Sliding Scale Therapy – A Complete Guide (2024)

In this guide, you’ll learn what sliding scale therapy is and how it makes therapy more affordable.

Most therapists don’t believe that a person’s income should limit their access to therapy, and many use sliding scale fees for that reason. 

Read on to find all the information you need, including how it works, and whether you’re eligible for it. 

Let’s dive right into it.

Sliding Scale Therapy
Photo by cottonbro from Pexels

What does sliding scale therapy mean?

This is a scheme that allows men and women with lower incomes to pay less for therapy.

When a therapist offers a sliding fee, high-earners will pay the normal ‘market rate’ for a session, while low-earners will be offered a discount based on their ability to pay. 

In most cases, the amount charged will be directly related to their income. Other factors such as the number of dependents you have may also be considered. 

How are sliding scale fees for therapy calculated?

Therapists are free to implement a sliding scale payment structure however they want. They can also choose not to offer it at all.

Usually, those who do offer these discounts will first outline the ‘market rate’ paid by normal clients, and the minimum rate they’re willing to charge.

From there, they’ll choose a sensible sliding fee structure to link a patient’s earnings to the fees they’ll pay within this range. 

Here are some structures that are often used to create sliding scales.  

  • Different fees for income ranges. For example, clients who make $25,000 – $35,000 a year might pay $35 per session, while those earning $35,000 to $45,000 could pay $45 per session, and so on. 
  • Fees based on a formula. A therapist could use a formula such as Annual Income x 0.001 to find a suitable fee for each client, implementing their minimum and maximum cap.
  • Fees based on the Federal Poverty Level (FPL). Many therapists in the United States will compare a client’s income to the FPL to determine their fees. The FPL is standardised across the country and includes dependents in its calculations.

Some therapists will ask clients for proof of earnings before offering a discount, although others are happy to take their client’s word as truth.

You may be asked to re-confirm your earnings after a few months of therapy, in case your circumstances have changed. It’s also acceptable to ask for a sliding fee after a few months of paying full price, in the case that you have stumbled on financial difficulties. 

How do you get a sliding scale therapy?

Some therapists don’t advertise sliding scale rates on their websites. Others do. Either way, you’ll most likely have to contact your therapist and ask for a discount. 

This can be an awkward conversation, but don’t fret. A good therapist will be empathetic to low-income clients. It’s unlikely to be the first time they’ve been asked for a discount. 

Most therapists recognize that it’s a society-wide problem when people cannot afford mental health services and will do what they can to make a deal work for you.  

Why may therapists not offer discounted services?

There are many reasons why a therapist might not be able to offer a reduced fee. It’s not just greed.

Here are some of the more common reasons:

  • Ethical concerns. Some therapists consider it discriminatory to charge people different fees for the same services.
  • Client perception. Therapists don’t want to be perceived as price-gougers. People who discover they’re paying more than others may feel resentful towards their therapist. 
  • Insurance restrictions. Some insurance companies won’t allow their network providers to offer varying rates. If a therapist goes on to do it anyway, they could be charged with  insurance fraud.
  • Some therapists can’t afford to lower their prices. Therapists need to be able to cover the running costs of their business, while paying themselves a reasonable salary. If they’re short of clients, they might not be able to do this while offering discounts.  

Alternatives to sliding scale therapy

If your therapist doesn’t offer sliding scale therapy, it’s worth checking whether you’re able to lower costs via these methods instead.

  • Pro bono sessions. Perhaps you can negotiate to receive five sessions for the price of four, for example.
  • Payment plans. Maybe, instead of paying per session, it will be possible to spread the overall cost of your therapy over a longer period of time. 
  • Shorter sessions. Ask whether your therapist will consider 30-minute sessions at half the cost of their hourly rate. 

Online therapy apps tend to be cheaper than face-to-face, and can be just as effective. So, explore whether you can afford high-quality mental health care using the likes of Betterhelp or Talkspace instead. These two highly-rated online services both offer a sliding scale fee structure too.

Group therapy tends to be cheaper than individual therapy. So, if you look for couples therapy or a group counselling session, you may be able to get help for a lower fee.   

There are free online counselling services like 7 Cups Of Tea and free helplines for those struggling with depression. 

Also, remember that some mental health resources are covered by your health insurance company or an employee assistance program (depending on where you work), so you may be able to cover the costs that way. Before buying health insurance, it’s worth checking whether you’ll get access to mental health support if you need it, because many insurance policies don’t offer this.     

Would you like more information about low cost therapy? 

I hope this article was able to help you find a solution that will work for you.

Therapy and counseling are such useful resources, and mental health professionals are doing all they can to make it affordable for more people. By offering low-cost support, we help to make the world a better place.

If you’d like more information about affordable mental health services, feel free to get in contact via the comments section below.

I’m always happy to help the people who use this site to find information on these topics.

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About The Author

Bijan Kholghi is a certified life coach with the Milton Erickson Institute Heidelberg (Germany). He helps clients and couples reach breakthroughs in their lives by changing subconscious patterns. His solution-oriented approach is based on Systemic- and Hypnotherapy.