What If You Can't Afford Therapy?

From Bartering to AI - There are Options!

Today’s question comes from the /r/therapy subreddit. Fun fact, I am banned from that subreddit, and I don’t remember why. I got in some argument with an admin, and they flexed their internet powers on me. Oh well. I thought this question was great, though. It’s one that is worth coming back to every so often, so let’s break down some of the options when you aren’t able to afford therapy.

Make Sure You Check Insurance

The first step is to make sure that you can’t actually afford therapy. Out of pocket therapy in the United States (and most places) can be prohibitively expensive. You may see rates ranging from $150 to $300 for a single session. For many, this is an unreasonable amount of money to spend, especially if you are getting weekly therapy.

However, most insurance plans have some mental health coverage, so it is important to have a look if you are insured to make sure that you aren’t missing out on resources. When you have medical insurance, you may be able to find a provider that is “in network,” which would typically make it so that you only have to pay a copay rather than the full fee amount. In other cases, if a provider is not within your network, you can pay out of pocket and then submit paperwork to your insurance who will then reimburse you (up to a certain amount) for your sessions. Most of my current therapy clients do it this way.

There are multiple ways to check your insurance coverage including logging into your insurance provider’s website to look at the coverage under your current plan or to use their search feature to find a provider that is in network. You can also give them a call or use a chat function on the website or app to get more direct information. If it turns out that you have insurance coverage and you need to find a provider that you can see, you can use a tool like Psychology Today’s Find a Therapist Tool and plug in your insurance provider as a search filter.

University Counseling Centers

If you do not have coverage or your insurance coverage is inadequate for your needs, you can also have a look at universities in the area. If your university has a clinical psychology or counseling psychology graduate program, they may have a clinic where you can see a graduate student that is currently training to become a therapist. For these centers, services are often provided free or at quite a low cost to community members.

Similarly, if you are a student at a university, you may have access to free therapy through your school. The website for your school should have all of that info. If you still can’t find anything there, you could ask someone at your school’s medical clinical/health center if they are aware of any services available to students.

When obtaining services at a university clinic, you will want to clarify the level of provider that you are working with. Generally, they will fall into one of these categories:

• Graduate Students - these are unlicensed students that are learning how to do therapy and are directly supervised by more advanced students and licensed therapists on staff. There is absolutely nothing wrong with seeing a grad student, but they are typically not fully able to work with more severe mental health issues at this stage in their training.

• Interns - students that have completed their graduate training, and they are undergoing their required internship to gather clinical hours to apply for licensure. They may be obtaining a PhD, PsyD, or a master’s level degree like LCSW or MFT. They are directly supervised by a licensed professional.

• Post-doctoral Interns - for those who get a doctoral degree and want to become psychologists, they also have to complete a full year internship after they graduate before they can apply for licensure. Again, they will be directly supervised by a licensed professional.

• Licensed Therapists and Psychologists - Many university clinics have licensed professionals that also provide services there in addition to training interns.

The services available through university clinics and counseling centers will vary significantly between schools, but it is definitely with checking out their website, sending a message, or giving them a call to see what options you have.

Sliding Scale

The term sliding scale can mean various things in the field of psychology. Essentially it means that some providers offer lower cost services to those who need them. Sliding Scales are not directly governed by our licensing board or the state in most cases. They are simply something that individual providers can offer. Therefore, the amounts and process will vary.

For some clinics and providers, they have a standard sliding scale with different rates for therapy based on different levels of income. For this, they may ask for some form of proof of income to make sure that you actually demonstrate need. In other cases, they may just take your word for it. Many providers offer a handful of sliding scale slots in their caseload that are financially offset by other people that can afford to pay full price.

In other cases, sliding scales are directly negotiated with the provider. For example, I had someone that I worked with a few years back that asked if they could do a series of 10 sessions at $50, which is what they could afford at the time. We negotiated the terms and boundaries of this, and then we went ahead with treatment. So, even if a provider that you’d like to see does not advertise a sliding scale, it may be worth it to reach out and ask.

Bartering

Photo by Carl Tronders on Unsplash

This is much less common, but for psychologists, our code of ethics does allow us to accept barters for services as long as it is not exploiting the client and the services or goods are reasonably comparable in value. So, let’s say that you can’t afford therapy, but your family runs a farm. You could potentially exchange a weekly box of produce for therapy sessions. Similarly, if you have a skillset like graphic design, accounting, or HVAC maintenance, you may be able to negotiate a trade of services for therapy.

Community Mental Health

Depending on where you live, there may be services through your county or region that are accessible for individuals with low or no income. I would suggest starting with a Google search for your city or county. For example, “Dallas community mental health.” From there, having a look through the relevant website, you will find different programs and offerings from individual therapy to housing assistance. Often, they will offer a call or visit with a coordinator who can help you identify the services that would be relevant to you and that you might qualify for.

Support Groups

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Although you should absolutely pursue individual therapy if that is what you need, support groups can also be a helpful part of the equation, especially if you need a bridge to hold you over between therapy sessions or while you try to find a provider. Support groups can be found in various places including health clinics, universities, and even some private practices. Additionally, some organizations have free online support groups. For example, the Anxiety and Depression Association of America has a whole database of support groups that you can look through. Some support groups are drop-in, and others require a commitment of some kind. Given that most are online these days, it allows you to look more broadly and shop around.

Artificial Intelligence

This is perhaps a bit of a controversial one, but these days AI can make a pretty damn good therapist. And that’s coming from a pretty damn good therapist. Many people will vilify AI, and there are some legitimate reasons to do so. But when it comes to helping people with mental health problems, as long as the person engaging with the services has adequate reasoning abilities, there is a lot of work that can get done without ever seeing a person face-to-face. To be clear, AI is not currently a replacement for therapy, and it does not constitute medical or professional help, but it can be a much more potent form of self-help that might be just what you need when you are lacking other resources.

One option within the AI realm would be to find a pre-packaged solution that is made specifically for helping with mental health issues. One that I know of is the Feeling Great app by Dr. David Burns. Dr. Burns is a legend in the mental health space, credited with helping bring cognitive behavioral therapy to the masses. In his app, he has worked with his development team to train the AI to reflect his own personal approach and techniques. When I interviewed him on my podcast, he told me that the AI was more effective at establishing accurate empathy than human therapists. I’m not necessarily surprised by this. There is something special about being heard by another human, but humans also have a lot of bias and preconceptions. AI doesn’t necessarily have those issues, and it also has infinite patience and essentially infinite time.

Another approach would be to use one of the common large language models, like ChatGPT. However, I would highly encourage anyone doing this to invest in the premium version, so that you can train a GPT to specifically help with mental health issues. I’ve been interested in trying to train a GPT to become a good therapist myself, so let me know if you’d want me to do that and share the results with you. I think the first step would probably be gathering resources related to research-supported therapeutic techniques for the issues that you are experiencing, as well as documentation on general helping skills, and loading those up into the knowledge base of the GPT. Then you can give it a personality and some guidelines on how to work with you.

Again, this is not exactly going to replace the need for psychotherapy (yet), but I think it could go a long way toward expanding access to advice and mental health information.

You Are Not Out of Luck

Being unable to afford therapy is a frustrating and sometimes scary experience. Personally, I hate the way the mental healthcare system works, and I think that both providers and patients pay the price. But if you are in a position like the person that asked this question, you are not hopeless. There are various ways that you can get help for free or for low-cost. Hopefully one or two of the options presented here were new to you!