t spoken. Apparently the leap to results-oriented treatment billing is simply too foreign a concept to comprehend at first."

    "Why is this? Well, clients sometimes confuse this concept with some kind of scam, where people ‘guarantee’ a product, don’t deliver and then keep the money. Or they simply don’t believe that you are serious, because this is so far outside their previous experience. Academics tend to have a different issue, one that strikes at the heart of the practice of psychology and medicine. Currently, a great deal of statistical tools are used (often incorrectly) in research because investigators are not designing for a binary solution set of ‘it worked, or it didn’t work’. Instead, test outcomes are usually so vague or contradictory the best they can hope for is often only slightly above the threshold of the placebo effect. This mindset can also lead to completely bizarre situations like I saw in my own doctoral training, where we were taught measurement scales that ignored the specific client problem we were treating, and instead rated ‘overall improvement’ – sadly, because there really were no effective treatments for specific problems."

    "When Frank Downey and I designed the structure of the Institute in the 1990s, we fully expected that our first generation techniques simply would not always work (or work partially) for some clients. We were developing something entirely new, there was a lot we didn’t yet understand, and people’s problems are often very complex. However, we were only interested in full elimination of symptoms (note that we use this phrase because is socially and often legally unacceptable to talk about ‘cures’). Partial successes were valuable from a research viewpoint, but with ‘pay for results’ the only meaningful outcome is “what we agreed upon is done”. This means that therapists have to actually deliver; and if they can’t, that they are not financially penalizing clients because of their (or the Institute’s) own limitations. This also has the tremendous advantage that we don’t have to do extremely costly third-party studies – after all, the client is the one who really knows if the problem is gone and stays gone."

    ~ Dr. Grant McFetridge
    Hornby Island, BC

3.1: What is ‘Pay (Charge) for Results’?
The Institute for the Study of Peak States is pioneering a way of charging clients that is different from the one used by most all conventional therapists (although it is already used in many other professions). When talking to clients, we call it ‘pay for results’, and when talking to therapists, we call it ‘charge for results’. All therapists who license our processes and use our trademark agree to abide by this condition in all the work they do, whether it is using our techniques or anyone else’s.

How does it work? In the initial session, the therapist and client come to a written agreement of what is to be worked on and what criteria would constitute success. The fee is negotiated at this time (although most therapists use a predetermined flat fee that makes this step much simpler). Open-ended fees such as by the hour are not acceptable – the client has to know exactly what he is agreeing to and what he is going to pay as part of the contract. Obviously, some people won’t choose to become clients, but there is no fee for this initial consultation since there were no results. After treatment, if the predetermined criteria for success are not met, the certified therapist does not get paid, and does not charge for the time spent. Clearly, some clients won’t generate income and, in cases with dishonest clients, the client will get the service but the therapist will not be paid. However, this fee structure is not unusual – it is standard for most businesses, and the fees are adjusted to take these problems into account. Appendix 10 shows a simple way to calculate what a therapist’s minimum fee needs to be when using a single ‘fixed-fee’ billing.

In some cases, the Institute sets a non-negotiable criteria for success for some licensed, specific processes used by our certified therapists – for example, someone who hears voices no longer does; the addict no longer has cravings; peak states processes have to actually give the client the sensations of the state; and so on. Another example of this pay for results principle is in research. Although we on occasion do contract with a client for a specific outcome that we have to do research to solve, the Institute never writes a contract with clients charging them for the hours spent on investigating treatments for new diseases.

3.2: The Rationale Behind ‘Pay (Charge) for Results’
The ‘charge for results’ principle solves a number of serious problems in the medical and psychological healing profession.

In this chapter we’ll discuss a number of practical reasons why charging for results is a good idea for therapists. However, from our perspective the primary problem with current billing by the hour is an ethical one. It is simply morally repugnant to require money from clients you don’t help. The principle of the ‘golden rule’ describes this clearly – ‘do to others what you would have them do to you’. Many clients come to therapists in desperate need of help, and often they are the people who have the least ability to pay due to the nature of their problems. These people need their resources to get real help, not support a sense of entitlement in the therapist. This is very much like taking your car in for repair, and having the mechanic tell you he can’t fix it, but that you now owe him thousands of dollars for the time he wasted.

Probably the most serious practical problem ‘charge for results’ addresses is the (hopefully) unconscious incentive for failure in the current system. When we charge by the hour we get rewarded for our failures. The payment reinforces the failures and as you know, what we reinforce we get more of. This principle is well described by Kylea Taylor in her book Ethics of Caring, where she displays a chart of the traps therapists can easily fall into with clients. Thus, standard billing practices where you are billing by the hour, not based on performance, has several potential problems:
  • The typical therapist unconsciously wants to keep his client coming in to therapy so that the therapist continues to be paid.
  • The typical therapist is again unconsciously resistant to learning new, faster techniques because this would interfere with his income stream.The therapist has to suppress their own instincts and buy into a system that denies the ethical issue against charging people when nothing is accomplished.
From our perspective as a teaching and certifying organization, ‘charge for results’ also solves the major problem of how to verify a therapist’s competence. Normally, therapists and other health professionals take exams to show competence. Unfortunately, this measure does not actually work well, as anyone who has taken high school or college exams can well testify! By using pay for results billing, we find that therapists either are or quickly become competent or they simply don’t earn a living. Thus, this system itself is automatically self-correcting - our therapists are financially motivated to become better healers and seek out better treatment techniques. (Of course, we do check their knowledge and skills before licensing to help them through the transition as a new therapist. And we support them in becoming better therapists for the first year; but the problem of competency quickly solves itself without financially penalizing clients.)

‘Charge for results’ also solves another common problem – rejecting newer therapies simply because the therapist is comfortable with what he already knows. As the Nobel physicist Max Planck, the founder of quantum theory once famously said, “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.” Fortunately, with the ‘pay for results’ principle therapists are forced to actively seek out newer, more successful techniques, rather than simply avoid change or rely on organizations that have a vested interest in promoting obsolete or ineffective techniques.

In summary, the Institute’s ‘charge for results (success)’ fee structure means that the therapist charges for performance, not for time. It has many advantages:
  1. It encourages therapists to be as capable as possible.
  2. It encourages the therapist to make clear and realistic criteria with their clients.
  3. It minimizes the problem of unrealistic client expectations.
  4. It discourages the problem of prolonging a client’s unnecessary suffering by becoming a ‘paid friend’.
  5. It encourages therapists to refer clients to therapists who can heal the client.
  6. It minimizes the problem of the client forgetting that they ever had the problem after it is gone (the apex effect). and
  7. Is ethically satisfying.
With the ‘charge for results’ format, the therapist is automatically supported to reinforce results, more focused on the client’s issues, and faster when working with clients. It is ethically satisfying, and is also an almost unique feature in the therapist or medical marketplace.

3.3: Therapist Fears About ‘Pay for Results’
As part of our regular therapist training, we have our students practice healing on their fears about using ‘charge for results’ in their work. Because these issues (often involving survival fears) unconsciously drive the therapist, we’ve found that rational discussion of the issues involved is often a waste of time till the underlying emotional issues are eliminated. Some common triggers are:
  • I feel guilty that I charge so much for such a simple/ fast process.
  • I feel guilty charging extra to compensate for clients I can’t help.
  • What if the client gets healed and says they didn’t?
  • I don’t understand what the client really wants – I am missing the real issue.
  • I am afraid the client will have a too high expectation of me.
  • This is too complicated.
  • I am afraid of legal actions.

3.4: Writing the Contract - Negotiating Outcomes
As we will be showing in the next few chapters, the ‘charge for results’ principle has a major impact on exactly how you diagnose and do treatments with clients. Rather than offering some sort of emotional support or helpful advice, the therapist now has the job to accurately define the client’s real problem and succeed in healing it.

We’ve found that initially most of our students have a very difficult time writing the ‘pay for results’ contract with the client. Often this is because the techniques and practices that they’ve learned in the past get in the way, be it conventional therapy, breathwork, or other modalities. Although diagnosis can be difficult, identifying the desired outcome is far, far easier than people realize.

Simply ask your client what the major problem is. Clients are in your office for a reason, and usually it is fairly straightforward. Generally the client has only one major problem, even if they have trouble putting it into words. A major mistake made by most therapists happens at this step. If they are not careful in the wording of this question, they will get a laundry list of problems. It is exactly the same as if a car mechanic asked about the problems in your 15 year old car – a general question gets a reply that the door squeaks, the trunk latch doesn’t work, there is rust on the body where you banged it, and so on. But the real reason you are there is because the car is belching smoke out the tailpipe!

Sometimes there really are several issues. Never write a single contract for multiple issues, because any one failure means you won’t get paid for any of your work. Instead, you offer to work on and bill the issues separately. Put in these terms, the client immediately prioritizes and identifies what they are really there for. They decide what is financially important to them.

When writing the contract, less is better! If you’ve focused down to the real problem, usually an agreement to eliminate the emotional pain around a single phrase that evokes the maximum suffering (what we call the ‘trigger phrase’) is all that needs to be put in the contract. Again, new therapists mistakenly put a laundry list of symptoms into the contract, but all this does is include unrelated problems into their agreement that they are now obligated to also heal. Keep the contract simple, and keep it focused.

A new therapist can write a results contract without even a clue on what is causing the problem. This is fine, and their failures will become a learning experience for the therapist. However, with experience the therapist will now sometimes recognize an issue they know they cannot heal. In this case, they let the client know this, and offer to work on issues surrounding the problem. For example, a client has OCD that the therapist doesn’t yet know how to eliminate. So once they let the client know this, they ask if the client would be satisfied if they eliminate an issue connected with having the disease, such as stress or embarrassment. In another more extreme example, a client was dying of cancer. Although the therapist could not heal the disease, he found that the client’s secondary issue was fear of death, which he was able to successfully heal (the cancer-triggered fear of death was caused by a near drowning as a boy).

One problem we’ve seen come up with therapists doing contracts is ‘overselling processes’. By this we mean that they know some treatment, say the Silent Mind Technique, and instead of really figuring out what the client needs, they suggest that the client should do a (usually expensive) treatment instead, implying that it would probably fix the client’s problem. This only ends in disaster; even though the client agreed to the contract, they will be unhappy afterwards because they still have their problem. This is in contrast to a therapist who actually figured out what the client wanted and realized that he would be unable to provide it, so offered other options around the problem. In this latter case, the client is treated as an ally, rather than as an income source.

Take clear notes on what you have agreed to! Let the client read what you wrote and see if he/she understands it. Use the client’s wording exactly; don’t try to paraphrase. This helps make sure that the expectations are well defined (the criteria for success); this will be necessary to avoid the apex problem after you’ve finished.

In summary, stay focused on what you can do, and if needed break the problem down into its key elements, and offer choices for them to decide on what is important for them. (Chapter 4 goes into more depth on writing contracts; Appendix 2 shows several examples of client contracts.)

    Example: The client wants a divorce
    The client has a painful issue – problems with a partner – and wants to learn the therapy so that he can help himself. You know that there are usually dozens of issues with a partner, so you focus on what the key one or ones is. In this case, the client basically wants to be with another person. You don’t make a judgment but explain what therapy can do (get him to calm around his feelings). The client realizes that the key problem is about his anxiety about talking to his spouse on this issue. And he wants instruction on how to do EFT as part of the package (this assumes that EFT works on this client's issues).

    In the contract, you could include EFT instruction or bill it separately. In either case, you need to determine criteria for results. It may be that results in this case is just exposure to the technique, and there are no explicit goals, or it could be a certain level of proficiency. Defining which you are comfortable providing is up to you, and you can negotiate with the client to determine what works best for both of you. An experienced therapist would not include it in the primary contract, and might simply take some time to show the client the process as part of the treatment, along with advice to watch free videos on YouTube.

    Example: The client can’t feel
    The client was unable to remember her past, or feel emotions or body sensations. This is typical in cases of extreme sexual abuse at an early age, and in fact this turned out to be the case with this client. Determining what the client wanted as a result had to be tempered with a recognition that regression therapies would not be effective. (This assumes that the therapist does not cord with the client to suppress the extreme feelings of the abuse in the client.) Thus, the therapist would have to evaluate whether the client was a good candidate for healing issues, or whether they should just write an agreement for coaching and support time, support either on specific issues. Or whether the client should simply see a conventional therapist or peer support group for emotional support.

    With more experience, the therapist might recognize the client’s numbness is from an ameba problem and refer the client to a clinic for that treatment. In this case, once the numbness was gone the traumatic emotions could now be felt and follow-up treatment would probably be needed. The issue might also involve a trauma that blocks memory, or an MPD issue where the current dominant personality was not the one that experienced the trauma. The client would have to decide if they wanted treatment for this, as the trauma or the splitting was allowing them avoid the traumatic memories.

3.5: Setting Fees and Estimating Treatment Time
In the ‘pay for results’ approach, the contract includes a predetermined fee. Appendix 10 shows a simple, low risk and effective way for therapists to set this fee. In this approach, the general practice therapist simply offers one fee for any client problem. This is typically how most ‘pay for results’ therapists do their charging (although some specific disease treatments may use a different predetermined set fee.) Because we know that there is a certain percentage of clients who the therapist can’t help, the therapist has to know when to give up trying. Fortunately, this optimum ‘cutoff time’ minimizes client costs while maximizing therapist income. This cutoff point is typically in the 3-6 hour time frame. Clients who take longer are not charged, but are sent to more advanced or specialized therapists, such as ones who work in our clinics.

It is possible to use other methods of billing, such as estimating how long therapy will take and billing on this basis. Or perhaps use some sort of combination of approaches. However, these increase the financial risk to the therapist, and increase the cost, sometimes dramatically, for about half the clients. We don’t recommend these other approaches unless you specialize or are very experienced. If you are interested in the formulas for these other fee methods, we refer you to our Institute website.

    3.5.1: The ‘rule of three’
    Therapists need to plan on including the time for two brief client follow-ups after the issue has been fully healed: one a few days after the issue has initially been fully healed, and another about two weeks after treatment is optimum. This should be scheduled with the client as a normal part of treatment. But why? This follow-up is due to the epigenetic cause of trauma and the limitations of most healing techniques. Waiting after ‘successful’ treatment allows relevant ‘hidden’ or untriggered traumas or traumas that weren’t fully healed to become activated by daily circumstances in the client’s life. This can also be due to ‘time loops’ that put the problem back into the client. This problem is not simply a client’s attention moving to a new issue, although that can obviously happen and cause problems of its own.

    We don’t have a good estimate for how often these additional healing sessions are actually needed, but assuming it happens with a third of the clients is probably reasonable. Planning for this with the client is simply good business practice and an assumed part of ‘charging for results’.

3.6: Duration of conventional treatment
The time a typical client will actually spend doing conventional psychotherapy is quite short. Oddly, it is very hard to find any studies defining exactly what these times are, especially in the last 10 years. In one summary article from 2000 (without any supporting references): "In reviewing the data about psychotherapy utilization and outcome, it is increasingly well-known that there is no such thing as brief therapy because there is no such thing as long-term therapy. About 90% of all psychotherapy patients come for less than 10 visits with the mean treatment episode being about 4.6 sessions and the modal number of visits being just one." In a large 2011 study of major depressive disorder: “The modal number of sessions for any treatment in the community mental health system was one in both 1993 and 2003. The median number of psychotherapy sessions was 5.0 in both 1993 and 2003. The average number of psychotherapy sessions was 8.5 (SD = 10.0) in 1993 and 9.4 (SD = 10.6) in 2003.”

Fortunately, our approach to therapy fits this typical client pattern. As Gay Hendricks, the developer of Body Centered Therapy has said in his trainings: "The client should be healed in two sessions. If it takes more than three sessions, the therapist doesn't know what he's doing." We agree. Thus, basic certified therapists should try to fully treat as many clients as possible in the first session, heal the typical client in two or three sessions (about 2 to 4 hours), or, at worst, end treatment at about three or four sessions (4 to 6 hours).

3.7: Results Criteria and Time Duration Guarantees
When you work with a client, you need to determine exactly what the criteria for results are. In many cases, it may mean that you write down something that can be checked on the spot. In other cases, the client may need to actually go somewhere or meet someone to test if the intervention was successful. As a therapist, it is up to you and your client to decide what is acceptable, and for how long you are willing to wait to see if the results are stable.

For example, the Institute clinics offer specialized, often expensive treatments for various conditions or disorders. We generally require payment from the client after three weeks without symptoms. (Two weeks would be adequate to verify stability of the treatment, but that third week generally makes the client feel more secure because of the large fees involved). After that period, if the symptoms came back for some reason we would simply refund the money (and/or try to help the client). In a therapy situation, a much shorter time would be adequate and more prudent unless you had made an agreement with your client otherwise. You may also need to determine if you want to have the client agree to more treatment before you do a refund, or just do a simple refund. (Note that if you give more treatments, this data goes into your running tally of income and total client contact time for estimating future fees – see Appendix 10.)

3.8: Client Satisfaction and the Apex Problem
When you heal a client’s issue fully, you’ll quickly encounter the problem of clients forgetting that they ever had the issue you healed. This is because when they try to recall what the problem felt like, there is no feeling left and so the client simply ‘can’t remember’ what the problem was. (This is like forgetting which arm you hurt when there is no pain left to guide you.) This may mean that they won’t want to pay you – “it was never a problem” - and worse, will tell others that the therapy session was useless or a waste of time. As far as they are concerned, their real issue is the new one that they’re feeling at the moment.

You can deal with this problem in several ways. First, education: the apex problem is addressed in the client brochure, and you will have to explain it to them up front. Explaining the nature of the latest generation of therapies and how they work is important. Second, make a record. One way to do this is to have them write down exactly what the issue is, how bad they feel, give a SUDS (subjective units of distress) rating, and particularly focus on the parameters of the ‘charge for results’ you’ve agreed on. Writing is ok, but a far better way to do this is via video or audio recordings. This captures the immediacy of their suffering, and later the clients are almost always surprised that they felt that way – they simply no longer remember.

The other advantage you have is in charging a predetermined, fixed fee that they have agreed to in a contract. How you collect fees is up to you – and obviously may vary from client to client – but one way to address this apex problem is to have them write a check for the amount you’ve agreed upon, and simply hold it for the duration of the therapy. Since they were willing to do this, at some level the clients decide that this must have been an important problem since they wrote the check!

3.9: Some Situations Don’t Allow ‘Pay for Results’
In some circumstances, the ‘charge for results’ fee structure isn’t possible or isn’t appropriate to implement. For example:
  • For health insurance company payouts (and they won’t allow a performance based fee structure);
  • The client wants to try out one of the techniques that you know and doesn’t have any particular success criteria;
  • The client is your student and the session is part of or supporting a training program.
As long as particular circumstances really inhibit ‘charge for results’ criteria, and this is clear to the client, the therapist can put an exception rider on the client agreement on a case-by-case basis. However, outside of teaching situations, this situation rarely arises – you can generally figure out success criteria for almost any activity.

Unfortunately, we’ve also seen that therapists are reluctant to approach insurance or other organizations to suggest they switch to this type of billing, either generally or in their particular case. As this financially benefits the company involved, it will be interesting in the future to see if the insurance companies themselves end up pushing for this change.

3.10: Disputes with Clients
In spite of your best efforts, there will be clients that you have problems with. Hopefully most of these people will decide not to work with you after the initial interview, but some will. Accept this as a fact of life, and not as some sort of personal failing on your part (We assume you do take it as an opportunity to look at your own issues, though).

If the problem is that a client feels he didn’t get the results agreed upon, and you can’t come to a quick and amicable agreement, the response is simple. Remember, “The client is always right”. You’re in this business for the long haul, and word of mouth is critical to your success. You simply don’t charge (or refund the money). Obviously, there will be some people who will take advantage of this – but that happens in every business. You simply plan for it in your fees. Fortunately, in our experience dishonest clients are very rare.

As far as Institute certified therapists are concerned, their client brochures (and our websites) also tell clients that they can contact the Institute if there are disputes. This is part of our licensing agreement, and it makes it obvious to clients that these therapists are part of an exceptional professional organization. Over the years, we’ve rarely have problems with these licensed therapists but it sometimes happens. As part of their license agreement, we retain the right to end their license and their use of our licensed tools, trademarks and logo.

3.11: Trademarks, Logos, and Affiliate Organizations
When one of our trained therapists signs a license agreement with the Institute, they receive the right to use our processes for specific diseases or problems, have clinic backup for difficult clients, and get access to new discoveries and safety updates. They also get the privilege to use a certified therapist Institute logo on their documents and websites for advertising purposes. But this logo means more than using cutting edge therapeutic tools - it means that they have agreed to use only ‘charge for results’ in all their therapy work. These unusual therapists are leading the way to a fundamental change in the way therapy and medicine is done in the world.

The Institute also lists affiliate organizations or individuals from around the world on our websites. Aside from being cutting edge organizations that do excellent work in various areas, they also use the ‘charge for results’ (or donation) principles in their work. We feel privileged to have met and known these different individuals and groups who also work to make a difference in the world.

3.12: Questions and Answers
Q: Do you have any suggestions on how to advertise ‘pay for results’?
A: One therapist found that saying ‘No Result – No Fee’ in his advertising worked well.

Note that offering a ‘guaranteed’ healing is not appropriate (as in ‘guaranteed or your money back’) as many places have laws against such wording when applied to psychotherapy. Note that these laws were designed to combat fraud, not forbid the use of the ‘pay for results’ billing model.

Q: "I'm still unsure on how to set the criteria for results. Do you have any advice?"
A: Some therapists tend to think this step is much harder than it is, even though they already unconsciously do it in their practices anyway. You are in a partnership with your client - you are making an agreement that both of you feel is desirable and possible. It doesn't have to be huge and difficult - it is just whatever you both want it to be. For example, if you both agree that a 30% reduction in a symptom is the result, that is fine - you don't have to make it some kind of perfect healing.

The key here is that your client agrees that what you contract to do is worth the money he will pay. The agreement can range from just a willingness for the therapist to listen to the client, to an agreement to get partially or fully get rid of a chronic, long-standing problem. There are no set rules, other than it is what you both have agreed to.

Q: "How do I keep from going broke while I still can't do diagnosis well?"
A: We recommend you use the fixed per contract fee from Appendix 10. It won't take long - probably 20 clients or so - before you find that you are much more confident of your ability to diagnose and set the results criteria.

Q: "I'm a therapist using a variety of techniques. If I get certified by the Institute, do I have to charge for results even though I don't use your techniques with the client?"
A: Yes, your whole practice would have to change to incorporate 'charge for results' (where possible). Being certified is a license, as if you got a McDonalds franchise. You can't start serving burritos while having the Golden Arches and McDonalds name on your door. To some therapists, this feels like too big a change in their comfort zone. Thus, they don't become certified but use the publicly released techniques like Whole-Hearted Healing as just another technique, and just don't use the non-public-domain material they learned in class.

Q: "My big problem is getting clients who are just a bundle of problems, and I don't know how to clarify their issue to get an agreement on results. The client doesn't recognize that he has separate issues, as he just feels bad and wants it to stop."
A: Some clients really are a bundle of problems, and in that case, you would isolate the worst ones and offer to work with them either separately or as a group, depending on what you negotiate with the client. A person like this might be a good candidate for Inner Peace state. There are also certain disease processes that can cause this effect, such as the s-hole problem or the addiction bugs. You may also want to bring in a specialist or advanced practitioner/mentor right from the start if it is big and bad enough.

However, clients like this are the exception. In our experience, the real problem is that the therapist has gotten 'lost in the client's story'. Thus, as one tries to unravel it, the client moves from one problem to the next. Having them staying focused on the emotion and feeling that is the dominant sensation for them is the key to getting to the core issue. Remember - you can offer calmness and peace about their issue.

Some clients simply want to talk and feel connection. You are basically a paid friend. Identifying this and coming to an agreement about what constitutes results for this person can be done. However, you are generally more expensive than standard therapists in this situation. However, since in this case no healing is needed, you might want to lower your fee because there is no risk of not being paid. You are basically charging just a talking fee.

    Paula Courteau writes: "Some clients, and this includes most people with depression, and people with a history of abuse, will need regular sessions in order to maintain decent functioning; in the case of depression this is because we don't know the root cause of every type of depression; with abuse there are often several triggering events. If you're very clear about this state of affairs with these clients, and they still want to work with you, then a teaching or coaching model with a per-session fee might be more appropriate than a per-issue system." However, if the client has an explicit or implicit expectation of healing, then a series of brief, pay for results contracts is the correct choice.

Q: "I have a client with very complex problems, and it will take a long time to unravel them. How do I charge?"
A: You also identify major issues and offer to charge for each separately. This causes the client to evaluate what is really financially important to him, rather than you trying to make the decision for him.

Setting a maximum time you can work with a client keeps you from getting into a financial bind with him when charging for results. However, this doesn't mean you don't have to help the client - it means that you work with your specialist/advanced practitioner/mentor to deal with the client in a more efficient fashion.

Respect your own limitations - you can’t be everything to everyone.

Q: "I'm frustrated with this system and its limitations. I will just go back to what I already know."
A: Unfortunately, learning and actually using new skills often involves discomfort. One of the problems here is that many therapists have never had to do a charge-for-results approach for their livelihood. However, if you'd ever done consulting, worked at a car dealership, or had your own business you would probably think it was perfectly normal. The people at those jobs all work for a fixed fee and don't always know if it will work or not for any particular client either.

Interestingly, we've had a couple of therapists notice that they didn't have a feeling of calm underneath their sense of frustration with this new system - a key indicator that the feelings are from past trauma - so they healed their issue, and to their surprise, found themselves feeling very comfortable about it.

Q: "There are lots of other therapists out there doing excellent work. I don't see how the Institute’s certification stuff is significantly better. After all, your material is now mostly in the public domain.
A: Yes, there are many therapists with the same skill and success rates as Institute certified therapists. What you have that is different is: 1) charging for results; 2) Institute clinic backup for your practice; 3) the chance to do peak states work with some clients; 4) hopefully an eventual name recognition with the Institute: and 5) after you become comfortable with the basic techniques, the possibility of working at one of our clinics.

Q: "I feel there are too many rules by the Institute. I want to be trusted to use my own judgment, because I'm an honest, ethical, competent person. I'd like to move forward slowly into these new ways of working. There wasn't anything like this in my old bodywork profession."
A: Many people in the helping professions have never had exposure to the way a high technology company operates. The certification agreement with our graduates is a license to use the some of the material we've developed, something that many are not familiar with from their own working background. Fortunately, although unfamiliar, it is quite normal and accepted in other professions - including the concept of 'charging for results'.

Because we're backing up our certified practitioners with support and our reputation, the agreements we make are more specific than many are used to from other modalities. Additionally, the material we're developing is experimental, and requires more careful handling for safety and quality control.

Q: "I didn’t succeed in healing the client before my 3 hour cutoff time. Now what?"
A: You have to decide if you want to continue or not. You may have already realized that you can't help this person anyway. If you simply stop right now, on average, you will make your income goals - because you already figured this happening in the prices that you charge people. At this point, you should refer the client – or if you are so inclined, to continue to try and help and accept that your equivalent hourly income will be somewhat reduced.

    Paula Courteau writes: " I would also ask: is the person healing anything at all? That is, is it taking a long time because the person can't heal (can't get in body, can't feel, resists the process, etc) or because the issue is complex? If there is good progress and the issue keeps progressing, I might consider spending extra time. If we're spending most of the time being blocked, I'd quit without hesitation and forfeit my fee."

Q: "I've decided to run over my three hour cutoff limit ("I'm almost there!"). Was this a bad idea?
A: Obviously, you may gain your fee if you succeed. However, it is wise to plan on failing, which means your income will take a dip depending on how long you continue. Sometimes the learning time is good, as you stretch yourself. However, remember that you have the Institute clinics ready to assist (if you are certified by the Institute).

Q: "There is no way I'll have enough clients if I heal each in just three sessions!"
A: This is both a problem and an opportunity. For better or worse, the nature of therapy is changing due to the introduction of power therapies. The therapist has to figure out ways to get a continuous flow of clients, such as by working for an institution that finds and funnels them to the therapist. Thus, having something that sets one apart from the competition is important, such as 'charging for results'. Word of mouth might help you, if the apex problem doesn't defeat it - but the best way to avoid this overall problem of client base is to specialize in one problem or problem area, and build your reputation on that, rather than be a generalist.

Q: "How many practice sessions will it take me so I can calculate fees accurately?
A: Roughly 10 successful sessions will give you good enough information to compute your standard minimum fee and optimum cutoff time. However, you should keep a running tally as you get better at diagnosis and healing, to make sure your equivalent hourly income rate is still on track.

If you are setting fees by estimating completion times, you are going to need a much bigger experience base! We only recommend this for very experienced therapists, or therapists who specialize and are familiar with most of what can happen.

3.13: Key Points
  • ‘Pay for results’ addresses ethical problems by making explicit agreements: (1) you are paid only if all the predetermined success criteria are met; (2) the client knows how much treatment will cost before it starts.
  • The ‘pay for results’ billing system is standard for many industries. With minimal practice it is simple to incorporate into therapy.
  • The ‘pay for results’ principle automatically requires the therapist to identify the key client issue and determine the outcome of therapy (criteria for success) that the client wants.
  • The simplest billing system for ‘pay for results’ is a fixed fee for all clients. It incorporates a predetermined ‘cutoff time’ for when to give up on trying to heal a client issue.
  • With ‘pay for results’ the client determines the results they want, except in the case where they are using a specific process that has predetermined outcomes.
  • The use of subcellular psychobiology and modern trauma therapies means that the client is usually healed in a few sessions. This fits well with the actual amount of time that typical clients are actually willing to put into therapy.
  • The apex effect causes many clients to forget they had a problem after it is fully healed. You need to plan on this happening by keeping written or recorded material of the client’s difficulty before treating them.

3.14: Suggested Reading
  • The Ethics of Caring: Honoring the Web of Life in Our Professional Healing Relationships by Kylea Taylor and Jack Kornfield (1995).
  • "Pay for Results" by Dr. Grant McFetridge (2014). This PDF has four parts:
    • "Understanding 'Pay for Results' for Therapists". This is Chapter 3 from the Subcellular Psychobiology Diagnosis Handbook.
    • "Examples of 'Pay for Results' Contracts". This is Appendix 2 from the Subcellular Psychobiology Diagnosis Handbook.
    • "Pay for Results' – Fee Computation Guide". This is Appendix 10 from the Subcellular Psychobiology Diagnosis Handbook.
    •  “Pay for Results – Statistical and Mathematical Modeling for Fee Calculations”. It derives the underlying equations and statistical models for optimum fees used in appendix 10 for fixed-fee and variable fee pricing for therapists.

...or visit our Forum

RSS icon PeakStates news (RSS)

Revision History
Sept 18, 2014: Put this chapter from the Subcellular Psychobiology Diagnosis Handbook online.