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How Can I Negotiate Fees with My Therapist?

How Can I Negotiate Fees with My Therapist?

One of the most surprising ways to get affordable therapy is to pay out-of-pocket to see a private practice therapist. 

 

This goes against the advice we often give at OpenCounseling. It's usually more expensive to see private practice therapists than therapists who work at agencies that accept a wide range of payment options. The highest rates you'll pay for therapy are to independent therapists, especially those who don't accept insurance. So, we rarely say this is the most affordable route.

 

However, there are ways to get affordable therapy from a private practice therapist. In fact, many people get incredible, budget-priced therapy from private practice therapists who advertise high fees. How do these lucky clients do that? They go to that therapist and negotiate a lower rate. 




 

In some cases, they don't even have to negotiate. They simply find a therapist who offers a sliding scale and get assessed for a more affordable rate based on their income.

 

It's not always that easy, though. Therapists don't always evaluate a sliding-scale fee for you by default. So, what do you do if they don't? Read on to learn when and how you can negotiate a lower rate with a therapist.


Rule Number One for Negotiating Therapy Rates 


If you want to successfully negotiate a lower rate with a therapist, when you do it is as important as how you do it. Rule Number One is that you are much more likely to successfully negotiate a lower rate at the start of therapy than you are in the middle of therapy.

 

It's better to start by negotiating with a therapist, because at that point, you have nothing to lose. You don't have a relationship with the therapist yet. You haven't opened up to them too much, so it's less likely a rate debate could feel personally insulting to either of you. It won't bring up as many power dynamics to talk about money in the beginning and also won't come across as a judgement you're making about the quality of their work.

 

It's honest and simple. You're telling the therapist you would like to work with them, but you have a bottom-line number for your budget you can't go past. You will quickly learn whether the therapist is open to negotiation when you start this way. Either you'll work out a rate you can both accept, or you'll shake hands and move on to the next therapist on your list.

 

Note that there are exceptions to this general rule. We'll talk about these in the next section. But in general, it's not a good plan to hope to "get in" with a therapist and ask to pay less later. It will put both you and the therapist in an awkward position—and it's less likely to work.


Exceptions to Rule Number One

 

While in most cases, it's best to negotiate rates at the start of therapy, there are exceptions to this rule. It's like signing up for insurance: most of the time, you need to do it during the open enrollment period. However, you can (and should) also do it when you have a major life event (known as a "qualifying event" in insurance lingo).

 

The same occasions that are considered qualifying events in insurance enrollment are also good times to negotiate new therapy fees:

 

  • When you lose a job or get a new job
  • When you lose insurance coverage
  • When you have to take a pay cut
  • When you have or adopt a child

 

Any of these events change your budget and what you can afford. Therapists are trained to be exceptionally sensitive to things the rest of us don't notice—they can certainly be expected to appreciate how major life changes affect us. Good therapists will easily understand the impact of losing income or taking on a major new responsibility that cuts into your monthly budget.

 

So, any time your income or your budget significantly changes, it's okay to talk to your therapist about it and ask if they can lower their rate for you. This is the principle sliding scale rates are based on, anyway—what you pay is a reflection of your income and what you can afford. If you have a good working relationship with your therapist and are making a lot of progress with them, they are even more likely to want to work with you to set a new rate.


 

Rule Number Two for Negotiating Therapy Rates

 

The second most important thing to know about negotiating therapy rates is to understand that it's a negotiation. This means you both must be willing to compromise. When a therapist agrees to negotiate, it means they are willing to come down from their standard rate—but negotiating also means you need to be willing to come up from the bargain-basement rate you might prefer.

 

Therapy is worth something. Good therapy is worth a lot. You don't win by insisting on paying less than what therapy is actually worth. That might be counterintuitive, because it goes against a lot of our cultural messaging. We love to brag about getting a good deal, and what we usually mean when we say we got a great deal is, "I can't believe I paid so little for this." 

 

That's not really a good attitude to bring into therapy. Therapy is not an idle, throw-away pastime. It's not shopping for a rug at the flea market. It's an act of commitment to yourself. Refusing to make room for therapy in your budget is a sign you are refusing to invest in yourself.

 

So, remember, the goal is not to "get away with" paying an unbelievably low rate. It's to get a good therapist to meet you halfway. It's to come to a mutual agreement to pay a fair rate. This means what you pay won't put you in a financially precarious position or make it impossible to keep going—but it also means it will accurately reflect what the service they provide you is worth.


 

Rule Number Three for Negotiating Therapy Rates

 

The third rule for negotiating therapy rates is to make sure that the problem you're trying to solve will actually be solved by getting a lower rate. What we mean by this is that the issue isn't always money even when we think it is. 

 

We have a lot of emotions tied up in money—and they connect to issues as deep as our survival instincts or primal wounds from childhood. We don't like to spend when we don't feel safe. We don't like having to pay for what we should have gotten for free in childhood. 

 

These issues are so profound—and so universal—we've written an entire other article on them. We encourage you to read that article along with this one for much clearer insight on the right time to negotiate. In short, however, look out for the following signs that the issue is deeper than your budget:

 

  • You feel like you're not getting much out of therapy anymore. (This means it might actually be time to quit therapy, take a break, or get a new therapist instead.)
  • Something happened in therapy that triggered a transference reaction or made you feel mad at your therapist.
  • You're feeling frustrated in other areas of your life, especially areas having to do with money, like work.

 

The main issue with trying to negotiate rates for any of these reasons is that paying a lower rate won't actually solve the problem you're trying to solve. Your efforts are also less likely to be successful than when there are material reasons you need to lower the rate you pay. 


 

Tips for Negotiating Lower Rates with a Therapist

 

Now that we've established some ground rules, let's take a look at what you can do to increase your chances of successfully negotiating rates with a therapist. 

 

Tip Number One: Look for Therapists Who Advertise That They Offer Sliding-Scale Fees

 

When you begin your therapy search, look for therapists who specifically advertise that they offer sliding-scale fees. This doesn't guarantee that they will be able to accommodate you, but it increases your chances significantly. 

 

By offering sliding-scale fees, they are advertising that they want to help clients who may be suffering financial hardship. These therapists understand that the same things that can bring people to therapy can affect their income—such as the loss of a loved one or an inability to work due to depression or anxiety.

 

When you reach out to these therapists, be open and clear from the beginning that you are hoping to be approved for sliding-scale. Many of them will hold a limited number of client spots for this, and they should tell you right away whether they can accommodate this request.

 

Tip Number Two: Show a Willingness to Be Flexible

 

Therapists, like all of us, perform a service with the expectation of reimbursement. So, if your therapist is open to sliding-scale fees, you'll be more successful if you're willing to work with them on making the arrangement mutually beneficial. 

 

Like we pointed out in Rule Number Two, negotiation takes two willing people to work. The therapist has to be willing to come down from their standard rate, and you have to be willing to come up from the lowest rate you'd like to pay.

 

That said, there are other ways you can offer something in return to a therapist who is willing to lower their rate for you. For example, you might agree to scheduling your sessions during off-peak hours (such as in the morning), working with a therapist trainee who is building their experience, or taking fill-in appointments when other clients reschedule.

 

By showing this flexibility, you also show your therapist appreciation for the accommodation they've made, making them more likely to continue to offer the lower fee over the long-term.

 

Tip Number Three: If You Are Paying Out of Pocket, Ask for a Fee Reduction

 

Many therapists advertise certain fees knowing that they will only receive a certain percentage of that rate back from insurance companies. If you are paying out of pocket, ask if your fee can be reduced at least to what their expected reimbursement from insurance would have been. 

 

Not only does this keep what you are paying on par with what insured clients pay, it also saves your therapist the hassle of filing insurance reimbursement forms and disputing denials. Making sure you pay in full and on time can sweeten the deal. Not only will it keep you in your therapist's good graces, it will provide a nice counterpoint to how long they have to wait for insurance payments to come in.


 

Where You Can Find Therapists with Negotiable Rates

 

Another important tip is to look in the right place. How do you find therapists who offer sliding-scale rates, reduced fees, or even pro bono slots? Here are a few places to get started:

 

  • OpenCounseling: Therapists who list themselves in our directory know the mission of our site and usually offer lower-cost services.
  • Psychology Today: You can use a filter on their search page to limit the results of your search to therapists who offer a sliding scale.
  • Open Path Collective: By paying $59 for a lifetime membership, you gain access to a nationwide database of therapists who provide therapy for $30 to $60 an hour.
  • Give an Hour: Therapists who participate in Give an Hour offer pro bono (i.e. free) slots to members of the military and trauma survivors.
  • University Counseling Departments: Some universities offer free or low-cost therapy to people willing to see a student or therapy trainee.
  • Community Counseling Centers: Community mental health centers, other public mental health agencies, and mental health non-profits nearly always offer sliding scale rates.
  • Federally Qualified Health Centers: Federally qualified health centers (FQHCs) and other integrated health clinics increasingly offer mental health care alongside primary medical care. Most integrated clinics offer sliding scale fees (FQHCs are required to offer them). Read our article to learn more about these clinics and how to search for them.

 

Note that you have to qualify for a sliding-scale fee to actually get one. Therapists reserve their lowest rates for the clients with the greatest need. If you want a lower rate, but multiple therapists or agencies are telling you that you don't qualify for one, you may need to take a closer look at your budget and figure out if the reason you want to pay less isn't really a financial one. 

 

On the other hand, some sliding scales are stricter than others. Public agencies tend to have tighter income ranges than private practice therapists who offer sliding-scale rates. We encourage you to be creative and keep looking. In addition to the above options, you may be able to find free or low-cost therapy at churches, other spiritual organizations, and local non-profits. 


 

Conclusion

 

It's an open secret that many therapists are willing to accept less than the standard rate they advertise. Many offer sliding-scale fees or are otherwise open to negotiating with clients about rates.

 

Many therapists will be willing to work with you based on your needs and ability to pay. You're even more likely to be successful if you follow these rules:

 

1. Negotiate at the start of therapy instead of in the middle of therapy.

a.The exception to this rule is that you can (and should) renegotiate rates whenever a major life event significantly impacts your income or budget.

2. Approach the negotiation with a willingness to be flexible. Be willing to actually negotiate instead of having only a single number in mind. Be willing to offer other things in exchange for a lower rate, such as flexibility about appointment times.

3. Make sure the problem you're wanting to solve will actually be solved by getting a lower rate. If you need to take a break from therapy, switch therapists, or leave a toxic job, paying your current therapist less won't actually fix the issue. You can read our other article on this topic for examples of when money isn't really the issue.

4. Start your search by looking for therapists who are more likely to offer flexible fees. Many therapists advertise that they offer sliding-scale rates. Therapists who accept insurance may also be willing to work with you if you can pay the same rate insurance would pay.

 

If you're having trouble locating a therapist who can accommodate your needs, use our therapist directory to be linked to providers in your area who have already committed to offering lower-cost services. With communication, flexibility, and assertiveness, you can connect with a great therapist who meets your needs–just remember to offer back these qualities as a client to keep your therapist open to the arrangement.



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Stephanie Hairston, MSW
Posted on 11/15/2021 by Stephanie Hairston, MSW

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a masters-level clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments. She has also worked as a technical writer for a medical software company and as an editor for a company that appeals denials of insurance coverage for behavioral health treatment. As a writer, she is motivated by the same desire to help others that brought her into the field of social work and believes that knowledge is one of the most essential recovery tools. She strongly believes in the mission of OpenCounseling and in making therapy accessible for everyone.