“No one becomes a therapist in the hopes of making it rich.”
Nearly 20 years ago I fell into a deep depression. It had been building for a long time, but when I had what I still refer to as “the breakdown,” it seemed to happen all at once.
I’d been given a week off from my job over the holidays. But instead of using that time to be with loved ones or embark upon holiday adventures, I shut myself into my apartment and refused to leave.
Over the course of that week, I deteriorated quickly. I didn’t sleep, choosing instead to stay awake for days on end watching whatever happened to be on cable.
I didn’t leave my couch. I didn’t shower. I closed the blinds and never turned the lights on, living by the glow of that television screen instead. And the only food I ate, for 7 days straight, was Wheat Thins dipped in cream cheese, always kept within arm’s reach on my floor.
By the time my “staycation” was up, I couldn’t return to work. I couldn’t leave my house. The very idea of doing either set my heart racing and my head spinning.
It was my dad who showed up on my doorstep and realized how unwell I was. He got me appointments with my family doctor and a therapist right away.
Back then things were different. One call to my job and I was placed on a paid mental health leave of absence, provided with an entire month to get myself back to a healthy place.
I had good insurance that covered my therapy appointments, so I was able to afford daily visits while we waited for the meds I’d been prescribed to kick in. At no point did I have to worry about how I would pay for any of it. I just had to focus on getting well.
If I were to have a similar breakdown today, none of that would be true.
Like everyone in this country, I’ve experienced the diminished access to affordable healthcare, and especially affordable mental healthcare, over the last 2 decades.
Today, my insurance provides for a limited number of therapy visits. But it also comes with a $12,000 a year annual deductible, which means that attending therapy almost always results in my having to pay completely out of pocket anyway.
Something I still do at least a few times a year, if only to check in and recalibrate my thoughts.
The truth is, I’m a person who would probably always be better off with regular therapy appointments. But in my current circumstances, as a single mom running my own business, I don’t always have the resources to make that happen.
And unfortunately, it’s often when I need therapy most that I can afford it least.
A struggle I know I’m not alone in facing.
We live in a society that likes to point a finger at mental illness as a scapegoat for everything from homelessness to mass shootings, but in placing that blame we somehow still fail to prioritize getting people the help they need.
It’s a flawed system that doesn’t set up anyone for success. But it’s not just those in need of mental healthcare who suffer at the hands of that system.
It’s also the therapists themselves.
“No one becomes a therapist in the hopes of making it rich,” adolescent therapist John Mopper tells Healthline.
“Being able to do what I do for a living is the most amazing thing on the planet,” he says. “The fact that on any given day, I can sit across from six to eight teenagers and have 6 to 8 hour conversations, hopefully impacting someone’s day in a positive way, and get paid for it? It’s honestly what gets me up every morning.”
But it’s that getting paid for it part that can sometimes put a damper on the work most therapists are trying to do.
Mopper is co-owner of Blueprint Mental Health in Somerville, New Jersey. The team consists of him and his wife, Michele Levin, as well as five therapists who work for them.
“We are completely out of network with insurance,” he explains. “The therapists who don’t take insurance tend to get a bad rap from some folks, but the truth is that if insurance companies would pay a fair rate, we would be more open to going in-network.”
So what, exactly, does a “fair rate” look like?
Carolyn Ball is a licensed professional counselor and owner of Elevate Counseling + Wellness in Hinsdale, Illinois. She tells Healthline that there are a lot of factors that go into setting a rate for therapy.
“As a private practice owner, I look at my education and experience as well as the market, the cost of rent in my area, the cost of furnishing an office, the cost of advertising, continuing education, professional fees, insurance, and finally, the cost of living,” she says.
While therapy sessions usually run patients anywhere from $100 to $300 an hour, all of the above mentioned costs come out of that fee. And therapists have their own families to take care of, their own bills to pay.
Ball’s practice is another that doesn’t take insurance, specifically because of the low rate of pay insurance companies provide.
“One thing I think people don’t realize is how different the therapy hour works from other medical professions,” Ball explains. “A doctor or a dentist can see as many as eight patients an hour. A therapist only sees one.”
This means that while a medical doctor may be able to see, and bill for, as many as 48 patients a day, therapists are generally limited to about 6 billable hours.
“That’s a huge difference in income!” Ball says. “I honestly believe that the work therapists do is just as important as the work other medical professionals do, yet the pay is significantly less.”
On top of all that, billing through insurance often comes with added costs, according to clinical psychologist Dr. Carla Manly.
“Given the nature of insurance billing, many therapists have to contract with a billing service. This can be both frustrating and costly,” she says, explaining that the end result is the therapist often receiving less than half of what was originally billed for.
Therapists know their session rates can be a deterrent to seeking treatment.
“Sadly, I think this is all too common,” Manly says. “Many people that I work with have friends and family who need therapy but don’t go for two key reasons: cost and stigma.”
She says she’s helped people from across the country get low cost referrals for therapy when needed. “I just did this for someone in Florida,” she explains. “And the ‘low cost’ services were between $60 and $75 per session, which is a great deal of money for most people!”
No one is disputing that counselors need to make a living, and each of the practicing professionals Healthline spoke to has set their rates with that need in mind.
But they’re all still individuals who entered a helping profession because they want to help people. So, when they’re faced with clients, or potential clients, who truly need help but can’t afford it, they find themselves looking for ways to help.
“This is a hard one for me,” Ball explains. “Going to therapy can positively change the course of someone’s life. Your emotional well-being is paramount to enjoying quality relationships, cultivating meaning, and building a sustainable self-esteem.”
She wants everyone to have that access, but she’s also running a business. “I struggle to balance my desire to provide help to everyone with the need to earn a living,” she says.
Ball reserves a number of sliding scale spots on her schedule each week for clients who need the help but can’t afford the full fee. Mopper’s practice does something similar, setting aside appointments each week that are strictly pro bono for established clients who have expressed that need.
“Offering some services at no charge to clients who don’t have the means is actually tied into our ethical guidelines,” Mopper explains.
Manly fulfills her desire to help those most in need in other ways, volunteering weekly at a local drug and alcohol rehab center, hosting a weekly low cost support group, and volunteering with veterans.
All three mentioned helping people find affordable services when it’s just not possible for them to be seen in their office. Some of their suggestions include:
- community clinics
- college campuses (which sometimes have counseling grad students with reduced rates)
- peer counseling services
- services like Open Path Collective, a nonprofit helping people find local reduced cost therapy services
- online therapy, offering services through video or chat at a reduced rate
There are options available for those without the financial means, but Manly acknowledges, “Finding the resources, which is often ‘easy’ for a therapist or other professional, can be daunting or scary for someone suffering from depression or anxiety. That’s why it’s so important to be able to lend a helping hand to offer referrals.”
So, if you need help, don’t let money be the thing that keeps you from getting it.
Reach out to a local therapist in your area, and find out what they can provide. Even if you can’t afford to see them, they may be able to help you find someone you can see.
Leah Campbell is a writer and editor living in Anchorage, Alaska. She’s a single mother by choice after a serendipitous series of events led to the adoption of her daughter. Leah is also the author of the book “Single Infertile Female” and has written extensively on the topics of infertility, adoption, and parenting. You can connect with Leah via Facebook, her website, and Twitter.