How Therapists Can Help People That Can’t Afford Therapy (It’s NOT Sliding Scale)

Therapists often feel that they have an ethical responsibility to offer therapy services at a discount, known as “sliding scale” or in some cases through accepting insurances that barely pay a living wage.

But it is not your ethical responsibility to offer low-fee or insurance-based therapy services.

The systems for supporting people’s mental health are broken. Therapists are not the ones that ought to be making a sacrifice in their lives because the world is the way it is.

Yet if you are inspired to help people who cannot afford therapy, there are some effective ways to offer some help and ways that can reach more people than sliding scale ever could.

When you do an individual therapy session, did you notice that you are helping a single individual in that session? Like, as in, only one?

Did you also notice that the cost is still too high? Even if you drop your hourly rate to $60/session and the client attends weekly sessions for 3 months, that’s a total of $720. With many people living paycheck-to-paycheck, that’s a number that is still out of reach.

So, here’s what you’re really trying to solve if you want to make your help more accessible to those with low income or no income:

How Can I Help More People While Charging Them Less Money?

Let’s look at the physical fitness industry as an analogy because it kinda works.

If I’m looking to start working out, but I don’t have much money, I wouldn’t walk up to the most elite bodybuilding coach and ask if they can train me for $60 an hour because I can’t afford their $500 an hour rate.

I already know that a personal trainer, especially an elite expert, is going to be out of my budget. I wouldn’t even try. I wouldn’t even expect them to help me for $60 and hour.

It is well known that getting a personal trainer is a luxury item.

So, what might I do instead? Well…

If I have absolutely no money, I might go to the public library and get some books, for free, to help me read about how to put together a basic workout. Or I might also hop onto a computer there and watch some videos on YouTube or read some blogs

Or, if I do have a small budget, maybe I’d join the YMCA or the community gym. Or even the fancy gym if it was in financial reach. I would use group classes to learn how to do things.

Or I could even find things online too! Maybe I’d search and find something with a low monthly subscription that allows me to access to the information that can help me and do really fun at-home workouts.

Only if I had the money to hire a personal trainer would I be able to.

But for someone wanting to learn how to put together a workout routine, that information is readily available for me to help myself, for free and for a very low cost, through one-to-many offerings.

Here Are Ways To Make Therapy More Accessible To Low- and No-Income People

If you are a therapist who is truly feeling like you want to help in making mental health accessible to all people, regardless of their income, create content, courses, products, and one-to-many services.

Self-help is a billion dollar industry which, for some weird reason, isn’t overflowing with content created by therapists.

So why are you spending 1 hour a week earning $60 to help one person instead of writing a book that could impact the lives of millions? Or creating a course that could transform many lives beyond the ones that are even in your geography?

Or, instead of one-on-one services, how could you impact 20 within that same window of time? Or 100? Or 1000? Or 100,000?

Even group therapy can help more low-income people while still helping you earn a decent wage.

“But Healing Happens In Relationship With The Therapist”

You may be reading this article thinking that healthy relating is the key component to the success of therapy. You might be thinking that something like reading a book just wouldn’t cut it.

Here’s the thing: you’re right.

Content and courses don’t replace the relational aspect of therapy.

And, to make your objection stronger, cognitive-level-stuff can only go so far anyway. Evidence shows that CBT doesn’t heal the nervous system, and the nervous-system-level healing is where so many of us need healing. (Maybe it does exist but as far as I know, I don’t know that there’s a self-help-way to heal one’s own nervous system).

In an ideal world, therapists would be able to earn what they deserve AND low- or no-income people would be able to get the care they need, which may include one-to-one therapy.

But until our systems and society evolve to that point:

  1. You, as a therapist, are still not ethically obligated to offer your services for low-pay to make up for it
  2. Our current world desperately needs more mental health content, books, courses, and group services, we need things to help more people

The books “Courage to Heal” and “Father Daughter Incest”, along with YouTube content creator Laci Green (not a therapist), helped me so much in one of my most important periods of personal healing. I was suicidal. These resources helped me feel less alone, less ashamed, and more hopeful that I could heal. The world needs more mental health resources so those that are trying to heal have access to something that can help in some way.

You Could Also Dedicate Time To Creating New Types Of Therapy

In addition to content and courses, there’s also an opportunity to create new types of therapy that people can do by themselves or in their communities.

If content and courses lack the “relational” aspect that can heal, can something be developed to better help people heal themselves or each other? Like maybe a program where you can train thousands of people on simple active listening skills so they can help everyone around them heal?

Maybe there’s a self-healing modality that is yet to be discovered. Maybe it’s one you could develop to help more people even beyond what you could ever possibly be capable of in your office.

Find What Feels Good, Only Take Appropriate Responsibility

One of my favorite yoga teachers used to say, “Play around in this space, find what feels good.”

The amount of pressure, guilt, and responsibility therapists put on themselves, and the shame therapists put on each other, is tremendous.

Stop that.

You are not ethically obligated to offering your help for pennies. You are not intrinsically more responsible than a teacher, or a senator, a plumber, or a CEO for our broken society.

Therapists should take an appropriate and healthy amount of responsibility for making the world a better place.

Emphasis on appropriate and healthy.

You need to find what is a good fit for you. And even though the issue of mental health access is serious, allow yourself to follow your joy in helping. Last time I checked, it’s hard to find joy if you are constantly worried about money because you aren’t earning enough.

It’s not that you should never do sliding scale or accept insurance. If it feels good to you and you still earn enough to take good care of yourself, then do it.

But if your goal is to make therapy more accessible to more people, and developing one-to-many content, products, classes excites you, I am cheering you on.

Not as a replacement for therapy but as something that is better than what we have now: a broken mental health system, therapists who are hurting themselves, desperate to fix it through self-sacrifice, and an absence of options that can help the many that need it.

It’s possible to earn money and help a ton of people.

I believe in you so much.

About Kat Love

Hi, I'm Kat! I'm the founder and lead designer here at Empathysites. Therapists helped me heal from childhood sexual abuse so now I help therapists with creating their websites. I write on topics like website design, strategy, and turning website visitors into clients. Reach out anytime if you'd like to say hi. PS. my pronouns are they/them/their. Thanks.