My therapist reduced his rate when I was simultaneously having insurance issues and my household income had gone down, which was very helpful. I brought it up over email and then he followed up with the discussion at the beginning of the next session. It was awkward, but he was reassuring about it and made sure I knew he wouldn't offer a fee that was lower than he could sustain. He was somewhat flexible about the amount over time, so one month I paid 60% of the full rate, most others 80%. He also let me wait to pay in full until my insurance payments came through, which made things much easier at times.

Now that things are caught up, after my insurance reimbursements kick in I end up paying an amount that's affordable for me, and he's making 90% of his full self-pay fee. I feel more reassured now knowing that although his full fee is very expensive, it's not immovable.