Fees, Trust, Access to Care
We are living together in an ecosystem.
What do I say?
It is often stressful and baffling to decide what we’re able or willing to pay for therapy. Even when we’ve settled on an answer, we might be shaken and disappointed by the options we find online. How am I supposed to know whether the relief I get will make up for the added financial stress? Will it be worth it? What if I don’t know whether I’ll be able to pay at all?
Most people find themselves having to reckon with a trade-off between financial stress and the improvements that therapy can bring. If you’re reading this page, I’m guessing you’re someone who’s considering working with me; you’re probably someone who arrived here through a link in the payment section of my contact page. If so, you are mainly the one I’m writing for.
Before you look at the table below, there are a few things I’d like you to know.
The first thing I’d like you to know is why I’m presenting a range of options in the first place. Like many therapists, I offer my services on a “sliding scale.” This term may be familiar to you by now, but in case it’s not: the session cost is not one-size-fits-all, but instead something that we agree on to match the reality of your financial situation.
Some clients aren’t aware that fees paid at the higher end of a sliding scale are enabling the therapist to offer sessions at the lower end of the scale. Here, I call these higher fee levels “Full” and “Solidarity” rates to meaningfully convey what clients are doing when they agree to those rates. That is, to fellow clients who might not otherwise have the opportunity, they are offering the same access to care that they have.
The second thing you ought to know is that — due to my insurance contracts — my private-pay sliding scale is only available to uninsured clients (a huge portion of Texans) and insured clients who are out-of-network (see my FAQ) or whose specific treatment is deemed not “medically necessary” by their insurance company. It’s a nuanced topic; I encourage you to read this article for an explanation of the meaning of these terms, along with other privacy, clinical factors, and rights regarding insurance.
A final thing to know before looking at the table: I know that people’s incomes don’t necessarily reflect the fuller picture of their financial situations. This table makes suggestions; they might not align with the practical reality of your life. I welcome those considerations.
| Tier | Annual income | Fee |
|---|---|---|
| Essential | < $22k | $15, or pay-what-you-can |
| Low-income | $22k – $40k | $40 |
| Reduced | $40k – $65k | $80 |
| Standard | $65k – $100k | $120 |
| Full | $100k – $175k | $185 |
| Solidarity | > $175k | $250 |
As I mentioned, what you see here are suggestions based on your income. On our consultation call, we’ll be discussing – among other things – how we’re going to handle payment. If cost feels like a barrier for any reason, you can let me know before the call or during it if you’d like. Pay-what-you-can means what it says. No matter how things are in your life, I would like to connect with you.
When you click one of these fee options on my contact page, you are not making a commitment: you are just warming up the start of the payment part of our conversation by giving me some idea of your situation. I will never ask you for proof of income or why you picked the option you selected. And as we chat, your answer may change, one way or another. That’s okay.
One more thing: it’s very important to me that we keep having sessions at the pace you feel is right for you. Much more important than the fee level you choose. If at any point, for any reason finances are making you feel like cancelling a session, I would prefer that we lower your fee than you miss a session for financial reasons.
When we have our consultation call, I will be welcoming any questions, curiosities, or concerns you might have, including any surrounding this topic of payment.
That said, even as you read this, you might already find yourself wanting to know more. You might be asking:
Where did all of this come from?
The fee levels you see in the table above are based on the best data I can find about the actual distribution of household incomes in Austin at the time of writing (summer 2026). For instance, the approximated income range listed next to the Standard rate is the middle 14% of household incomes in the city.
The Essential rate (or “coverage gap” rate) corresponds to an income range that would qualify for Medicaid in most other states (Texas has not expanded Medicaid). These incomes are not high enough, however, to qualify for subsidized health insurance on the ACA Marketplace. For these clients, having this fee option may be make-it-or-break-it for accessing care at all.
In the U.S., there is a well-documented skew in access to therapy across the population, where clients who get established with a therapist are disproportionately middle- and higher-income. There is a wide range of factors contributing to this phenomenon, but the prohibitively high cost of mental health care is at the forefront. I have designed my fee structure to face this reality.
There are services designed to close this gap. I will not delve into the topic here – it is socially and politically loaded and incredibly complex – but suffice it to say that the constraints those services operate within make it extraordinarily difficult for them to fulfill their missions.
Moreover, with few if any exceptions, the niche I sit in within the mental health care ecosystem – that is, long-form, attachment-based talk therapy – is not something for which those services can access funding. Low-cost long-form therapy, available at a scale that matches the need, is virtually non-existent.
The bottom line is that for the vast majority of lower-income folks, the kinds of experiences that my clients have by working with me are not accessible through services like those.
Then what’s the difference?
Fully functioning “sliding scales” – at least when clients participate in them in an informed way – are a different approach to closing the access gap. They operate directly at the level of the care provider. They are an opt-in system through which higher-income clients choose to subsidize lower-income clients’ access to the very same care they are receiving. It is not a nebulous, far-away thing; it is personal.
In order to work, sliding scales rely heavily on the hope that clients who can sincerely afford to pay more will indeed do so on the trust that the therapist is using their contribution for this purpose. That is a lot of trust to put in someone up-front. After all, when you’re making this decision – tentative as it may be – you’re speaking with this person for the first time. It’s a leap of faith.
I don’t take that leap for granted, and to a large extent, this reading is an effort to build that trust beforehand. After the therapy starts, trust develops in the relationship through repeated sessions; just as that trust keeps clients engaged and invested for the long(er) haul, it also keeps them feeling confident about the contribution they’ve chosen to make.
The costs of this kind of therapy are high. There’s no hiding that, nor should they be hidden. This kind of therapy is built on an authentic relationship between the client or couple and their therapist that’s deeply attuned to them: it responds to their wishes and lets them experience growth and change at whatever pace their minds and bodies are ready for.
In contrast, the more impersonal, formulaic, and rushed a therapist’s approach is, the more clients they are able to treat in a week. That approach has a place; it fills a niche, and I address that during consultation calls. But for a therapist to be able to sustain very personal, flexible, and steady care that goes at a client’s pace, the number of clients they can see each week is much more limited.
There are other factors too, but the concern is this: for this kind of long-form therapy, having low fees across the board (not a sliding scale) requires having more clients, and having more clients decreases the quality of care, either because the therapist seems stressed, distracted, and distant, or because they burn out and leave the field. You might have felt these consequences through some popular therapy platforms in recent times.
I recognize the care you’ve put into this topic by making it to the end of this reading, and I deeply appreciate it. By now, it’s clear that I’ve put a great deal of thought into this aspect of the therapeutic arrangement. I’m also aware that in sharing this, I’m revealing some parts of my worldview. In the process, I hope you’ve also seen signs that I can respect and connect with your own, in its differences and similarities alike. In my clinical opinion, part of the kind of long-form, relational therapy that I offer is providing first-hand experiences that real, safe, caring connection is possible between people, even in our differences. We are much more than our opinions.
May you be well!