At first glance, starting therapy can feel daunting. Add in the US’s complicated health insurance system and it can feel downright perplexing. More and more therapists aren’t taking insurance, which means you can pay around $100 to $200 up front for an hour-long session. If paying that much for therapy isn’t financially doable for you, you’re not out of options.

Enter the sliding scale. Some therapists offer their services on a fee structure that allows patients to pay at a discounted rate depending on what they can afford. While a therapist may simply ask you what you can afford to pay, some use formulas to determine what to charge sliding scale clients. Ultimately, most providers determine the rate based on income and financial obligations. 

Below, we break down who qualifies for a reduced therapy fee, how to find a provider who takes sliding scale payments and more. 

What exactly is a sliding scale and how does it work?

Therapists typically charge a flat rate for their sessions. If they take your insurance in-network, you’ll pay a fraction of that cost. This also applies if they’re out of network but your plan has some out-of-network benefits. In the most expensive scenario, if you don’t have insurance or the therapist doesn’t accept your insurance, then you’ll have to pay that full flat rate out of pocket. 

If you can’t afford to pay the entire amount, your therapist might give you a discount, whether it’s a percentage of the cost or a flat rate you agree on, in the form of a “sliding scale payment.” 

There aren’t regulations surrounding sliding scales. When a therapist isn’t working with an insurance provider, they can charge whatever they want. Any therapist, no matter their license or the type of therapy they provide, can decide to offer sliding scales to their patients if they want to. But because they’ll be making less money charging people less for sessions, they might only offer it to a certain number of clients.

How do therapists determine the cost of a sliding scale payment?

A provider might look at factors like your income and your dependents, or other financial obligations. Grace Dowd, a therapist in Austin, Texas, says you could pay as little as a co-pay would cost if you had insurance (so, about $20 or $30 for a therapy session) or a certain percentage off the full rate.

In her practice, Dowd has a baseline amount she tries not to dip below for potential sliding-scale clients. She typically asks what their budget is, then sets a rate accordingly. 

She’s adjusted rates on a sliding scale with existing clients too. For instance, if a patient loses their job and insurance coverage, she might negotiate a sliding-scale rate that helps them continue with therapy until they figure things out. 

Therapists with niche specialties, like an in-demand form of trauma therapy or a specialized type of cognitive behavioral therapy that treats insomnia (CBT-i), may not be as likely to offer sliding scale fees, Dowd says, simply because the cost of specializing can be high. 

Where a therapist practices matters too. Some therapists are part of group practices, and there may be limitations on how many sliding-scale clients they can accept. 

For instance, a hospital system might offer you a payment plan, says Abby Gagerman, a therapist in Deerfield, Illinois, whereas “an independent practitioner in solo practice or a group practice would be more likely to do the sliding scale.” 

Now that I know what this is all about, how do I find a sliding-scale therapist and set a rate?

Sometimes therapists advertise that they offer sliding-scale payment plans on their websites. Other times, you might have to do a little digging. If you’re not sure, it’s worth asking a provider you’re interested in if they accept sliding-scale clients. “Some therapists might be seeing as many sliding-scale clients as they can right now, but they might be able to recommend someone else or put you on a sliding scale waiting list,” says Dowd. 

You can also find discounted therapists at options like Open Path Collective, a network of mental health clinicians who work virtually with clients in need of cheaper access to therapy. While some group practices or clinics may require income verification before giving clients a discount, Gagerman says most therapists generally use the honor system. “Therapists can usually get a grasp of a client’s financial situation when they’re working with someone,” she says. 

Keep in mind, your therapy rate could change at any time. Any therapist is entitled to increase the sliding scale fee when they see fit. If your financial situation changes or you get insurance, let your therapist know about those changes and what you can afford — after all, the honor system goes both ways.