Does money matter? The effect of fee structure on psychotherapy effort and outcome variables

Debate about the therapeutic value of fees in psychotherapy has been present since the publication of early psychoanalytic writings. Two theories, based on psychoanalytic and cognitive dissonance concepts, have both predicted that the payment of some fee contributes to effective psychotherapy. The present study examined psychotherapy effort and outcome data collected from client families receiving psychotherapy services at various family therapy clinics, under the auspices of the Maryland Association of Youth Service Bureaus. Some of these clinics charged a flat fee for psychotherapy, some used a sliding scale fee structure, and others provided free services. Data from sites that now charge fees were examined across a period before and after fee structures were implemented, allowing for a pre-post comparison within sites. Results indicate that fee structure did not interact with the time of data collection (pre-fees or post-fees) to affect either psychotherapy effort or outcome variables. Discussion focuses on questioning the assumption that charging fees improves psychotherapy.