Sliding Scale: Definition, Benefits, and Finding Therapists

What Is a Sliding Scale?

Therapy is expensive, with cash rates in the United States averaging from $50 to $150 per session (and up to $250 or more per session in some parts of the country). Many uninsured Americans live below the poverty line and are unable to pay these rates out of pocket.

To meet this need in an affordable way, many therapists offer sliding scale fees. This means that a person's fee is based on their ability to pay rather than a standard rate.

If a person does not have insurance (or cannot afford their deductible), their therapist might offer reduced out-of-pocket fees to make therapy more affordable. Although therapists are not required to offer a sliding scale, the American Psychological Association's ethical guidelines encourage psychologists to reserve a number of spots in their practice for reduced rate or pro bono services.

Although most therapists want to offer affordable care to clients, they have bills as well, and so typically a therapist will have a limited number of sliding scale spots available. Some therapists even offer free therapy sessions to low-income clients; however, some will include a small fee (for example, $5 per session) to increase client investment in the therapeutic process without creating financial hardship.

Navigating the Costs of Therapy

Verywell Mind's Cost of Therapy Survey found that:

• Among individuals seeing a therapist, about half are worried about paying for treatment long-term.
• About one-third have canceled or reduced the frequency of sessions due to cost.
• Despite these financial challenges, only 36% of individuals say they have ever negotiated their therapist's fee.
• Meanwhile, 44% of Americans in therapy have never even heard of sliding scale payment options for therapy.

What Sliding Scale Can Help With

Living in poverty is incredibly stressful, and research has consistently shown that those in poverty have a higher risk of mental illness than those with financial security. At the same time, therapy is less accessible to people in poverty due to the high cost.

Furthermore, some people with severe mental illness symptoms might not be able to work, which not only limits income but significantly inhibits access to health insurance. Even those with insurance might have a high deductible they cannot afford to pay before their benefits start covering sessions.

Sliding scale therapy makes mental health services available to everyone, not just those who can afford to pay the full fee. When clients have the option to pay based on a sliding scale, accessibility to mental healthcare increases.

Things to Consider

• Therapists who offer sliding scale fees typically list these rates on their website. However, they might have extra flexibility depending on a person's unique circumstances. If the listed rate seems unaffordable, it never hurts to ask if there is any wiggle room in the rate.
• Therapists might also be willing to work with clients on payment plans.
• A person's mental health needs should also be considered. Certain conditions, such as severe dissociative symptoms or eating disorders, may require a therapist to have specialized training to provide competent care. In these cases, the therapist will provide referral information rather than continuing services.

How to Get Started: Finding a Therapist Who Offers Sliding Scale

• Many therapists provide a brief phone consultation at no cost to the client so that both parties can assess whether the relationship might be a good fit. During this consultation, the therapist will ask things like why the client is seeking services, what symptoms they are experiencing, and how they will pay for services.
• It is appropriate to ask the therapist about their rates, whether they offer sliding scale fees, and what their policies are about payment plans. If a person requires sliding scale options for therapy, it is important to discuss this prior to the first session.
• If a therapist determines that they need to make a referral because they do not specialize in a person's needs or they are not able to accommodate their financial situation, it is appropriate to ask about the referral's credentials and sliding scale options.
• Open Path Collective is an organization that connects people to low-cost therapy sessions starting at $30 per session.

Benefits of Sliding Scale Fees

Sliding scale fees are an important step in making mental health services affordable and accessible to everyone regardless of income and financial resources. If a person cannot afford the cost of therapy, services can still be available at a rate they can afford if they know where to look.