New clients should be asked to pay at every session. As you get to know a client, you can handle the transactions on a monthly basis. But don’t let your “accounts receivable” “age out” with any client unless you know him or her very well, and are sure of the client’s basic healthiness. For clients who are more impaired, developing their responsibility about paying you as surrogate for their handling their obligations in the general community is of course an integral part of the therapeutic plan.

You need to include in your contract with your client language authorizing you to terminate the client for failure to pay the fee. This language probably best reads in the same paragraph in which other non-compliance issues are covered, such as being intoxicated for sessions or failing to undergo psychiatric treatment where indicated.

That language will give you the option of initiating a termination, if necessary. Remember that you are still obliged to provide referrals for continuity of care, and that your lawyer’s bargaining position for you will be less strong if you have terminated care during a period for the client of severe emotional crisis.

If you are going to terminate a client, write him or her a letter explaining your grounds. In most situations, it will be possible to write this letter as a warning, telling him or her that if the bill is not settled by X date, the last time you will see the client is Y date. Send the letter by certified/return receipt mail and keep a copy.

Don’t think that going to small claims court is a good choice. You are opening yourself up to an escalation of the difficulty, all the way up to there being filed against you a malpractice claim or even a disciplinary action. Sure, it’s quite likely to be all trumped up, but you’ll still spend time and money defending yourself.

If your client has a borderline personality disorder or has strong paranoid traits (or seems particularly unable to relate to you under whatever diagnostic rubric seems most cogent), be especially careful. While of course litigants come in all emotional shapes and sizes, the most unreasonable tactics and protracted litigation are often engaged in by persons who have these conditions.