Frequently Asked Questions

Last week, I wrote about the reasons why a therapist might choose not to accept insurance (or might not be able to sustainably take insurance). As I was writing it, I began thinking of questions I get about the cost of therapy and the need for system-wide changes. I decided to address some of those questions here, since it is a separate issue from my previous post.

As with that post, this is an issue I feel passionately about. I hope this comes across in my writing.

Photo by Jonathan Andrew on

“But Dr. Amy, why aren’t you lobbying for these changes?” (Yes, this is a question I get.) I do, and I am. But I am busy helping my clients and working under the system as it is! Therapists need all of you helping us if we are going to make progress in this fight.

“But aren’t therapists in this job to help people? Why are they being so greedy?” Listen, we did not invent capitalism. We just live here. My landlord does not accept feelings of goodwill in leu of rent. Most of us have tens (if not hundreds) of thousands of dollars in student loan debt that we are expected to repay on top of daily living expenses, plus we are expected to do a lot of non-billable work on top of our sessions.

“Well, I think therapists charge too much.” That’s not a question. And I encourage you to ask yourself how much time and energy you commit to telling lawyers, dentists, and medical doctors that they charge too much. A typical therapy session costs a fraction of many of those rates. Why do you expect us to work for less?

“What can I do if I can’t afford a therapist’s rates?” This is an important and fair question. Just like therapists have bills, our clients also have bills and expenses. Therapy is valuable and priced as such, but many struggle to afford to pay out of pocket. First, every therapist I know who does not accept insurance offers sliding scale and pro bono spots to clients who cannot afford the fee. Open Path Collective is a directory to help people find therapists offering these reduced rates to make services available and affordable.

“I don’t get paid enough either! Why aren’t you talking about teachers/nurses/some other profession?” I actually do think that many professions are underpaid, and I am happy to lobby for living wages and sustainable income for everyone, not just myself. I talk about therapy the most because that is what I know. I try not to speak to things if I might share the wrong information, and I do not want to talk over the people in that line of work. Do you actually want to do the work, or are you hoping we will all settle? Because I am there for you with the first one, but I get frustrated by whataboutism.

“What can I do?” Call your representatives, or write them letters/emails if you are like me and hate making phone calls. Call your insurance company and tell them to make changes. (No, they won’t enact a system-wide change based on a customer complaint, but the point is to light the fire and pressure them into addressing issues.) Make noise. When you are frustrated about the cost of therapy, address your anger at the system and not at therapists.

Helping therapists make a living wage allows us to provide better care and see more clients. It reduces one barrier to entering the field, which is one piece of the puzzle of addressing the provider shortage. System-wide changes in mental health are way overdue.

Published by Dr Marschall

Dr. Amy Marschall received her Psy.D. from the University of Hartford in September 2015. She completed her internship at the National Psychology Training Consortium with specializations in assessment and rural mental health. Currently, she specializes in trauma-informed and neurodiversity-affirming care, and she is certified in telemental health. Dr. Marschall runs a private practice, RMH Therapy, where she provides individual and family therapy as well as psychological assessments across the lifespan. Dr. Amy Marschall is an author and professional speaker.