Therapy on a sliding scale basis

This afternoon, I contacted a male therapist in the Bath/Brunswick area. He had been recommended to me by Sidran Institute for the treatment of PTSD. They mentioned he would be willing to negotiate the fee for his services.

When I asked him if he would be willing to treat on a sliding scale basis, he told me that he would consider it but doesn't offer his services for free. I wasn't expecting anything pro bono anyway. He told me that he would consider the fee if it was acceptable to him. He mentioned that his usual fee was $100 per hour. I told him that I could only afford to pay $30 per session because I am disabled. Unfortunately, I don't receive a SSDI and SSI for reasons which I will not elaborate here. I informed him that I would have health insurance by the end of May through my spouse's workplace if he would be willing to accept this arrangement for now.

The therapist responded that this proposal was unacceptable because it was less than $70 per hour. He told me that he doesn't do charity work. I responded that he shouldn't advertise a negotiable fee because it was misleading. Then, the jerk hung up on me.

I am really frustrated. I have contacted the local chapter of NAMI that recommended that I call a local m.h. organization regarding services. I was informed that this org. no longer offered waivers on a sliding scale basis because their funding has been slashed by the state. I would be required to pay $135 per session.

No one is willing to help you if you lack health insurance. This country needs universal health care. I have been deteriorating psychologically for sometime but don't want to commit myself in order to receive some counseling. Is a sliding scale fee so unheard of in this day and age? Thanks.

i lived in the rockland area for a while... Maine is the worst. i feel for you.

i will tell you though that the universal health care system, while i think is still better overall, still neglects mental health. It's the lowest on the ladder... especially in the remote and rural areas. Pdoc care is completely free here.. and most dont do any therapy with the patients bc they dont have time. There is public care in psychology but there is a list and the Ts dont make as much as the private ones so the Ts often dont stick around... and a lot of times the free clinics are at the teaching hospitals where you get the fledgling T's. Now that isn't the worst that could happen.. i prefer new doctors for example bc they arent jaded yet But with these guys it means they wont be sticking around either... you cant form long term trust. CBT is the therapy du jour because its quick and cheaper.

so yeah.. fight for good universal health care.. but fight to make sure they get it right.

btw... when i saw where you were i immediately thought of this one T in Brunswick who really messed up a friend of mine... maybe you are better off!

Hi Ecrivain,

I live on the other side of the country, and sadly, we have some similar issues here. Like you, I'm on disability. I, too, have challenges finding a therapist or counselor who is willing to see me for fees I can afford. It's a very tough thing. "Sliding fees" from their perspective is a different thing than we'd like to see sometimes, as you mentioned.

I don't know what your area is like. In our area, we do have some community health centers which offer counseling and mental health treatment for some individuals. If you qualify, they see patients for extremely low cost. It could be worth exploring that option in your area. If it exists, it would be more likely to fit in your budget. If there is a teaching hospital in your area which accepts Medicare (assuming you're on Medicare) you may be able to get your therapy covered by Medicare and pay a lower fee that way also by being seen through a clinic there. Medicare does have some benefits for mental health therapy, although it can be hard to find a therapist who accepts it. Those people exist, but you'd be more likely to find them through a University hospital which has a central bills processing system as the paperwork is more extensive than most therapists can do on a regular basis.

Depending on how your PTSD occurred, you might have better luck contacting an organization connected with that situation. If you're a veteran, for instance, try contacting the Veteran's Administration (which, by the way, offers a lot of support groups, therapy, and other opportunities which I believe are free of cost). If you were a victim of child abuse or violent crime, there are groups who provide support to people who've experienced these types of trauma. If you call or write them and explain your situation, they may be able to provide some more specific referrals who have better sliding scales. You get the idea.

I don't know if any of this will help. It may be stuff you already know, but it's what I've learned over time, and thought I would pass it along in case it is useful. Hang in there. I hope you'll be able to find a therapist soon.

Take care,
ErinBear

Thank you for responding Erin Bear. I am not a veteran so I can not access any services from the VA. I am disabled but do not receive disability in the form of SSI/SSDI. It would be too complicated a story to discuss here. Needless to say, I do not receive any Medicare/Medicaid.

My trauma is rather complicated. I am a survivor of a sexual assault, a date rape, a physical assault involving a schizophrenic sibling, two auto accidents (one involving an illegal immigrant), sexual harassment in the workplace, disownment by paternal grandparents due to religion/ancestry, and estrangement from biological family. In addition, I have been involved in legal action regarding the sexual assault, the sexual harassment, the auto accident with the illegal immigrant, and the schizophrenic sibling. As you can gather, I have suffered multiple traumas.

I have contacted several mental health organizations besides the one that quoted me the $135 session fee. While there are not a lot of community health centers in my states, the ones that do exist have waiting lists that are months long. I was on a waiting list when I had contacted one facility. They had a practitioner who would be willing to meet with me but she did not have experience treating complex trauma sufferers. Furthermore, she would be leaving her practice in a month and a half. I didn't want to open myself up and make myself vulnerable to someone who would not be around by the end of May.

This organization suggested that I voluntarily commit myself to receive the treatment that I need. I was flabbergasted by this suggestion. I am not a harm to myself or others so why would I agree to institutionalize myself. In addition, without health insurance, I would incur more bills that I could not pay and there is not guarantee that charity bill would foot the bill because of my spouse's income. I want help not institutionalization.

perhaps you can look into online therapy?

<font color="purple">He really sounds like a jerk, a therapists client is his only income, but if the sessions are only one hour long then I can imagine him having more then one client a day, so is $100 a session REALLY necessary? </font>

I can really sympathize with you. We have universal healthcare here, thank God, but therapy isn't covered unless it's with an MD. My psychologist is a PhD and so she's not covered at all, so I'm paying $160 / session every week. I know she does do some sliding scale work, but not much and the going rate for psychologists around here is about 150-160 per hour. Our local pyschiatric hospital offers free limited short term councilling for specific problems.

Women's centre's are also often a good resouce. They often run group therapy sessions or can refer you to low cost practitioners.

Good luck in finding help.

--splitimage

Hi Ecrivain,

I've been thinking more about your situation. I'm sorry I misread your initial post - I thought you said you were on SSDI/SSI - and I'm sorry I misunderstood that. In terms of not having Medicare, that may be a problem in other ways, but it may not help so much in this regard. At least in my experience, it is almost impossible to find therapists who accept Medicare. I've always had to pay myself, which is unfortunate.

I did have another thought, though. Do you have a crisis line in your area? If you try calling them, even if you're not in danger of hurting yourself, you might be able to ask them for referrals. They often are a good source of referrals for low-cost counseling, too. They might know of more resources in your area if you're willing to make that call. If you have phone lines like the Befrienders, Contact, or Samaritans, that would be another resource, and they, too, could have referrals. Catholic Charities may have resources to suggest if they are in your area, and I don't believe you need to be a Catholic to contact them. Sometimes they offer free or low-cost counseling (I've heard this from a counselor who works for them) for as little as $2 per session for people who are on very low incomes. It could be worth exploring if this is offered where you live.

You could also try support groups. I know it's not the same as seeing a counselor one-on-one, but there are many support groups which are free, and others which are low-cost. There are many support groups online which can be a great help, also, specifically oriented to the issues you have. That is a free resource. It might take some exploring to find the right group for you, but it can help, both while you're trying to find a counselor, and beyond.

I hope you'll find a counselor soon, and the support you're seeking. My thoughts are with you.

Take care,
ErinBear

I know this is frustrating and that guy was definitely a jerk, but real sliding fee scales are out there-- My therapist works on a sliding fee scale in which I decided the fee when I started with him, based on what I could afford. I did not have health insurance at the time because I was not yet married and had just moved to Philly and did not have a job yet. I did research on the website for Psychology Today and searched by sliding fee scales.