The 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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