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.
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 Low-Cost Treatment 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.
If you’re a student at a university or college, you can often access the school’s “counseling services” at no additional charge (although you may have to pay for medications). While not all counseling centers at universities are setup to deal with serious mental illness, all of them can see you for an initial appointment at no charge, and find you a referral within the local community if needed.
Teaching hospitals may also be a source of low cost treatment, although this will vary from hospital to hospital. Some hospitals have minimal psychiatric care abilities and facilities. It’s often worth checking even non-teaching hospitals too, as sometimes they may be aware of a local treatment program that may be consistent for low cost care.
If you’re currently employed full-time, employee assistance programs (EAPs) are primarily setup to help an employee in a company deal with general life issues, such as financial planning or family strife. However, an EAP is often a wonderful resource to check because they keep an updated listing of services and programs within your local community. What you discuss with an EAP counselor is strictly confidential and is not relayed back to your employer.
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, if you’re looking for help with paying for your medications, check out this listing of pharmacy discount programs as well as Psych Central’s own free discount card that can save you up to 80% off the price of medications.