Finding good low-cost therapy is often more meaningful than simply nailing down a good price. For many people, sliding scale psychotherapy represents a lifeline. But it can also represent a potentially awkward topic undertaken with their therapist:
Gutheil and Gabbard write, "Money is a boundary in the sense of defining the business nature of the therapeutic relationship. This is not love; it's work" (1993, p. 192). Thus the fee and fee arrangement are important determinants of the nature of the therapeutic process and the boundary of the patient-therapist relationship.
Reaching out to experienced analytic therapists is the easiest way to avoid a protracted negotiation over price. Many of them will have worked out similar arrangements in the past, and become adept at sidestepping some of the difficult and embarrassing parts of this conversation. You may even come away feeling better understood and supported than you did going in.
Working out a good system to evaluate and agree on pricing is a tricky process, but once it’s done, you can move forward with the really fruitful work of psychotherapy. Just watch out for a few familiar pitfalls along the way:
As with any fee arrangement, therapists should try to clearly articulate, preferably in writing, and agree upon the arrangement. The concern with the sliding scale is that it can put therapists and clients in a conflict of interest where clients may have an investment in presenting a scaled down financial picture in order to obtain a lower rate. If this negotiation takes place at the beginning of therapy, it can contaminate the therapeutic relationship. Some factors, such as retirement investments, upcoming inheritance, etc., cannot be easily factored into the equation of the sliding scale.
The moral: be open, speak clearly, and don’t be afraid to ask for what you need. At PPSC, we proudly offer sliding scale therapy for patients across New York. Start here to learn more.