Sliding Scale Therapy: Our Guide to Getting Affordable Care
Sliding scales are essential if you’re looking for affordable therapy. They can open the door to many therapy options you might not have thought you could get.
Sliding scales allow therapists to charge competitive rates and keep their therapy practices afloat while also making it possible for a wider range of clients to afford to see them.
The income-based discounts that sliding scales provide can make it possible to see a therapist for half of their listed rate—or even less.
Unfortunately, though, many people who could benefit from sliding scales don’t know about them or how they work.
We want to help you find affordable therapy and make sure that you don’t overlook therapists you could actually afford to see. Read on to learn how sliding scales work and the potential discounts you could get from a therapist who offers one.
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What Is Sliding-Scale Therapy?
Therapists who offer sliding scales base the rate you pay on your income. This makes it possible to get therapy with them even if you don’t have insurance (or they don’t accept your insurance) and you can’t afford their standard advertised rate.
Having different clients pay different rates allows therapists to succeed financially and absorb the costs of running their practices while still being able to help people who can’t afford their regular rates.
Why Is Therapy So Expensive?
Therapy rates can seem high, but they reflect the costs therapists have to absorb to maintain their practices. In addition to paying individual taxes and renting office space, private practice therapists have to pay for their own health insurance, liability insurance, licensing fees, and the continuing education courses and credits they must take to maintain their licenses.
Most therapists don’t believe that a person’s income should determine whether or not they get therapy. While therapists are people, and some are greedy or otherwise unethical, far more are compassionate individuals who want to help as many people as they can.
Most therapists wish they didn’t have to turn anyone away but know that they couldn’t survive as professionals and support their families if they didn’t charge competitive rates, or “reasonable and customary” rates for where they live.
When therapists can’t consistently offer therapy for rates everyone can afford, sliding scales are one way they can compromise and open their doors to more people.
Where Can You Find Sliding-Scale Therapy?
Private-practice therapists often, but not always, offer sliding scales. To find the ones who do, you can search online therapy databases or reach out to local therapists by phone or email to ask.
If you’re not sure where to start, you can use a search engine to search for “therapists in [your town or city] sliding scale.” (You may get better results if you experiment with where you put quotes, such as only putting them around “sliding scale.”)
You can also search the OpenCounseling affordable counseling database to look for providers in your area that offer therapy for reduced fees. Helping people find affordable therapists is why our site was created! We list many kinds of providers that specialize in lower-cost therapy.
Where Can You Find Therapy for Reduced Rates?
If you’re not finding private-practice therapists who offer sliding-scale rates you can afford, think outside of the box.
You can often find therapy for less at places you wouldn’t have even thought to look for a therapist, such as primary care clinics, local colleges or universities, or places of worship.
For more information, you can read our articles about these kinds of affordable providers:
- Community counseling agencies
- The public mental health system
- Integrated primary care clinics
- University counseling clinics
- Faith-based counseling centers
- Employee assistance programs
In these articles, we explain what these providers are, how they work, who they’re for, and how to find them.
Community counseling agencies, non-profit mental health clinics, and publicly-funded mental health providers often offer sliding-scale therapy for lower rates than private practice therapists. One reason is that these clinics frequently receive income from sources private practice therapists don’t have, like state or federal grants or charitable donations.
You might also want to consider trying affordable online therapy through BetterHelp (a sponsor). BetterHelp doesn’t call it a sliding scale, but they do offer what amounts to the same thing: an income-based discount of up to 10 to 40 percent off of their base monthly rate of $360.
You may also be able to find therapists in your state who offer online sessions through their own websites for affordable sliding-scale rates.
How Does Sliding-Scale Therapy Work?
A sliding scale is a range of rates that increase or decrease based on a specific variable (usually your income).
Most therapists who offer sliding scales mention it on their websites or online profiles. Many won’t list their full fee scale online, though, especially on sites they don’t update frequently, as rates may change over time. To find out what rate you’d pay, you can call or e-mail them to inquire. Some may ask for proof of income, but some won’t.
While many therapists indicate on their online profiles that they offer a sliding scale, they don’t always tell you what it is, which can leave you assuming you’d pay more to see them than you actually would.
For example, you might look at a therapist’s profile and scratch them off your list after you see that they charge $150 an hour, not realizing that they offer a sliding scale and that based on your income, you could see them for $80 an hour.
That’s why it’s always important to ask if a therapist has a sliding scale and to ask them what the range is if they have one.
The way therapists set up sliding scales varies. Some assign a specific rate to a specific range of incomes. For example, a therapist might charge people who make $30,000 to $40,000 a year $60 per session, while charging people who make $120,000 to $150,000 a year $150 per session. Some use a formula to determine their fees, such as [0.001] x [Annual Income].
Since most sliding-scale fees are tied to income, your rate may change if your income changes significantly. If you lose your job and have to take an interim job that pays less, your therapist may be willing to lower your fees, especially if you both already have a good working relationship.
How to Ask About Sliding Scale Therapy
Even if a therapist doesn’t specifically advertise that they offer sliding-scale rates, it doesn’t hurt to ask. A good therapist won’t be upset by a polite, reasonable request for a reduced fee from a client who wants to see them but who can’t afford their full rate.
Do consider whether you actually need the discount you’re about to ask for, though. Money isn’t always the real issue. It’s fair to ask for help so you don’t have to skip car maintenance or a trip to the grocery store to afford therapy. Sometimes, though, you might want to pay less than you can actually afford because you’re not really convinced therapy will help. You’re just not sure therapy is worth it.
If that’s the case, it’s better to wait until you’re ready to commit to therapy—financially and otherwise—than to try to get “cheap” therapy. You might think that paying less is a safe bet when you’re not sure if you’re going to get much value out of therapy—but the truth is, nothing wastes more money than paying for therapy when you’re not ready for it. That’s almost a guarantee you won’t get much out of it.
If money is the issue, though, don’t hesitate to negotiate. Therapists love being able to help and don’t want to screen you out just because of how much money you make.
How to Negotiate Therapy Rates
If you’re nervous about negotiating rates with a therapist, we can help. You can read our article “How Can I Negotiate Fees with a Therapist?” for tips, tricks, and information about:
- How to negotiate therapy rates
- When to negotiate therapy rates
- What to expect when you ask for a reduced rate
- Where to find therapists who are open to negotiating rates
Knowing when and how to negotiate—and knowing who’s more likely to be open to adjusting their rate for you—will increase your chances of a successful negotiation.
Note that it’s not always possible to get a sliding-scale rate. Some therapists don’t offer a sliding scale because they accept insurance and don’t want their rates cut by insurance companies who would base their payments on the low end of that scale. Some fear upsetting or losing clients who would find such a system unfair.
Therapists who decide against offering sliding scales sometimes choose another way to help clients who can’t afford their regular rates. Other cost-reduction methods therapists use include providing a certain number of pro bono sessions, allowing clients to sign up for payment plans, or offering half-hour sessions for half of their hourly rate. If a therapist tells you they don’t offer a sliding scale, ask if they offer any other options like these.
Where Can You Find a Therapist?
If you think it’s time to start seeing a therapist but haven’t found one yet, let us help. You can use the search tools on OpenCounseling to find free or low-cost therapy where you live. You may also want to consider trying affordable online therapy through BetterHelp (a sponsor).
Other options include using insurance (and searching for a therapist on your insurance plan’s website) or calling a mental health crisis or information line to ask for a local referral.
You’re not alone if you can’t afford to pay $150 or $200 an hour for therapy. The good news is that you don’t have to pay that much. There are many ways to get good therapy for less.
Ways to get help with the cost of therapy include seeking financial assistance through the public mental health system, getting therapy at low-cost local non-profit clinics, getting online therapy for a discount, or finding a private-practice therapist who offers affordable sliding-scale rates.
What About Insurance?
Using insurance is a great way to get affordable therapy. When you see an in-network therapist, you may only have to pay a $25 or $35 co-pay for each session. In most cases, this will be less than even the lowest rate on a sliding scale.
Of course, in-network therapists are only an option if you actually have insurance. But even if you do, using insurance to pay for therapy isn’t always an option.
Many therapists participate in only a limited number of insurance networks, and an increasing number of therapists don’t accept insurance at all.
The reasons therapists give for giving up on insurance are numerous:
- The amount of paperwork they have to do for insurance companies results in hours of unpaid labor every week;
- Even after doing all that work, insurance companies fight with them over paying claims, quibbling with everything from diagnoses to whether therapy is “medically necessary”;
- The amount that insurance is willing to pay is significantly less than what many people are willing to pay out of pocket for therapy; and
- Many insurance companies are refusing to accept any new therapists into their networks.
Many of these therapists choose to offer sliding-scale rates instead. This allows them to offer therapy for an affordable rate without all of the headaches that come with accepting insurance.
Sliding scales are popular among therapists who want to serve a wider range of clients. They allow them to cover the costs of running a private therapy practice while also being able to see more people. For many therapists, offering a sliding scale is an appealing alternative to the hassles of accepting insurance.
For these reasons, more therapists than you might realize offer sliding scales. We encourage you to research all of the sliding-scale therapy options you have where you live. You might be surprised just how affordable therapy can be.
Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments.