Yeah--I was like this when I started out in PP, and a senior clinician remarked to me that there are two aspects that should psychologically separate in PP, which now having had more time in PP I agree with:
1. what does the patient need clinically in an optimal scenario: is it a one-time eval, is it ongoing treatment, what's the modality of treatment, etc.
2. what is the financially feasible context with which the treatment is delivered, is it medicaid clinic, is it an insurance-based practice, is it a cash combined treatment
When you don't have a lot of patients, psychologically you want to hold on to every dollar, but the "correct" way to do things is to have a uniform policy. People who can't afford your services, in general, shouldn't be in your practice. And I am talking about this strictly on pragmatics. If you are not filling fast enough then you should just drop your rates altogether for every intake until you fill faster. Sporadic fee adjustments are very confusing and cause confusing countertransference.
As an extension, IMO sliding scale fee schedules are totally fine, but should also have hard criteria rather than being "case by case". Ethically, you want to avoid the treatment-interfering psychological pitfall of oh I gave you a special so you are financially demeaned to me--meanwhile, the patient's a borderline so tries to extract every favor from your to keep you on your toe through self victimizing.
The most challenging cases by far I have had are people who complain about cost from day 1. This is actually a good filtering mechanism. This is why Louis Vuitton and Burberry never have sales--so how do they price their products? They price by examining the market as a whole. You want to exude quality. Quality doesn't haggle.
