How to Find — and Pay For — a Therapist

Photo by Logan Cameron (cropped) on Unsplash.

As a therapist I make a point of acknowledging in every first session the effort the client put into getting into therapy in the first place. I know getting into therapy takes effort because it’s part of my daily conversations with people in my personal and professional life. Recently a family member sent me a text that said, “If I had a friend who was having panic attacks what should that friend do?  Are there apps that will help?” I got this text the day after I replied to an email from a client I saw as a student at my university’s counseling center: “How can I find a therapist I can afford on my intern salary? My parent’s insurance is out of network where I’m living now.” Almost every week patients at the hospital where I’m training tell me they waited over six months on a waitlist to see me because they couldn’t find anyone else who would take their insurance — and this is all before they even begin the work of the actual treatment.  

I know the research on the benefits of therapy, yet when I’ve had to find a therapist I’ve found myself wondering if retail therapy, cat petting, or Netflix marathons wouldn’t work instead. It can be so hard to find someone you can afford, at times that work for you, who makes things better instead of worse. The good news is that it’s possible; the bad news is that it can be complex. To demystify the process a little, I’ve tried to answer common questions from my perspective as a therapist, broke graduate student, and person who cares about access to mental health care.

Question 1: How can you afford a therapist?

• Do you have insurance?
  • Yes, and I know how to use it
    • I’m always impressed/jealous of people who have a good grasp on their insurance. If that’s you, then your next step is probably to pick a provider off the list your insurance company or primary care doctor gave you. Check out Question 2 for tips.
  • Yes, but I don’t know how to use it
    • The first step is to understand the terms of your insurance. Call your insurance provider (this number is often located on the back of your insurance card) and ask if you have session limits, a deductible, and a co-pay. Also ask what types of mental health services are covered (i.e. testing, group therapy, couple or family therapy), the number of sessions per year that are covered, and if they have a list of counseling providers (preferred providers) that you must choose from for the insurance plan to provide the maximum coverage. If they have a list, use that; if not, you can check out GoodTherapy.org or other listing sites and sort by insurance company. If you have a therapist you want to try but who isn’t covered by your insurance or is cash only, ask if the therapist does “superbills” which give insurers the information they need and may allow you to get some reimbursement from your insurer.
  • No, or yes, but for some reason I can’t use it
    • Are you a student?
      • If you’re a student at a college or university it is very likely that counseling is included as part of those assorted fees tacked onto your tuition. Look for your school’s counseling center; you’ll likely have access to at least a few free sessions and free referrals and other services like crisis drop-in sessions and therapy groups.
    • Do you have an employee assistance plan?
      • Many employers, especially large corporations, have employee assistance plans (EAPs) which, as an employee, you have free access to. These EAPs usually give access to several free therapy sessions, case management, and referrals to other services. Your HR department can give you more information about your EAP.
  • Can you afford to pay anything out of pocket?
    • Yes, I can afford full fee
      • Full fee gives you a lot of options, which can be overwhelming. Look at Question 2 if you want some guidance for how choose your best option.
    • Yes, I can afford something but not full fee
      • You may be a good fit for sliding scale fees. Many therapists keep one or two of their slots for sliding scale clients. The amount you pay is based on what you can afford, within a range of the therapist’s usual fee. For example, a friend who charges a $100 a session offers a sliding rate of $50-$70 a session. The downside is these spots can be hard to find as they aren’t always advertised or open.
      • Another good option is university training clinics. Many universities with a graduate training programs in mental health fields run clinics to help their students get experience. These students have taken foundational coursework and are supervised by fully licensed professionals. Training clinics can also be a way to afford services insurance may not cover, like couple counseling or family therapy. You can find training clinics by searching for the name of your local university plus “training clinic,” or you can call the university psychology department and ask to be directed to the right place. I’ve seen training clinic rates range from totally free to $70 a session, and there may be a sliding scale.
      • Other tips include asking your therapist if you can switch to biweekly sessions instead of weekly. You can also look for associate therapists, who have graduated and have provisional licenses but need more supervised hours (or to pass their license exam) to get their full license. They are often building their practice, so they tend to offer lower rates and have more openings.
    • No, I can’t afford anything right now
      • There is probably a non-profit in your area that specializes in social services. There is probably also a community mental health center that accepts low/no income clients. Search for your city/town and terms like “therapy cooperative,” “human services,” and “community counseling.” They may offer free individual therapy, free groups, or have referrals to other opportunities. You can also check out your local university training clinic, which may offer free sessions.
      • As a stop-gap until you find a free therapist or your financial situation changes, here are some things you can do that might help. There is no substitute for professional therapy when needed, but that doesn’t mean you can’t get some help elsewhere. There are apps that can walk you through the basics of self-help for sleep problems, depression, anxiety, etc. The ones I recommend to clients are What’s Up for symptoms of depression and anxiety, Wyza for relaxation/calming, and Mindfulness Coach for introductory mindfulness. The website 7 Cups of Tea offers trained “listeners,” which can be helpful if you need a nonjudgmental ear. An old school option is to check out some of the great bibliotherapy or self-help books in your library. I like The Worry Cure by Robert Leahy for anxiety and Get Out of Your Mind and Into Your Life by Stephen Hayes for depression.

Question 2: Do you know what kind of therapist you want to see?

• Yes
  • That’s awesome! I hope you find a great therapist soon. What you should do is figure out what payment options you have, and then review the next steps outlined in Question 1.
• No, I don’t even know where to start
  • The biggest thing to know is that most therapists are trained to help with most mental health problems. We have research that supports the idea that the majority of what works in therapy is the relationship between therapist and client. Start by figuring out your payment options, and from there look for Yelp reviews, ask friends, ask your primary care doctor, or just pick someone geographically close. Once you’ve identified a potential therapist, you can ask them why they think they would be a good fit for you. Many private practice therapists will do a free phone or in-person consult session to see if you’re a good fit for them and vice versa.  If you start therapy and it isn’t working for any reason, then you have the right to ask your therapist to give you a referral to someone else. Asking for a referral can be uncomfortable, but it’s not uncommon and your therapist will not be offended.
• No, but I know I have a specialized concern (eating disorder, substance use disorder, psychosis, relationship problems, parenting problems)
  • If you know you need someone who has specialized training for certain conditions and populations, then you will want to identify what kind of training you’re looking for. Unfortunately, especially in private practice, some therapists claim they can work with anything and anyone — which is usually not the case. Look for therapists who list exactly what training/experience they have; for example, a Certified Eating Disorders Specialist (CEDS) is a more consistent standard than someone who took a weekend seminar on eating disorders ten years ago. For psychologists, anyone with ABPP after their name indicates a board certification in a specialty area such a neuropsychology or family psychology. Look up advocacy groups for your concern and see what certifications or training they recommend.
• No, but what are some good things to look for?
  • For people trying therapy for the first time, especially when their concerns are related to depression or anxiety, I usually recommend they look for a therapist who uses a cognitive behavioral therapy (CBT) approach. CBT is the gold standard for many conditions and is typically short-term. With CBT you won’t be spending several days a week for ten years on a sofa, so it’s more budget-friendly. Another thing to look for is someone who doesn’t claim to work with every condition from A-Z for pediatrics through geriatrics. Generalists are completely normal and fine, but it’s a red flag if someone says they specialize in many things or that they practice every type of therapy.
• No, because I’m so confused about the difference between all the degrees and licenses
  • I have spent a lot of time explaining to my mom, people on planes, and myself the differences between all the mental health degrees/licenses. The short version is this: Psychiatrists are MDs who can prescribe medication. It is increasingly rare for them to offer talk therapy. Psychologists are PhDs who have advanced training in diagnosis, assessment, and treatment, especially for serious mental illness. If you need testing for something like ADHD or autism spectrum disorders, a psychologist is who you should look for. There are also many types of therapists who have masters-level degrees; for example, clinical social workers, mental health counselors, and marriage and family therapists. All of these therapists are trained to work with a variety of concerns, but with slightly different lenses as to how they think about diagnosis and treatment. Licenses vary by state, so check out your state’s Department of Health for the specifics.

Question 3: Is there anything else getting in the way of making that appointment?

• Nope, I’m making an appointment now
  • Awesome, that can be the hardest part of the whole process. Good luck!
• Yes, I can’t find a time that works for me
  • Try university training clinics and private practitioners (especially associates) for a wider variety of hours than most healthcare system associated providers offer.
• Yes, but it’s super specific
  • The Substance Abuse and Mental Health Services Administration website (Samhsa.gov) is a great resource to get more info on any of this. I’m also happy to address things from my personal perspective in the comments.

Melissa Caris is a therapist and PhD student who is glad for a chance to write something without an abstract or in-text citations. She lives in Seattle with her husband and two cats.

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