Understanding Your Payment Options

Why is therapy so expensive? 

Why can’t I find a therapist that takes my insurance? 

Why don’t I get a full hour of therapy? 

Why are there no-show fees?

I’ve been working in mental health for almost ten years, in private practice for six of those. How to charge for a service that is so personal is a challenge, especially as my eyes were open to my own privilege and I began to challenge the systems of capitalism and white supremacy that had been baked into my worldview. 

You can find all kinds of perspectives surrounding how much counselors “should” charge or if they “should” be taking insurance. I have felt the pull of needing to pay my bills and not wanting to be burned out to do this; and the push of feeling like it’s my responsibility to make therapy accessible. I’ve increased my prices, offered discounts to clients, taken insurance, had a 24 and 48 hour cancellation policy, and stopped taking insurance. 

I adjust my payment policies and philosophies every few years. As I continue to learn from other leaders and discover more of my own values, I’m sure I’ll continue to change them as long as I’m in business. The purpose of this blog is to help guide you in using my  current policy: The Sliding Scale. You are welcome to use this to help inform your own practice or as a guide to help you decide what level may fit you best if healing with me. 

What is a Sliding Scale?

“The sliding scale is a tool that allows for a product or service to be obtained at multiple price points based on circumstances of the purchaser” – Alexis J. Cunningfolk –https://www.wortsandcunning.com/blog/sliding-scale

A sliding scale model of payment allows those with more financial privilege to contribute more and those with less to pay according to their means. The hope of this model is to sustain the business and service while making it as accessible as possible. 

A sliding scale model is usually offered in the form of different tiers or levels of payment options.

Why I use a Sliding Scale Model

I believe that all people should have access to resources that help them heal from the individual, collective, and systemic traumas we face daily. 

In our current industrial mental health system those who have more financial privilege and health insurance have more access to quality treatment and newer treatments. People with less financial privilege usually need to use community mental health centers which usually have very long waits and counselors having sometimes over 100 clients. 

Through a Sliding Scale model, I am able to help people from diverse backgrounds, promote equity, and sustain myself. I dream of us taking care of each other as a community and this model is just one piece of bringing that dream to life. 

Your Guide for Using BSHN’s Sliding Scale Model

When you do your free consultation with me we would discuss what level of payment you feel like works for you. I have three different costs for each of the services I provide:

Pay-it-Forward

The highest dollar cost is for those that have significant financial privilege. If you pay at this amount you are helping support those in the community support level. 

True Cost

The middle cost is the amount that I would charge in the absence of a sliding scale. This is for those that are able to meet their basic needs but do not have extra income. 

Community Support

The lowest cost is for those that would be prevented from getting the help they need without some support. 

Choosing Your Level

I’ve created a guide with examples to help you start the process of choosing your level. 

Important Things to Consider

Truthfulness: The sliding scale model relies on truthfulness. I trust that you know your circumstances better than anyone and you do not need to prove anything – I do not ask for income verification. 

Complexity: This model respects complexity. I realize that you may fit statements in each of the categories. Remember this is just here to help guide you and these examples are not rigid requirements. 

Sacrifice vs. Hardship: Our healing journey often requires sacrifice. If paying for a service would be difficult, but not have a long-term negative impact, it may be a sacrifice. You might have to consider your budget or go out to eat less. If paying for a service will have a harmful impact, like not being able to pay your rent or buy groceries, this would be considered a hardship. People that tend to use the Community Support level find the higher levels to be hardships. 

We Will Decide Together

Money is stressful! My Sliding Scale Model was created to be collaborative. If you do not know where you should land, that’s okay! We’ll work it out together. 

Thank-you for taking the time to reflect on your financial situation and the sliding scale model. This is just one way that I strive to be committed to equity and my community. I’m happy to answer any questions you have! Just reach out! 

Other Resources

The foundation of my model comes from Alexis J. Cunningfolk’s “Green Bottle Method” – https://www.wortsandcunning.com/blog/sliding-scale 

Embracing an Equitable Sliding Scale

https://www.embracingequity.org/post/embracing-an-equitable-sliding-scale

The Radical History Club: Sliding Scale

https://www.radicalhistoryclub.com/sliding-scale