What Is Sliding Scale Therapy: Do You Qualify?

By: Sarah Fader

Updated July 15, 2021

Medically Reviewed By: Wendy Boring-Bray, DBH, LPC

Deciding to see a therapist to address your emotional problems and/or mental health concerns using contemporary psychotherapy may be one of the most important decisions you will make in your lifetime. It is a hard-enough decision to make for many people without also having to worry about how they are going to pay for it. Yet, professional fees can be a burden if you do not have adequate income to pay them and keep your household running at the same time.

Many people do not seek treatment because they cannot afford treatment and this is a big problem in our society. Even those with health insurance are having this problem because many do not cover mental health care at all. One solution offered by many counselors is sliding scale fee therapy. If you qualify, this type of fee structure can make it possible for you to get the help you need without making you bankrupt.

A couple discusses their options with sliding scale therapy.

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What Is Sliding Scale Therapy?

A sliding scale is a type of fee structure therapists sometimes use to give people with fewer resources a lower fee. In fact, the sliding scale fee is commonly used in many types of industries including legal service or dental care. Affordable sliding-scale therapy is not a "sale" or a "discount" that can change over time. The amount you pay for affordable sliding-scale therapy is calculated by your income. The less income you bring in each month, the less you pay for your therapy sessions.

The therapist sets up one sliding scale that is used for all their patients. If you have enough money to pay the full cost of therapy, you will be billed at the therapist's standard fee. But if you're facing financial challenges that hinder your ability to pay, you'll be provided with therapy options at a reduced rate. For example, in an office where the full price is $175 per hour, if you make less than $70,000 per year, your fees may be $75 per hour, but if you make $120,000 per year, you may pay $100 per hour.

Does Everyone Get the Same Level of Care?

The sliding scale is just a way of determining how you pay for your selected therapy options. In most cases, the therapist's office personnel will apply the scale to your situation and take care of the paperwork to provide affordable counseling services for you and/or your family.

Whether you pay the full cost of your sessions or a reduced fee, the providers at your selected therapy center give you the same standard of high-quality care as clients who pay full price to attend the selected therapy center for counseling services. They make no difference in the way they treat you or the time they spend in each session. In fact, many therapists do not even know who pays what. Their billing is done by the accounting personnel rather than the therapist.

Do You Qualify?

If you feel you can't pay the full price, you can present your income information and number of dependents to a social worker or other clinical psychology therapy provider. It's worth taking advantage of sliding-fee scale therapy to get matched with a wonderful therapist that meets your needs.

Deciding how much you'll pay is a straightforward process for the therapist's office staff. If you meet the criteria, you'll pay lower fees based on your level of need. Regardless of your income, today's mental health clients are able take advantage of sliding scale to get services for common mental health challenges like eating disorders, substance abuse, social anxiety, and to participate in family therapy.

A social worker may also direct you to other options within your chosen therapy center by offering reduced-cost stress management alternatives. A social worker can help you find the best therapist and other mental health resources beyond sliding scale within your chosen therapy center like support groups. When you participate in support group sessions, you can discuss your challenges and relationship issues with the psychotherapy collective and like-minded clients to find solutions.

The amount you pay is usually adjusted by the United States Federal Poverty Guidelines and the usual and customary fee for mental health in the geographical area where you live.

What about Insurance?

Sliding scales are designed for people who are paying for the service themselves directly to a therapy center, social worker, or other mental health professional rather than those who are paying through an insurance company. You don't typically get a reduced fee for your copays or deductibles. Unfortunately, many insurance companies do not cover most mental health care anyway or they only cover a small percentage. In many cases, it's cheaper for you to pay out of pocket with a sliding scale fee than using your health insurance.

Making Sure You Know the Rules

Not every sliding scale within the psychotherapy collective has the same rules. Some may require you to verify income with a pay stub. Others may take your word for your income. Some require that you notify the office within a certain amount of time if your financial situation changes. The rules should be listed on an agreement that you sign with the therapist or their staff. You should always be very careful to read the agreement before signing anything, and if you have any questions, be sure to ask them to clarify. If you don't qualify for the low fees you would prefer to pay, there are other mental health resources, such as community mental health clinics and online therapy.

Why is Online Therapy Cheaper?

While seeing a therapist face-to-face may be the more traditional way to have therapy, it is also more expensive. This is because the therapist has to pay for the building they are in, utilities for that building, salaries for employees, business and office supplies, and some even have to pay for health insurance for employees. They also have to spend money on transportation to get back and forth to work.

Online therapy is so much cheaper because the therapist can work from anywhere, so they don't have to pay rent, utilities, and travel expenses. The therapist doesn't have to pay employees in most cases, and there is the added benefit of time saved because you and your therapist can "see" each other whenever you're free.

This new flexible form of online therapy breaks the barriers of typical Monday through Friday appointment times and allows for clients and therapists to connect on their own time. Getting started with online therapy is as easily as completing a quick registration process with your email address, providing information, and selecting a therapist that meets your needs.

Does Online Therapy Work?

The therapy you get online is the same as you would get in a more traditional setting. In fact, this type of therapy may be even more effective because it's so convenient. And those suffering from depression or anxiety disorders may find online therapy even more beneficial because they have a hard time going out in public.

With depression, you may not even feel like getting out of bed, so how are you supposed to get dressed and go to an appointment with a therapist? This is another reason why many people with mental health disorders do not get help. The added stress of looking for a therapist, scheduling an appointment, and actually making it to that appointment is enough to make many individuals change their mind about going. With online therapy, all you have to do is get on your smartphone or other electronic device and you can do that from anywhere.

Other Choices

There are other options as well. Some of these include group therapy, schools, teaching hospitals, employee programs, and chat rooms.

  • Group therapy: One option is group therapy, which can be found in many areas at local churches or community centers. Most of the time, the sessions are free or very low cost and you would meet with a group of people and a therapist or clergy who mediates the session. The therapist does not usually give you individual care but will help keep the conversation focused.
  • Schools or teaching hospitals: You may also be able to get counseling from a local school or teaching hospital. If you're a student, you should be able to get counseling from your school at no charge. Teaching hospitals and clinics usually offer free or low-cost therapy in a teaching situation where you'd be seeing both the therapist and an intern who is receiving training.
  • Employer assistance programs: Some employers offer employee assistance programs that may have free or low cost mental health care. This is usually separate from your health insurance and is a resource to help employees deal with life issues like divorce, grief, and other major problems.
  • Online Chat Rooms: There are also online chat rooms where you can talk to others who have similar issues. You'll be able to anonymously chat online with others who want to share their experiences and offer help to those that need it. Some people don't like the idea of talking to random strangers about their problems, but others like this better than talking to a therapist. There's something freeing about chatting with people who have no idea who you are and can't see you. You can try 7 cups of tea to connect with caring listeners, free of charge.

Of course, there are downfalls to online chat rooms as well. Without a therapist or other professional to mediate, things can be unorthodox, so you have to be prepared. But all you have to do is click one button to get out of that room. And there are a lot of options. Some chat rooms are specifically for certain subjects like depression or anxiety, while others are more general.

It's important to note that online therapy is intended for non-emergency situations only. Visit your nearest emergency room if your issue is an emergency or you're facing a life-threatening situation. If you're unable to make it to the nearest emergency room, make an emergency call to an agency like the National Suicide Prevention Lifeline that can provide immediate support options 24-hours a day.


Seeking therapy can help you. Don't let finances get in the way. Whether you find a therapist who will work with you on a sliding scale, or you choose online therapy at BetterHelp, get the support you need. Take the first step.

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