What Is Sliding Scale Therapy? How to Find Affordable Mental Health Care in Massachusetts

What Is Sliding Scale Therapy?

Sliding scale therapy is when a therapist offers reduced cost therapy sessions.  Sometimes they offer the same reduced rate to everyone, and sometimes the rate “slides” up or down depending on someone’s income or financial hardship.

Why Do Some Therapists Offer Sliding Scale Rates?

Therapists offer sliding scale therapy because they want to make therapy accessible to folks who benefit from but would not otherwise be able to afford their services.  This might include patients who don’t have health insurance, or patients who have insurance but cannot afford to use it. 

I save twenty-five percent of the spots in my calendar for sliding scale appointments because it aligns with my values of keeping my therapy practice inclusive. 

Which Patients Are Considered Uninsured or Underinsured? 

Uninsured means someone has no insurance, but they might still be looking to access affordable, low-cost therapy. 

Under-insured means someone has insurance, but the fees associated with using their insurance are high.  This might be because of their plan’s deductible, co-pay, or the amount of money they have to pay as co-insurance before they meet their deductible. 

For example, let’s use this case of a recent Massachusetts patient who has insurance. They have a plan with a $30 office visit co-pay, a $60 specialist co-pay and a $3,000 deductible.  Their therapist is in-network with their insurance company, but they have to pay the “max allowable” charge until they meet their deductible, and then afterwards they will be responsible for the co-pay.  This sounds ok so far, but in the this case, the insurance company’s “max allowable” is $134.00, this means the patient is going to pay $134.00 each week for twenty-two weeks until they meet their deductible, and then their cost will drop to just the co-pay. If $134.00 a week is unaffordable for the patient, they would be considered “under-insured”. 

A patient might also be considered underinsured if they have insurance, they can afford the terms of their insurance coverage, but they are unable to find a therapist that that takes their insurance.  Even though Massachusetts has the highest per capita number of behavioral health providers in the country, this doesn’t necessarily translate to ease of access.  Even though Western Massachusetts is saturated with a number of wonderful providers, we frequently hear from prospective patients that they have been searching for a therapist for months, and we are the only provider who has returned their call. 

How Are Sliding Scale Fees Determined?

Every therapist has a different practice, I choose to offer one fixed rate of $55.00 per therapy session for everyone, because I don’t want to muck about in the private financial situations of my patients.  This involves a bit of an “honor system” where folks tell me they meet the criteria, and I trust them. 

Other therapists might use a bracket system where they offer a few different rates that correspond to different total household incomes.  Other therapists use a “pay what you can” system, where they offer a range, like “my sessions cost between $40 and $100” and ask patients to pay what they can afford. 

Where Can I Find Sliding Scale Therapy? 

The Pomegranate Institute partners exclusively with Open Path Collective, they are a “grassroots nonprofit organization committed to closing the mental health gap.”  Prospective patients pay a one-time registration fee of $65.00, which grants them access to a therapist database of over thirty thousand therapists who have agreed to accept sliding scale spots between $35 and $70 a session. 

Other on-line directories like Psychology Today, TherapyDen, and Inclusive Therapists can help you search for therapists that might be a good fit for you, and therapists often indicate in their profile if they offer sliding scale, and what their rates are. 



In Massachusetts, Community Behavior Health Centers offer crisis services and outpatient therapy, and can help folks find affordable, low-cost therapy. In Western Massachusetts, clinics like The Center for Human Development, Community Services Institute, and River Valley Counseling Institute offer sliding scale therapy. 

If I Want to Access Sliding Scale Therapy at The Pomegranate Institute, What Can I Do? 

Check out our profile on Open Path Collective, and then complete your registration. Open Path will send us email letting us know you’d like to work with us, and we’ll reach out to you in a day or two. Not quite ready to sign up, but want to ask some more questions? Reach out! We’d be happy to chat.