Depression and anxiety are two very common mental illnesses that are even more common among women. Often, professionals will recommend therapy to help people cope with these and a host of other mental illnesses, like PTSD and personality disorders. Some people, like Mandy Moore, will even advise people attend therapy as a means of preventative mental health maintenance. But of course, therapy can be really expensive, and not accessible to everyone who needs professional help with mental illness.

The problem of access to therapy only compounds when race and class are factored in. According to a 2016 study titled “‘Sorry, I’m Not Accepting New Patients’: An Audit Study of Access to Mental Health Care,” Heather Kugelmass, a sociology PhD candidate at Princeton University, found that therapists were significantly less likely to return the calls of prospective patients who they perceived to be low-income, and particularly people of color. The study found that therapists were 30 percent less likely to return the calls of middle-class Black women and 60 (!) percent less likely to call back Black men, compared to white, middle-class would-be patients. Only eight percent of working-class people of any race got a callback and offer for an appointment.

Not only do people of color and working-class people have a harder time even getting a therapy appointment, but the cost of therapy becomes an issue even when a therapist is willing to take on these new patients. On average, therapy costs between $75 and $150 per session (sessions usually run 45 or 50 minutes) without insurance, and that cost is much higher in certain cities. For example, in New York, therapy can cost upwards of $200 to $300 per session.

Of course, therapy can be cheaper with insurance, but insurance is also costly, and 28 million people in the United States did not have insurance at the end of 2016, according to the Kaiser Family Foundation. The vast majority of the millions of people who don’t have insurance found that plans available through the Affordable Care Act were not affordable.

There are significant and real obstacles facing lower-income people who need therapy, and in some cases, it’s largely a broader issue of unaffordable care and inaccessible health insurance in general. However, there are ways to mitigate the costs of therapy. Here are some options worth looking into if you need therapy, but are worried that it will be too expensive.

check your insurance

If you have insurance, do some research to find therapists in your network and see what your sessions will cost through your insurance plan. Medical insurance covers mental health services including therapy, and if a therapist is in your network, the cost of each session will be less expensive than the out-of-pocket rate.

try a mental health clinic

Especially in big cities, there are often mental health clinics that offer therapy services on a sliding scale for individuals and families. In these clinics and health centers, the cost of therapy is determined based on income. Some universities also have training clinics, where students finishing up their graduate degrees in psychotherapy can treat patients with supervision from faculty. Here’s a list of training clinics that range from Boston to Boone, North Carolina, and Palo Alto, California.

check out web-based therapy

A woman uses a laptop on her sofa

Web-based therapy, offered through companies such as TalkSpace and BetterHelp (to name just two!), is often less expensive than in-person therapy. It’s also likely going to be easier to find a therapist more quickly. Online therapy models usually offer a range of services, from weekly chat-based sessions to video appointments, and prices will vary based on the therapy package a patient chooses.

Though it can be cheaper and more convenient, some experts caution that online therapy is insufficient to treat some patients and conditions. According to the American Psychological Association, “research hasn’t yet shown that stand-alone therapy online or via texting is effective for everyone in every situation.” Web-based therapy might not work for everyone, or at least not work as well as in-person therapy might, but it’s an option to consider if cost or ease of access to therapists offices is an issue.

seek recommendations from larger health care providers

Some therapists who have their own practice, and even those who are part of larger offices, offer their services on a sliding scale. It can be challenging to find therapists who offer therapy on a sliding scale, but larger mental health organizations often have resources to help find a sliding-scale therapist. The Anxiety and Depression Association of America has a search tool to help patients find sliding-scale therapists in their state.

check out group therapy

While it might not work for everyone’s specific mental health needs, group therapy can be just as effective as individual therapy in treating some conditions. Further, group therapy is usually much less expensive compared to individual therapy, sometimes as much as half the cost.

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