The Case Against Free Therapy
Friend: I’ve been trying to find a decent therapist but it’s been impossible!
Me: What happened? Maybe I can help?
Friend: Everyone is so money-minded. Two-thousand for something that should be free?! Who will shell out 8-10 grand for therapy?
Me: Free???
This conversation is etched in my brain like the lyrics to every One Direction song I heard in 6th grade – only without the nostalgic memories. Revisiting the interaction has launched thought spirals in my mind one too many times. I’d bet money that such mental marathons are a staple in therapists’ lives.
Therapists are drawn to this field for so many deeply personal reasons. One common thread is empathy. This double-edged sword helps us in the therapy room but also prevents us from assigning a monetary value to our work. How can a number reasonably capture the worth of the services we provide? How do we, people who are professionally trained to be sensitive to others’ battles, stand firmly on money matters? Empathy’s dark side is that it fuels therapist guilt. This inner conflict is exacerbated when clients raise questions over fees or share financial struggles. Therapeutic work is understood to be with vulnerable populations. In India, vulnerability is compounded by lower socioeconomic status among other variables. So, according to proponents of free therapy, since those in need are also often financially struggling, free therapy only becomes more necessary. In lay terms, our internalised beliefs about therapy and social justice roughly translate to: Therapy Should Be Free For All. While this argument is understandable, it also leaves out the therapist’s side.
Simply charging for sessions makes people view therapists as “money-minded.” After all, therapy is viewed as a “charitable” profession. And therapists? “Good people.” Do “good people” not have financial goals? Bills to pay? As a first step in the battle against free therapy, we must acknowledge our responsibility towards ourselves and our profession. Therapists pour a significant amount of time and money into their education and training. It would be ridiculous to ask your cardiologist for free surgery or your lawyer for free legal advice. I eagerly wait for the day it will be ridiculous to ask your therapist for a free session. But in the meantime, how do we make sense of clients’ reluctance to pay?
Like all things in therapy, conversations around fees carry a wealth (pun intended) of information about our clients. If these concerns surface at the beginning, it might flag clients that do not quite see the value in therapy. I like to think of these clients as the “visitors” described in Insoo Kim’s Solution Focused Therapy. They may not expect to gain much from therapy and they may have even put it off for quite some time. The second set of clients may be those who have emotional concerns but are not ready to work on them yet – the “complainants” according to Kim. They’ve already concluded therapy doesn’t work for them, and the financial pains are their newfound reason for avoiding the emotional work. You may not have much luck convincing these types of clients to stay in therapy regardless of your fees.
When it is worth noting, though, is when it happens mid-treatment. A client no-shows their 20th session and is furious with you for charging the fees. Interestingly, neither is it their first time no-showing nor has the policy changed. Why the change of heart? These clients are telling you something important. A rupture happened. Or you got too close to a big emotional revelation. The client may be retaliating to other aspects of therapy by focusing on your cancellation policy. Your best bet may be reflecting on your countertransference, reviewing session notes, or seeking supervision to pinpoint what happened and chart a course of action. While it may be tempting to waive the fees, it may also create a power struggle where clients threaten the therapist with rage. Plus, if we keep lowering our fees or changing policies, we may experience burnout, hostility, or frustration that may be counterproductive to the treatment.
The bigger question, though, is how do we address these conversations in therapy without the awkwardness? Psychoeducation can help the “visitor” and “complainant” client better understand the value of therapy and simultaneously justify its cost. Such conversations can highlight how therapy is different from “friendship” or “just listening.” Instead, it is a valuable service and compensating your therapist is akin to paying your doctor. Another type of psychoeducation may involve outlining how all humans alike, therapist or not, have financial goals and difficulties. This may have the added benefit of humanising the therapist. Finally, therapists who want to promote equitable access can offer sliding scales or pro bono slots depending on their bandwidth and financial flexibility. If financially strapped clients pay full fees, they may drop out of treatment. This puts immense pressure on the therapist to create more therapeutic outcomes in a limited time.
Another aspect of this is that not every therapist can afford to reduce their fees, which also speaks to another deeper-rooted issue when it comes to privilege and access. Therapists need to be able to afford years of training, consistent ongoing supervision, upskilling and going to therapy themselves. By undercutting the value of the services they provide it allows a small select few to become practising therapists. Which has a ripple effect on the diversity within the field.
The work we do is important. More so, it is intellectually challenging and emotionally taxing. It takes years of training and a lifetime of continuing education. We deserve to be compensated for the work we do. Mental health is still stigmatised and misunderstood, and psychologists are too often undervalued and underpaid. We care about our clients and genuinely do want to show up for them. After all, that is what drew us to this field. So, to my dear friend who thinks therapy should be free, I just have one question: Free therapy, but at whose expense?