What Is Sliding Scale Therapy?

Kristin Hall

Reviewed by Kristin Hall, FNP

Written by Geoffrey Whittaker

Published 11/03/2022

Updated 11/04/2022

So you’ve been poking around on the internet looking into what it’ll take to get some mental health support, and you keep coming across sliding scale therapy. Is it a type of therapy? Will you be weighed every time you see your therapist? Will there be waterslides? But really — what is sliding scale therapy?

When people talk about sliding scale therapy, they are talking about mental health therapy. But they’re also talking about money.

Sliding scale therapy isn’t a way of doing individual therapy so much as it’s a way of looking at how a therapy professional charges for their services. While that may not seem very interesting, it can be incredibly important both to your own bank account and theirs.

The good news is that, for the most part, sliding scale therapy is designed to help people with the cost of therapy.

And whether that’s related to your finances, your health insurance status or just a question of how you’re going to be able to make room in a tight budget for the support you need, sliding scale therapy might be your answer.

First thing’s first: sliding scale therapy isn’t really a form of psychotherapy. It’s a form of billing. 

There are many types of therapy that you may be directed to by a healthcare provider, and all of them, in theory, could be under a sliding scale.

When you participate in sliding scale therapy, your therapy experience is really unchanged. Instead, what does change is the way your provider bills you (and the scale fees that they apply).

It’s typically the case that, with a sliding scale fee structure, your income is what determines how much you pay. But it’s not some sort of pre-quantified number for the scale structure. 

In fact, whether to offer you a sliding scale cost for your sessions based on income levels and other needs is mostly left up to the discretion of your provider.

Luckily, the great majority of therapy professionals aren’t just well-trained, they’re also ethically minded.

So, if you’re struggling to make the numbers work, you have a good chance of finding someone qualified who, even if you can’t afford their pre-scale rate, will be willing to work with you at a rate that won’t exacerbate your mental wellness issues.

For context, therapy prices can vary for a variety of reasons. You might pay more if your therapy provider is located in a more expensive market, if they have more experience than the average provider in their area or if they specialized in a particularly in-demand type of therapy or mental health issue.

Therapy might differ due to the therapy provider’s cost to rent office space, experience level or even based on the number of available providers in a particular place. 

There’s also the insurance question. 

An insurance provider might already cover some, most or all of the cost of therapy sessions with an in-network therapy professional. If they don’t, a person with insurance may be able to find an in-network provider elsewhere, either by referral or personal research.

If you’re insured, chances are that you won’t be offered a sliding scale. While a therapy provider may work with you under their discretion on their final bill, the reality is that insurance can be a somewhat preventative problem for the inclusion of sliding scale therapy practices. 

And it’s not just limited to the patient. Therapy providers can also be cornered into enforcing a minimum cost per session or per hour to patients by the insurers they choose to work with, meaning that even those willing to help might have their hands tied on contractually set copays.

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As you’ve probably noted, the benefits of sliding scale therapy are decreased prices for the services you need. 

You don’t get any other extras or advantages — in fact, you may be competing with a limited number of sliding scale clients that a therapy professional can take on.

Truth be told, mental health professionals can struggle too, and while they may not want to charge a dime to help people, they have to charge many dimes to keep their practices open. 

But for the people who are offered some support, it can be a sigh of financial relief toward getting the help they need. 

After all, nobody’s going to benefit from therapy for anxiety by causing themselves financial anxiety. Nobody’s going to benefit from depression treatment if their financial situation starts making them feel hopeless in the process.

Paying less for mental health care is important regardless of what tax bracket you find yourself in, as long as it’s not at the expense of quality. 

Whether or not you’ll be offered a sliding scale for your therapy needs is another question altogether. If you’re reading this from your own private jet, you’re not likely to meet the criteria (also, where’s our invite?). 

If, on the other hand, you’re going through economic hardship, are struggling to make ends meet or are between jobs, you may very well be the kind of candidate who can get some financial relief from a willing therapy professional.

Forms like W-2s and other tax documents can be used to prove need, but it’s also a smart move to talk to a healthcare provider about what will help you demonstrate that you qualify. 

But if you’re not really in need, remember that these professionals are people too, and they have their own bills and expenses.

Don’t expect a free lunch — err — therapy session.

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psychiatrist-backed care, all from your couch

Therapy is something everyone can benefit from, but not something anyone should cut corners on. 

Luckily, sliding scales don’t really change the quality of the therapy being provided — they’re a way for an ethically minded therapy provider to offer equal support to those who are rich or poor, in need or living a luxurious life, regardless.

There are other ways to get access to mental health services, from working with network therapy providers your health insurance coverage covers, to agreeing to payment plans, to contacting government resources like social workers

Financial hardships may keep you from working with a non-scale therapy professional in private practice, but it shouldn’t prevent you from finding any affordable therapy at all.

But rather than cross your fingers that the ideal provider for your support needs is going to operate on a sliding scale, perhaps you might want to consider seeking out a more affordable version of therapy: the online kind. 

Like sliding scale therapy, online therapy isn’t really about the type of therapy offered. It’s a question of the medium in which it’s being delivered. 

This is a great time to mention that we also offer online therapy resources — a way to talk to a mental health professional today without having to worry about the steep costs of seeing someone in an office. 

Online therapy is convenient and can be done over your computer (or phone!) and you won’t need to put pants on, let alone mortgage a home to get access.

If you’re ready to get help, check out our mental health resources today — they might be what you’ve been looking for.

4 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. (n.a) Low-cost treatment. Retrieved from:
  2. American Psychological Association. (n.d.). How to choose a psychologist. American Psychological Association. Retrieved September 19, 2022, from
  3. Using a sliding fee scale: Some do's and don'ts. (n.d.). Retrieved September 19, 2022, from
  4. Sussex Publishers. (n.d.). Cost and insurance coverage. Psychology Today. Retrieved June 15, 2022, from

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Kristin Hall, FNP

Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership. 

She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH

Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare. 

Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.

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