What If You Can’t Afford Psychotherapy?
For most people with Bipolar II Disorder, some kind of psychotherapy is an important part of their treatment. There can be a lot of obstacles to getting that treatment – not having insurance, health insurance exclusions, a tight budget, or a lack of local options. Usually the problem has to do with either your finances or your insurance.
Paying for psychotherapy out of pocket is no joke. The cost per session ranges from $100-$200, and in order for therapy to be effective, you really need to go at least once a week, bringing your therapy bill up to $400-$800 a month. I think it’s a safe assumption that if you need to pay out of pocket for therapy, it’s because you already can’t afford it – the insurance plan, co-pays, or co-insurance.
Everyone’s situation is different, but I hope that everyone looking can find something useful for them.
We’ll proceed starting with the most useful things you can do, and ending with the least useful – but still useful – things you can do.
Finding a Therapist the Sneaky Way
There are a lot of ways around the traditional insurance copay, insurance coinsurance, or full-price triad model of paying for psychotherapy. Except for sliding scale fees, these options are more likely to be available the bigger the metropolitan area you’re in is. If you can’t find a clinic, center, or other low/no-fee option, there are still other options for you.
Sliding Scale Fees
Many individual therapists and therapy practices charge clients on a sliding scale. The less disposable income you have, the less they will charge you – up to a point. The lowest I have seen is $50 per session, but most practices probably stop at $75. This could cut the cost of psychotherapy down to a quarter of what it would have cost you.
If it’s still too expensive – often this is the case – you could go once every two weeks. Remember, though, that you really should go every week to get a benefit, and doing otherwise really may be a waste of money.
A clinic is an organization where therapists go for further training. If there is a clinic near you, you may be able to become a patient there at low or no cost.
Your treatment will be limited to the kind of therapy that the clinic is teaching, but that probably won’t be an issue, and it’s a hard deal to pass up.
The American Psychoanalytic Association has a list of low fee clinics in the United States.
You may also be able to find centers and clinics specializing in CBT, DBT, and somatic therapy. Unfortunately there are no centralized lists available. An internet search for “cbt training clinic,” along with your state or the nearest city is your best bet. Many of the CBT and DBT clinics are part of local universities, whereas somatic therapy is kind of off on its own.
Federally Funded Health Centers
These health centers may offer psychotherapy, and will provide treatment regardless of your income. You can find centers near you by entering your zip code on the Find a Health Center map.
Demographically Oriented Clinics
You may be able to get treatment through a local clinic whose purpose is often to serve an underserved or poorly served population.
There are so many of these clinics, serving unique and overlapping groups of people, that I’ll make no attempt to name them all; it would be a waste of time for you, the reader.
My best advice is to open a search engine, and look for “‘your demographic’ ‘your state’ mental health resource”. For example: “newly unemployed colorado mental health resource.”
Clinics like these serve the LGBTQ+ community, newly arrived refugees and immigrants, Native Americans (you can search for local resources from the linked page), and can be affiliated with government or non-profit entities.
The Wonders of the World Wide Web
Probably the biggest development for therapy resources on the internet is the availability of online therapy.
The open question is, is online therapy effective? It’s perhaps more along the lines of life-coaching and can’t replace real face-to-face psychotherapy. That said, I have not tried it, so instead of trying to judge it too much, I’m going to present you with a list of what’s out there.
The most useful form of online therapy would be something highly focused – a CBT program, for example, or a program focused on treating PTSD. That’s because these programs are more routinized and structured, and other kinds of therapy rely on the interaction between you and the therapist.
The APA calls it “telepsychology.”
If you’re going to go for online psychotherapy, I strongly advise against any kind of “messaging” plan. With this kind of service, you can send your “therapist” a message whenever you like, and they can get back to you… whenever. I don’t see any value in this beyond having someone to vent to who you feel is listening to you. It’s not nothing, but you deserve better.
Talkspace offers messaging plans starting at $65 per week. I’ll say it again – I’m not so sure about the efficacy of messaging plans.
https://www.online-therapy.com costs $39.95 per week. Disclosure – this link is an affiliate link, meaning you get a discount of 20% for your first month, and I make a little money if you use them. This does not mean that I endorse their services over any others.
Once known just for connecting people with active listeners for free, 7cups now offers online therapy for $150 a month (with unlimited messaging between you and the therapist). I like 7cups’ active listening program, but again, I’m wary of an open-ended messaging program without scheduled meeting times.
MDLIVE charges “just” $99 per session – more than an in-person session on a sliding scale. One benefit is that they also have psychiatrists available, for $259 for a first appointment and $99 for follow-ups. This could make them a good choice for someone facing primarily geographical barriers to finding care.
Thriveworks. Thriveworks starts at $65 per session (I need to point out here that that’s not much less than what it would cost to see a therapist in person on a sliding scale). They also accept some insurance, so this might be a good choice for someone who’s struggling to find a therapist because there aren’t a lot of options in their area.
Active Listener Support
Sites like 7cups.com will connect you with someone who is a trained active listener – informally trained via their website. Full disclosure, I have used 7cups as both a member and a listener. The ability to connect with someone whose “job” it was to pay attention to what I was going through, without judgement, interruptions, or life advice, has benefited me enormously a few times in my life so far. On the other hand, the last time I used the service I ended up chatting with someone who talked about how her life situation was worse than mine, and didn’t do much listening at all. So you never know.
Still, this service fills a special niche, when you’re feeling bad enough to need to talk to someone right now, but it isn’t a medical emergency, so professionals aren’t available.
Self Administered Programs
moodgym, a Cognitive Behavioral Therapy site, has been around for a while. For most of that time, it was free – it now costs $39.00 (AUD) per year to access it.
It’s a fairly basic concept – it’s a self-paced online CBT program that aims to help users with depression and/or anxiety. They do state explicitly that it is not intended for use by people with clinical levels of depression or anxiety. They even suggest – and I agree – that some of the exercises could be counterproductive for a person with that level of symptoms.
All that said, it’s an inexpensive resource that’s available to you when you don’t have other options.
A DBT Workbook
I came across this unexpectedly when I was looking for self-administered programs… this doesn’t technically count, because it’s just a PDF document that will probably help you best if you print it out. On the other hand, it does technically count, because I found it on the internet.
DBT stands for Dialectical Behavioral Therapy. It’s often used for treating Borderline Personality Disorder, but there have been studies demonstrating some effectiveness in treating Bipolar Disorder as well.
DBT is often administered in a group setting – it’s clear that the workbook linked to above is designed for a group. However, the book goes over the concepts that are part of DBT, and includes plenty of useful worksheets, and quizzes about the material.
You still won’t get the full benefit of DBT treatment, but it’s not nothing.
There’s Something Out There For You
With all that’s out there, you should be able to find something to help you when conventional psychotherapy seems out of your budget. Check up on the resources that would allow you to see someone in person first, and if that fails, the online resources could be a good option.
I still recommend following the guidelines I talk about here for finding a good therapist – in person or online.