Low-cost psychotherapy is nearly an oxymoron.
Experienced and highly trained mental health professionals, such as psychologists, psychiatrists or marriage and family therapists in practice for decades, can garner fees well over $100/hour for their services. Many ask for and get over $150/hour, and some in large urban centers like New York City, can command even higher prices.
While managed care in the 1990s and continued cost cutting by health insurance companies have placed downward pressure on most clinicians’ salaries, these fees still seem high and out of reach for most middle-class Americans. While private health insurance will pick up the majority of this cost if you’re covered (generally requiring a co-pay of between $10-30 per session), if you’re not covered or used up your allotment of visits for the year, you may be looking elsewhere for psychotherapy.
Most health insurance provided by employers for their employees places severe limits on the type and extent of mental health treatment they will pay for. Most often, these limits are expressed in terms of number of outpatient sessions allowed in one calendar year (sometimes 12 or less), or the specific types of medications covered. Once these limits are hit, the person in need of continued psychotherapy treatment either can appeal the limit, or seek out psychotherapy care elsewhere.
Discounted Fee Schedules — Sliding Scales
The first place to check is with your current therapist. Many, but not all, therapists offer a fee service schedule for cash-only clients that may “slide” – that is, the fee goes down based upon your income. If you’re making a middle-class salary, the discount offered by such sliding scales may not be much. But if you’re in the lower socio-economic class, this discounted fee schedule can cut a regular therapist’s fee in half or more.
Such discounted fee schedules are entirely up to individual therapists to set and for their own economic well-being, many therapists can’t offer them. Don’t blame the therapist – they are in a competitive business but often have few traditional business skills (which typically aren’t taught in graduate school to the budding therapist). Many therapists in sole or small private practices are firmly in the middle-class themselves, and rely on whatever their fees are to make ends meet. Therapists a part of a hospital or large group practice typically have more stable salaries and may be more flexible with their fees.
Community Mental Health Centers
Less expensive than private practitioners are public resources setup during the 1960s to try and help move the mentally ill confined to hospitals back in to the community. These community clinics, typically referred to as community mental health centers in the U.S., are available in hundreds of communities across the country. They are often funded and run by the local government, such as a county or town or city.
Community mental health centers rarely offer “free” psychotherapy, however. Like the sliding scale model in private practice, these clinics charge fees to people seeking therapy, but the fees tend to be much less than what is found in the private sector. Psychotherapy is subsidized in these centers by government funding (usually through local taxes and federal reimbursements, such as Medicaid), but they still try and recover some costs directly through the people using the services. An individual could pay as little as $10/session if they had virtually no income, or it could be free if they are covered by Medicaid.
Community Mental Health Centers Continued…
Community mental health centers are often training grounds for budding therapists. Therapists learn most of what they eventually practice by doing and being supervised by trained psychotherapists. So while the quality of the psychotherapy may leave a little something to be desired than that of an experienced therapist, it is often better than no care at all. Therapists in training are often more energetic, devoted, compassionate and focused than some experienced therapists, qualities of great importance in developing a positive therapeutic relationship (something invaluable for a client’s improvement in therapy).
Community mental health centers generally don’t see people experiencing life problems such as career changes or marital problems (unless they result in the person getting a serious mental disorder). Because their resources are limited, these public clinics tend to focus on more serious mental disorders, such as depression, bipolar disorder and schizophrenia.
These mental health centers often have long waiting lists to get an appointment, so be prepared for a wait (sometimes approaching months) to obtain treatment. Complain to your local politician to try and get more resources allocated to the center, as usually such centers are always in need of more funding.
Other Options
Other options to look into include a local support group, group psychotherapy, an open clinical research trial at a research institute or university, or a local university. Group psychotherapy, for instance, can often be had at costs far less than individual psychotherapy because many more people are contributing to reimburse the therapist’s time. Clinical research trials help us learn more about treatments that work and don’t work, and sometimes include a psychotherapy component which is paid for.
Working with What You Have
Life often doesn’t present us with the luxury of choosing what we most need when we most need it. Although many people feel like they can’t afford psychotherapy when they are at a low point in their life and have few financial resources, sometimes psychotherapy may be what’s most needed.
Don’t give up if finding low-cost psychotherapy in your community is your goal. It can sometimes be frustrating to call around from therapist to therapist, from group practice to community mental health center, to find a therapist that can meet your price and is available for an appointment. Helping prepare yourself for the process can help you set your expectations accordingly.
Last reviewed: By John M. Grohol, Psy.D. on 15 Aug 2007
