What is Sliding Scale Therapy? How Do I Know If I Qualify?

There is a very large problem in our society where people do not have the correct resources to receive the help they need for their health concerns. The cost of treatment can be particularly high, and when people are concerned about that, they revert to wrestling with their problems alone. Access to mental health services is an ongoing problem, especially when many health insurance companies do not cover the fees associated. Thankfully, there are many ways clients who cannot fully cover the cost of therapy or mental health services independently can still have access to the help they need. This is called a sliding scale.

A sliding scale is a flexible fee structure that is suited to your particular needs. One person may pay less than the other depending on their personal circumstances and what he or she can afford. This is a great option for people who are looking to pay what they can afford and work with a therapist who understands their financial needs as much as their emotional needs.

Why Is Insurance Not Always an Option?

If you find yourself struggling to find a therapist who is covered by your insurance, you are not alone. What you will come to realize is that many mental health professionals only work with one or two insurance networks and most will not use any. There are many reasons for this, including:

  • The amount insurance is willing to pay is much less than people are out of pocket;
  • There is still debate surrounding if therapy is a ‘medical necessity’ or not;
  • Many insurance companies refuse to add new therapists to their networks;
  • There is a significant amount of paperwork that insurance companies require that adds unpaid labor for therapists each week.

In-network therapists are only a good option if you have insurance, and if you do not, do not worry. There are many people working as freelancers and every year more and more people have little-to-no insurance coverage. Therapists understand this and some try to do their part to make their practice affordable.

The good news is: sliding scale makes it much easier for people who cannot afford the $150/hour therapy sessions. So if your insurance does not cover mental health specialists or you do not have insurance, read on.

Examples Of Sliding Scales

As we mentioned, a sliding scale is a way for you to pay what you can afford for therapy. For example, a private practice therapist may charge $100 per session. This therapist understands that their fee is appropriate, but not necessarily affordable for every potential client.

He or she could want the opportunity to connect and work with clients whose income does not allow them to participate in therapy. The therapist then engages in a sliding scale.

The therapist will keep their $100 per session fee, but offer sessions at rates less than that, depending on what the individual can afford. The therapist comes to an agreement with each client working on the sliding scale on the session price.

The sliding scale fee is calculated based on the client’s income in relation to the national poverty rate, as well as the state rate. The price of therapy, according to the Psychotherapy Collective, can range from $65-$200 per session. This is why sliding scale therapy is so important. In some cases, people who are eligible for sliding fees are able to receive free mental health services.

How Do They Work?

The way therapists set up sliding scales can vary. Some assign a specific fee per session to a range of incomes. For example, for people who make $25,000-$30,000/year, sessions are $40. They may charge people who make between $150,000-$175,000/year $150 per session. Others use the formula [0.001] x [annual income] to determine his or her fee.

Most therapists will advertise that they use sliding scales on their profile or website. However, they will not necessarily list their full fee for the sliding scale.

To find this out, it is always best to reach out to the therapist specifically to inquire. Some will ask for proof of income while others will not so be prepared for that. Therapists are also aware that life can change at a moment. If you are laid off or lose your job, your therapist may also lower or adjust your fee. Mental health clinics (both public and private) often offer sliding scale therapy for lower rates than private practice therapists. There are many options here to receive help if you need it.

How to Ask About Sliding Scales?

Being transparent about your financial situation is the best way to ask a therapist about a sliding scale. If you are just beginning your search, always ask the therapists you speak with their fee and what forms of payment they accept. Being upfront about payment right away allows you to save yourself stress later.

Communicate if the fee is more than you can afford. You do not need to tell them your entire financial situation if you are not comfortable, but be honest with them about what you can and cannot afford. They will then tell you if they work on a sliding scale and if so, how they can accommodate you.

Still nervous about asking for a sliding scale? Finances are uncomfortable. It is perfectly natural to feel uneasy here, but it is a very important part of the process. Below are some of our tips for boosting your confidence in this discussion:

  • Therapists are very empathetic. It is practically part of their job description! They will make you feel comfortable in this discussion. They are people too and have certainly dealt with money troubles at one point or another.
  • You will not be the first person to ask about a sliding scale. This is a very big part of their work, especially with health insurance being as complicated as it is. This conversation is a great opportunity to be vulnerable and could even benefit your sessions with this therapist if you go in vulnerable.
  • You have already done something difficult by engaging with a therapist. You should be proud of that; you are so close to receiving the help you need, do not stop short. If you are really dedicated to practicing therapy, be open with your potential therapist and help them help you. This is just the beginning of the journey to feeling healthy, make it enjoyable.

Other Options

There are plenty of great options available if a sliding scale is not the right path for you. Some of these other practices include:

Schools or Teaching hospitals

You may have the option to receive counseling from a local school or teaching hospital. If you are a student, your school should be able to provide mental health resources for you for free. Teaching hospitals typically offer free or low-cost therapy. This is because their practitioners are still learning. You will see your therapist and a student who is in training. This is not for everybody, but can be a great way to be involved in therapy for a low price and assist in someone’s training.

Employer Assistance Programs

Some businesses offer employer assistance programs that often provide low-cost or free mental health support. This is a way for employees to work through life issues and is often separate from insurance. Speak to your employer about if a program exists and how to access it.

Group Therapy

Group therapy can be very helpful for people looking for a community. These groups often meet at local community centers or churches. Often, this kind of therapy is free or low-cost. Therapists do not provide one-on-one support but help keep the conversations focused and engaging.

Go Online

There are many online platforms where you can anonymously chat with others. Some people do not like the idea of talking to internet strangers about their problems, but others prefer it to therapists. Websites like 7 cups of tea are great places to get started. However, chat rooms can be dangerous because there are no mental health professionals to mediate or provide resources, so be mindful of this.

Mental Treat also has a variety of professionals who specialize in different areas of therapy. Remember, therapists can have a variety of specialties, so if you find someone you think you would connect with, do not hesitate to ask them. For more information, go onto our platform and apply filters until you find the correct therapist for you.

A Word From Mental Treat

Seeking help for your mental health needs is the first step in making yourself feel better. It is crucial to make therapy a comfortable experience so that you continue it and feel supported. Spend some time looking for the right therapist for you, and especially one that is the right fit monetarily.

We have several articles on Mental Treat about how to receive therapy without insurance and in major cities. Please feel free to look at those for more information! You can also see on our platform which of our licensed mental health experts uses sliding scales. We hope that you have a successful and positive experience on your journey to receiving therapy. As always, take care and be well.


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