Low-Fee Therapy: Does Price Indicate Quality?

Stressed woman talking to doctor with notesThe enterprise of therapy is a strange one. The idea is to help those in need, but those most in need likely cannot afford it. The horrific mass shooting in Connecticut at the end of last year highlighted this unmet need in a dramatic way. The issue wasn’t about guns, as I see it, but mental health. The dramatic economic downturn in 2008 continues to rattle the world, and again unveils the inaccessibility of desperately needed therapeutic resources. Innumerable lives have been shattered, overwhelmed with distress, riddled with panic, and deflated by depression.

True, therapists need to make a living. And good therapists deserve to be paid well. That considered, can good practitioners reach those who cannot afford to pay handsome fees?

The field has not been utterly unresponsive to these crises. There are low-fee psychotherapy clinics, even zero-fee psychotherapy clinics. I worked at an economic crisis program in Los Angeles where the government awarded grants that would pay for clients who could afford only very low fees. But the money ran out pretty quickly.

In the final analysis, there simply isn’t enough for those in need. An additional concern is whether the help available is of the best quality. Many competent private practitioners have responded to the need by offering to reduce their fees. More generally, some practitioners will lower their fees because they want to work with a more varied population. Given the harsh economic times, some therapists have had no choice but to reduce their fees because they’ve found their clients are no longer able to afford them.

Many clients have concerns about beginning reduced-fee therapy. One client insisted on paying me a fee that was much higher than what I was asking for. I didn’t accept and, instead (of course), we talked about it. He revealed that he considered himself to be overly burdensome and wanted to compensate me for it. He also said he wanted to make sure I was trying my best. Clients may believe their therapists are more motivated when they are paid more. But this belief doesn’t hold up if the therapist is intrinsically motivated by the work itself.

In addition to the concern about motivation, some clients wonder, “By paying less, will I get a therapist who is not as good?” Or, “Am I forced to settle for second rate because I don’t have the money?” The assumption, of course, is that the best therapists are those who charge the most money. In fact, making money is a talent in its own right. Not every therapist is skilled in that regard or motivated to that end.

To be fair, a therapist can be gifted entrepreneur and also a top-quality therapist. There’s nothing to stop a person from achieving both ends. But a therapist’s therapeutic abilities depend on a host of factors other than his or her inclination for running a profitable business.

Take, for example, therapists who become certified psychoanalysts; they likely will never make back the financial investment they make—and the time they put in over the course of seven or so years. At minimum, the investment includes in-depth supervision, intensive education in a large body of psychoanalytic literature, and undergoing an intensive personal analysis. For the most part, becoming a psychoanalyst doesn’t increase the therapist’s marketability. More to the point, such an education may well make one a better therapist. That said, psychoanalysts don’t necessarily charge “low” fees, and one doesn’t need to become a psychoanalyst to privilege his or her professional development over money-making.

In the end, if you’re looking for a therapist and it seems like you can’t find one who is good and affordable, don’t be discouraged. It is very possible.

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  • Joey

    April 29th, 2013 at 12:29 PM

    It is a fad that what’s costliest is the best. It is often not true and especially so when human services are concerned. What one does with his patient is dependent on the responsiveness, the therapy itself and the bind between therapist and client. Money is important but paying more cannot always bring in something better.

  • danielle

    April 29th, 2013 at 4:31 PM

    I have to admit that before I went to work in the medical field I was one of those people who automatically thought that the best physicians were the ones who charge top dollar, but I have learned that this is not always the case.

    Sometimes the best providers are those who care little about the money, they just want to heal and help others feel better. And they don’t care sometimes even if they have to provide the care for free.

  • Darren b

    April 29th, 2013 at 11:19 PM

    I’m a physician and yes I have lowered and even waived off my fee for some people who I’m sure will have a tough time paying it. Not a big deal its just a gesture to say I care about the people I’m treating and about my profession.

    As for therapy, there are programs and there will always be professionals who will volunteer. But for a client to pay extra in the hope that he will get better services sounds ridiculous to me. Its not like we professionals out in less effort if we’re paid less or that we gain supernatural ability when you pay more!

  • Cela

    April 30th, 2013 at 3:51 AM

    Look at all of the online sites currently offering therapy either for free or for reduced rates. A whole lot of people are taking advantage of this and are benefitting from this quite a bit. Does it matter that they may be paying a fraction of what someone would pay for an office visit? I don’t think so, because my thought is that this is far better than what they may have been receiving before,so who cares about the cost? I find that may times people get stars in their eyes and they think that something is always better if it costs more. I think that in this case this is far from the reality.

  • Pacifica

    May 1st, 2013 at 12:04 AM

    I would have doubt with anything low fee too.Blame it on our culture or even on me I don’t mind but low cost does sound and seem low quality.And when someone doesn’t mind paying the right fee how does it even matter??

  • ian

    May 2nd, 2013 at 5:30 AM

    I think the amout a client pays is not a representation of the quality they receive.
    Many therapists have low over heads and are able to charge a low fee.

  • Sally

    May 7th, 2013 at 2:31 AM

    I find that it’s important to work with the clients who are highly motivated and are willing to do the tough work of looking at themselves and making steps in the right direction.Yes therapist need to make a living and earn money but if a client seeks out my services and is struggling to pay the higher price, I do not turn them away! By providing a reasonable sliding scale to clients I know that they will still receive the best quality counseling I can give them. I feel that by helping others out and reducing my fees at times will come back ten fold in the end. I am passionate about helping my clients. Bottom line is that we all need help sometimes and these are hard times. It’s important to me that they feel I will work with them on pricing and be fair. Seeking mental health therapy is the first step in the right direction for clients and I don’t want to close the door on those in need.

  • Lauren Zepernick

    December 17th, 2013 at 12:23 PM

    Hi Sally, my name is Lauren I’m 24 years old, a server currently. I was touched by what you wrote. I have been looking for a therapist for some time, but like you said times are tough and I haven’t been able to find someone. Where are you located? And is there a website with like minded therapists I could visit to possibly find one to fit my situation?

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