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How Sliding Scale Fees Work in Therapy

What it is, who it’s for, and what you can expect.

Key points

  • Sliding scale fees are negotiated between therapists and clients who can’t afford the full cost of service.
  • Some therapists offer limited openings for clients paying on a sliding scale.
  • The best way to find out about sliding scale options? Just ask.

Therapy can be a powerful tool for improving mental health and confronting life’s challenges. It can also be expensive. Many people don’t have health insurance, and even for those who do, plans may provide little or no coverage for mental healthcare or for providers out of network.

Therapists want to help people. It’s why they chose the profession. But they do also have to pay the rent for their offices, the fees for their licensures, and their own salary, so they do have to charge money for their services. That’s where sliding scale payments enter the picture.

Sliding scale payments are an agreement between a provider and a client to pay a reduced rate for therapy. Some therapists offer these agreements while others don’t. Of the therapists who do offer these agreements, they are often based on the client’s income or otherwise ability to pay, but how much of a discount is offered is ultimately up to the discretion of the therapist.

Who’s Eligible for Sliding Scale Payment?

Not every therapist offers sliding scale options, but enough do that it is always worthwhile to inquire. The Psychology Today Therapy Directory has a comprehensive list of therapists who include on their profile whether they offer sliding scale payment options or not.

For the therapists who do offer sliding scale fee payments, many will reserve only a few slots in their schedule for clients paying a reduced fee, so they can be difficult to obtain. Therapists have their own criteria for how much of a discount to offer and to whom they offer it.

“If someone calls me up and I thought they’d be a good match for me and I’d be a good match for them and they couldn’t afford my fee, then I’d see them for less money,” explains Cynthia Baum-Baiker, Ph.D., a psychotherapist in private practice in Philadelphia. She says she has kept about five slots open in her practice for sliding scale clients over the years, and wants to be sure to fill them with people who could benefit from her specific expertise and wouldn’t be served better by someone else.

Other therapists may not be as interested in who the client is or their situation.

Raquel Martin, Ph.D., runs a clinical practice out of Nashville. She accepts sliding-scale patients on a first-come-first-served basis and includes a field on her intake form where potential clients can request sliding-scale payment. Her rule of thumb for how much to charge someone on a sliding scale is how much the client makes in one hour at their job.

“It doesn’t matter if you can’t afford it because you have six people in your house or you can’t afford it because you’re a student. You can’t afford it either way,” she says.

What’s the Best Way to Ask for Sliding Scale Payments?

Just ask! Therapists are accustomed to the question and are not going to pass judgment on someone for whom therapy is a financial burden. Successful treatment is built on a feeling of mutual trust with a therapist, so any practitioner you’d trust to talk to about personal issues is someone you should be able to trust when talking about finances.

Know that the answer may be “no.” Therapists may not offer this to anyone, they may have all their allotted slots already taken, or may not think a client is the best match for them.

It may be helpful to do your homework before reaching out to a therapist with your query. Think about why a practitioner would be helpful specifically for you or the issue you’re dealing with.

“The best way to ask is an honest and respectful way. If someone has done their research and has an idea of why they want to work with me and can show me they don’t have the resources, then I’m willing to have the discussion,” says Ying Wang, M.D., a psychiatrist in Pennsylvania. “I would suggest people not be demanding. When someone approaches you that way, it’s off-putting.”

While it’s impossible to know who will have open slots for sliding scale payments, it might be helpful to focus on younger therapists, Baum-Baicker said. Therapists who have been working for decades may have a full roster of patients, but those just starting out in a practice may have more open slots to fill up and be more willing to adjust their rates.

The take-home message from therapists? It’s worth asking.

To find a therapist near you, visit the Psychology Today Therapy Directory.

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