Denver, CO

How therapists around the country use sliding scale pricing to make therapy more affordable

Dave Chung

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Sliding scale options can make therapy affordableCounseling South Austin

The holiday season and the start of a new year can create one of the busiest times of the year for therapists. From managing family stress to getting started with New Year's resolutions about mental health, many people look for a therapist who can help them manage what's happening or what's coming up next in their lives.

With the cumulative effect of the global pandemic continuing to grow, people are seeking therapy, possibly more than ever. According to a survey by ValuePenguin, 1 in 5 Americans have sought out therapy since the start of the COVID-19 pandemic.

That being said, therapy can be expensive, typically costing between $100-$200 per session throughout the country. While most would say that one's mental health is priceless, cost can be a real barrier to entry for many people who want to see a therapist, but don't know how they'd be able to afford it.

Sliding scale as a low-cost option

While there are community mental health facilities and a limited number of therapists who take insurance, many people want more options and flexibility when they're getting started with therapy to find the right fit for them.

As a result, many therapists offer a sliding scale option to help more clients be able to afford the therapy that they need.

By definition, a sliding scale means that fees can be different on a per person basis using some level of standards. However, it's often unclear how much sliding scale therapy costs and how therapists determine which clients qualify for these services.

To add some transparency to this more affordable payment option, I asked therapists around the country how they use sliding scale pricing within their practices. Here's what they said.

Based on income

Kelley Stevens, a licensed marriage and family therapist in Santa Barbara and owner of The Private Practice Pro, offers sliding scale sessions to clients that make minimum wage or less. To make therapy more accessible, she charges based on a sliding scale client's income.

"I offer 4 sliding scale spots in my practice at all times. I save these spots for clients who make at or below minimum wage. I charge these clients the equivalent of one hour of work for one hour of therapy. For example, if they make $15 per hour, then I charge $15 for the session."

At My Denver Therapy, a group practice in Colorado, they offer a limited number of sliding scale spots available for clients with financial needs. Similar to Stevens, they adjust fees based on a client's financial situation.

Based on profession or situation

Some private practices offer sliding scale services to people in specific professions, situations, or life stages.

Dr. Nancy Irwin in Los Angeles saves "two slots each week for sliding scale patients." She qualifies people for sliding scale therapy if they are students, teachers, social workers, unemployed, or disabled, among other conditions.

Psychiatric nurse practitioner Brittany Sherwood serves a specific clientele with her sliding scale services. She said, "I offer a blanket discount or sliding scale of 50% off all services for currently enrolled college students."

The honor system

For one reason or another, some people might not feel comfortable sharing their proof of income with a therapist they're meeting for the first time. Many therapists use the honor system when qualifying clients for sliding scale sessions.

Stevens explained, "I use the honor system when discussing sliding scale spots. I explain to potential clients that I reserve my sliding scale spots for clients who make at or below minimum wage, and I’ve never had someone take advantage of this system."

Megan Lee, co-founder of Soulutions Therapy in the New York/New Jersey area also uses the honor system to determine eligibility for sliding scale sessions. "Typically, I put trust in my potential clients to have an honest conversation about what is affordable at the time for them. I start out by telling them my fee and if they feel they cannot afford that, we have a discussion about it."

She also mentioned the importance of keeping fees flexible to make therapy accessible.

"The discussion remains fluid in that it can be revisited at any time, and I do my best to help clients get reimbursement from their insurance as well. I do not verify income or ask about salary – I think it's important to present mental health care as not only accessible but affordable."

Using the honor system was a common theme with therapists. Dr. Nancy Irwin also said, "I use the honor system, and have never had it backfire, as far as I know."

Nonprofits can also be an option

Numerous therapists mentioned Open Path Collective, a nonprofit that serves clients who lack health insurance or whose health insurance doesn’t provide adequate mental health benefits.

Open Path Collective verifies patient financials so that therapists can provide discounted services to those in need. Sessions with therapists who are participate in the collective typically cost between $30-$60 per session, which is much cheaper than the average cost of therapy.

David Klow, owner of Skylight Counseling Center in Chicago and author of the book, You Are Not Crazy: Letters From Your Therapist, offers sliding scale sessions from $0-$75 per session. Additionally, he has a nonprofit foundation called The Skylight Foundation which provides free mental health services in a private practice setting to those in need.

Similar to other therapists, Klow said, "We do it on the honor system and don't ask to verify people's income."

Sliding scale can help make therapy affordable

If you've been considering therapy but didn't know if you could afford it, look for a therapist who offers sliding scale services near you. You can also enter your ZIP code on Open Path Collective to see if there are participating therapists in your area.

Even if you don't have insurance or much room in your budget, there are options for you to find the mental health services that you might be looking for thanks to therapists who offer sliding scale options.

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