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Seeking Affordable Therapy

This is going to be about me. I am looking for affordable therapy right now, for myself. I do not know what the reader's reaction will be to this statement. I can imagine some concern that needing therapy might compromise my ability to provide therapy. Perhaps the opposite is true and you believe that I can understand you better since I am in the position of seeking therapy, just like you. Accountants have their own accountants, physicians go to the doctor, and therapists get therapy. We (therapists) have been trained not to talk about our personal lives at all (a trend that is shifting, by the way), so maybe you just do not hear about it much.

I am not necessarily in "crisis", per se. I just think being in therapy will make my life better right now. It is definitely how I would advise someone in my situation. I have been thinking about what I want in a therapist and exploring my options. I am looking for a therapist who can get started right away and does not need a lot of warm-up time (probably someone with at least 5 years experience). I am pretty clear about what I want to work on, and I can usually establish trust right away. I need someone who is aggressive and possibly confrontational (will disagree with me, at least). It cannot be someone I know (dual relationship). Finally, I need someone who can cut me a break on the cost. I cannot afford what SF therapists are charging these days (between $175 and $250/session). I think I can pay about $75-$100 a session, and I would like to see someone for about 4-8 weeks.

One of my first stops was, naturally, talking with my therapist friends. I sent out a couple emails and said, "Who do you know?", and let them know about my price range. The best response I got back was a person (Dr. Therapist) whose "sliding scale fee" for me was $150/session.

Here is what I was expecting from Dr. Therapist. "You're a therapist, I'm a therapist, I know how hard it can be out there for you since I am out there too, let me do you a favor because that is what colleagues do for one another, here is a ridiculously low fee because I hope someone offers me the same when I am in need. And hey, "weareallinthistogetherwehavetowatcheachother'sback." Not what I got.

$150/session is not a gracious price, but it is fair. As a therapist I know that it is probably not what an actual hour of her time costs. Dr. Therapist reportedly had a reputation of being effective in therapy and well-liked by her clients, so I was content with the quality of services being offered. What concerned me was the so-called "sliding fee scale". If you do not know, a Sliding Fee Scale is actually an equation used by service providers to set prices based on what the customer can afford. Independent practitioners (like myself) are less likely to use such a scale because it is harder to even out the income if there are too many low-income clients. It is hard to keep the doors open that way. Larger therapy groups are more likely to use a Sliding Fee Scale, in my experience. Most sliding scale providers set a fee by looking at your income and/or expenses, and make a determination from there on what you can reasonably afford. Some examinations of your "need" by providers is extremely intrusive (e.g., requesting info on how much you spend monthly on alcohol), some is minimal (e.g., verbally stating your annual income). I like Sliding Fee Scales for setting fees because everyone is measured by the same standard and quoted a fee that matches their current financial situation. If the scale is set up properly, and there is a good economic cross-section of clients (like in SF), no one goes hungry.

Dr. Therapist's "sliding fee scale" was not a Sliding Fee Scale because she had no relevant information about my finances. She could not possibly have made an informed decision on what to charge me under a Sliding Fee Scale. What she likely has are something I have been hearing more and more about: "A couple 'reduced-fee' slots in my schedule." As I understand, some therapists (perhaps this is more of a common practice than I am aware) have a minimum/maximum number of clients they need to charge at "full fee" (which might be inflated), and then have a "couple" clients they can charge a partial fee. If they actually have set numbers for how many reduced fee slots there are, and what they charge those lucky few, they are not going to tell you. This fee-setting policy seems to open the door to all kinds of things that could negatively affect the therapeutic relationship, quality of service, or integrity of the business and profession.

Dr. Therapist and I are in a helping profession, and very few of us have relevant or adequate business training. To that end, we got into this profession to do good, but good does not always result. For most people, and especially those seeking therapy, money is a big issue. Financial strain is actually one of the most common sources of stress and anxiety, including chronic anxiety and even generational anxiety. My hope is that you can find a qualified therapist who charges a fair price for services that you can afford. That was not my experience, but I am just starting the process. Here are the questions I am asking therapists about paying for therapy.

  • What is your fee?

  • Do you have a sliding fee scale, and how do you determine fees based on that scale?

  • Would you agree to see me during non-peek hours (mid-morning to mid-afternoon) for a reduced fee? (This is the time your therapist is posting to Twitter.)

  • Would you agree to a reduced fee for a set number of sessions?

  • What other options do you have for people who cannot afford your fee? (If they do not have a good answer to this, you should move on. Good therapists are problem-solvers motivated by compassion, objectivity, and reality.)

A couple other places I am looking are faith-based organizations, community mental health facilities (sometimes called Behavioral Health), psychological interns (pre-licensed therapists supervised by seasoned, licensed therapists who charge up to 50% less/session), and professional organizations (SF Psych Association, APA, other therapist locater services). It is my intention to record my experience in a way the reader will find useful. Stay tuned.

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