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 you may find it challenging to find low cost therapy.
Historically, health insurance provided by employers for their employees placed severe limits on the type and extent of mental health treatment they paid for. With the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, this disparity has technically been outlawed. But loopholes abound, and the new law doesn’t cover small businesses with less than 50 employees. Certain diagnoses can continue to be excluded, and providers may still need to get continuing authorization for treatment from insurance companies.
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.