Money. It’s what determines our ability to provide for our basic needs. In an unequal and violently capitalist society, that often means that many of us go without things we need because we don’t have enough money.
Some people have a lot of money and are defensive or feel guilty about the role of money in their lives. Others blame themselves for not having enough. As a result, we often respond with shame and avoid talking about money entirely. The truth is, money and class status is often inherited and is very rarely someone’s fault.
As a therapist, I am a professional who you pay for support with your life. Our relationship is defined by this fact. So, we’re going to need to talk about money, even though it will be hard.
When I first started my practice, I decided against taking insurance because insurance companies demand that therapists practice in a way that runs counter to my values. These demands include but are not limited to: utilization of a “bio-medical” framework of “mental illness,” accepting clients when we are not a good fit for each other, interacting with extensive layers of bureaucracy, and substandard compensation for my time.
That said, it is and has been a priority for me to work with people who do not have the financial means to pay the exorbitant rates that therapists can sometimes charge in private practice. My solution was to offer an open ended fee structure that gave my potential clients the ability to select a fee that feels right for them. However, as my practice grows I’m finding that I need to ask for more money to make this sustainable for me too.
The solution that I have come to is to have different tiers, and for those tiers to have a range of values, and to update my availability for each tier on a monthly basis. What this will do in practice is give me the ability to accept clients at a range of different fees.
All of these fees are representative of 50 minute session times. The extra ten minutes in the hour are minutes that I spend preparing prior to our session. Session fees are pro-rated by quarter hour, so sessions that might be shorter or longer will be a different fee. For instance, intake sessions are generally an hour and a half which would be 1.5 times our agreed fee.
Our fee agreement is subject to change as your financial situation changes. I will prioritize offering a lower fee to an existing client over a new client, to continue the work that we have been doing.
In general, consider paying more if:
- You are seeing me as a member of a friendship, couple, family, or other relationship (instead of as an individual).
- You are earning a salary rather than an hourly wage.
- You come from a family where you never had to worry about material needs.
- Someone else is helping you pay for therapy.
- You’re established in your field.
- You have the means to do so.
In general, consider paying less if:
- You have significant amounts of debt.
- You have regular medical expenses.
- You have people who depend on you financially.
- You come from a family where you or your caregivers worried about basic needs.
Availability last updated: May 2024
Tier 0: Free
Price: $0
Availability: No
Therapy is often inaccessible and unaffordable, and some therapists’ response to this is to offer free or pro-bono sessions. I want to clarify why I will not be offering free or pro-bono sessions.
Therapy being so inaccessible is a result of systemic problems – wages are too low, costs of living are too high, our government still hasn’t implemented a single payer healthcare system due to insurance company lobbying, our existing “benefits” systems keep people mired in poverty, etc.
As a single therapist, offering free or pro-bono sessions doesn’t impact these systemic problems. Actually, I think that when people try to solve these problems as individuals, it can turn attention away from the need for systemic change.
Collective organizing is what we need in order to make therapy accessible on a broader scale. I can’t do it alone.
I make videos on YouTube which I view as being a resource that I offer without expecting payment.
Tier 1: “I don’t have enough fucking money.”
Price: $50 – $74
Availability: No
If you are struggling to meet your basic needs, but feel that therapy is absolutely non-negotiable for you, then this is the tier for you.
Is this still a not-insignificant amount of money? Yes. I know it is. I appreciate you paying as much as you do, I know it’s a lot of money to someone who is struggling, and it’s not something I take for granted. This is as low as I’m comfortable going for now but that might change in the future.
This tier might be a good fit for you if you rely on government benefits, sometimes have to go without things you need, are unable to work, make at or below $20 per hour, etc.
Tier 2: “I can meet my basic needs.”
Price: $75 – $99
Availability: No
If you can generally meet your basic needs, and usually have some funds left over to do activities or save, this is the tier for you.
This tier might be a good fit for you if you can comfortably pay your bills every month, you spend money on outings once a week or more, you order takeout more than once a week, etc.
Tier 3: “I want to pay Renya what they consider a fair market rate for their time.”
Price: $100 – $159
Availability: Yes
If you are fairly comfortable financially, this might be the tier for you. That’s not to say that you won’t have money worries, but they will be different kinds of worries from the people at lower tiers.
This rate reflects what a lot of other therapists might charge for their non-sliding scale fee, so I think for most people it’s about what you’d pay elsewhere. For this reason, I might ask you if you can afford this fee when we talk on the phone before we talk about the other tiers. I’ll also ask, if someone else is paying for our sessions, if you can ask them to pay something in this range.
This tier might be a good fit for you if someone else is paying for our sessions, you are fairly compensated in your field of work, you supervise other people in your field of work, you take a vacation at least once a year, etc.
Tier 4: “I have OON benefits and would like to seek insurance reimbursement.”
Price: $160
Availability: Yes
If the insurance companies ask, this is my “standard fee.” Technically, everything else would be considered, “sliding scale.” The standard fee needs to exist so that my clients have one number to take to insurance companies when they seek reimbursement. If the insurance companies see that I’m charging “different rates” for “the same service,” they might claim insurance fraud. And that is something we would like to avoid.
Why is it the number that it is? Well, it’s about what my peers will say is their “standard fee.” Insurance companies will look at what therapists are charging in a given area to determine how much they reimburse for a given service. If I undercut my peers, the insurance companies might decide that they can reimburse all of us for lower rates.
This tier might be a good fit for you if you have the means to pay $160 upfront for our sessions, OON benefits, and the patience to follow up with your insurance company. It might be a good idea to double check your benefits before we agree to this rate.
Tier 5: “I have the means and desire to subsidize lower tier spots.”
Price: $161 – $500+
Availability: Yes
If you or your family have accumulated wealth, this is the tier for you. It doesn’t have an upper limit. That’s dependent on what you can do.
I would view it as a tremendous affirmation that we share values and are a good fit for each other if the people who have greater financial resources pay accordingly.
This tier might be a good fit for you if you/your family own more than one home, you travel regularly, you employ service workers in your home, you can drop a few hundred dollars on a shopping trip or night out and not worry about it, etc.
Where’s the money going?
Are you wondering where the money is going? Well, transparency is one of the cornerstones of my practice, so I am going to tell you.
Firstly, your fees pay for my operating expenses. These include supervision, professional dues, advertising, accounting support, computer repair, and access to software such as my online health records system, teletherapy platform, design software, this website, etc.
Next, your fees pay for my basic costs of living. These include rent, food, clothes, utilities, my taking time off, food and medical care for my cat, and extensive student loan payments. Fuck these student loan companies.
Next, your fees pay for my capacity to connect with other people. This includes conferences and events where I can connect with likeminded therapists and healthcare workers, organizing to make the world a better place, making YouTube videos, and outings where I see my friends.
Finally, your fees pay for my capacity to grow in the future. Possible areas for growth include opening up a physical location to practice therapy in Philadelphia, bringing other therapists in and incorporating into a worker co-op structure, and offering therapy at an even lower cost than I do now.