Once you have thought through the ethical implications of the Church Therapy model (click here for posts in the “Ethics” category), you may find yourself asking, “So how does this work practically?” There are a variety of different options for making church therapy work for your church.
The Ministry Model
In some churches, counseling is viewed as a ministry and there is no charge for meeting with a counselor. Most often, the counselor is the pastor and this differs from Church Therapy because here counselors are not serving both as a pastor and as a professional counselor for their church. That does not mean that a church therapist cannot be on the church payroll. In some contexts in which money is plentiful, a church (or group of churches) could pay a salary to a Christian professional therapist and enable them to offer free counseling to church members. Unfortunately most churches are either not in the position to pay a professional counselor a salary or they do not prioritize it. Other churches may feel that because a professional counselor can earn fees from other sources they should do this and free up church monies for other needs. Additionally, in the ministry model a counselor can choose to donate a few hours a week to be a counseling minister for free, but this is limited unless the counselor has no need for an income.
The Self-Pay Model
In this model, the clients pay a certain fee per session. This can be done in a variety of ways, but most common would be a sliding scale fee based on income. You can also have a set fee that everyone pays regardless of income but doing this will limit access to your services. Regardless of what exact amount you charge per session, you have two options for processing that money. The counselor can be officially self-employed and manage the money on his or her own, or the counselor can be an employee of the church and turn in all fees collected into the church. The church bookkeeper would then take out all taxes from the fees collected (both the employer and employee portions of Social Security and Medicare) and pay the counselor according to the rate agreed upon. In the self-employed option, the counselor may or not pay rent to the church for office space. If the counselor is officially an employee of the church, some of the fees collected may be set aside to cover building use costs. Either way, the fees collected cover all taxes and costs of the counselor’s position unless the church is willing to cover building costs and increase the pay of the counselor.
The Insurance Model
Using insurance to pay for counseling has some wonderful advantages and some serious downfalls. In this model, the counselor must already have a license and usually a few years past state licensure in order to obtain contracts with insurance companies. Essentially, the church is inviting the counselor to come on church staff to set up a private practice. Because insurance companies can only contract with an identified clinician, this model requires that the counselor be officially self-employed. Reimbursements from insurance companies are paid directly to the counselor and he or she is responsible for all self-employment taxes and record keeping. If you live in an area that has primarily low-income clients, insurance payments can mean that you can earn a living wage and the client will typically pay nothing. In a more affluent area, the client’s insurance may require a higher co-pay or your clients may be able to self-pay at a higher rate than an insurance company! The downsides of working with insurance companies include bureaucratic headaches, claim submissions, mandatory diagnosing, and session limits. In this model it is up to the church to determine whether or not to charge the counselor rent for office space or donate the space to the counselor in exchange for some staff responsibilities.
The Hybrid Model
If the church therapist is working towards licensure or newly licensed, he or she can seek out a partnership with a larger mental health agency. In my early days as a church therapist, I began with the self-pay model but because I live in an economically depressed area I found that even $5 was more than people could afford to pay. The church did not have money to pay me a salary so I maintained another part-time job for needed income. Within my first year I developed relationships in our community and ultimately pitched the idea of a partnership to the VP of a secular mental health agency. The agency hired me to work as a fee-for-service clinician with them doing outreach in the community via my church office. I was clear throughout the process that I was offering professional Christian mental health counseling and in the end they paid me at a slightly higher rate because I had this specialty! They also agreed to pay the church a set amount monthly for the use of the office space. This model worked well until I was able to secure my own contracts with insurance companies. Again the downfall is mandated diagnosing and significant amounts of paperwork.
I offer consultation services to any church seeking to hire a church therapist onto their staff. What model might work best for your setting? I’d love to hear your thoughts and comments.