Candice confesses that the high cost of becoming a therapist creates an exclusionary system, leading to a lack of empathy and accessibility for clients, exclusively for Different Truths.
Many professions are exclusionary because of how much they cost. Living in Europe, I wouldn’t have ever thought to go into law for that reason. People believe America is different, that the great American dream still exists. But not for all.
When I first immigrated to America, I spent $60k on my education to become a Psychotherapist. That’s without including housing and living, which I did by working on a visa. I had $60k from years of working and saving, and because I did not have children and did not have family to support at that time. Realistically, how much of the population can afford $60k? It means the profession has an overabundance of economically advantaged people in it. Which, on the face of things, shouldn’t be a problem, until it is.
The adage, you don’t know how someone else’s life is until you’ve walked in their shoes is very true. This is why when Rape Crisis Centres were first started, it was mandated that only people who had some first-hand experience of this would be counsellors. Imagine a counselling centre for black people, run by white people? A centre for the working class, run by the upper class? For women, run by men. Certain things don’t work.
If the majority of therapists are middle to upper class because those are the only ones who can afford to complete their studies, then how well will those therapists do when they encounter economically fragile people? It’s a question that nobody has bothered to ask or study.
Some years after completing my studies, falling on hard times due to visa woes, I was broke. I didn’t have any money because, legally, I couldn’t work in-country, and even when, finally, I could, I was playing catch-up. I had huge immigration bills, and others, and I had no spare cash. At another point in my life, I didn’t have money despite working 60 hours a week because I was paying off medical expenses. Another time, because I was supporting two other people. There are many reasons we may not have money. The point is, we don’t.
As a therapist, I didn’t charge high rates because I knew what it felt like to not be able to afford therapy. Even if you have health-care insurance in America, that is no guarantee of anything. I didn’t have health care for 15 years, but once I got it, my deductible was $3k. I had to pay the first $3k to afford any type of healthcare, including mental health care. This meant if I wanted to see a therapist, I had to pay for it out of my pocket, which I couldn’t afford.
The irony of being a therapist who can’t afford therapy isn’t lost on me. I refused to be the kind of therapist who priced herself out of the market and turned away those who were desperate. The result was that I couldn’t afford therapy for myself. Most therapists should be in therapy, if nothing else, to be a watchdog on their mental health to ensure the burnout that 99 per cent suffer doesn’t impact their clients and to ensure they stay mentally healthy. Others should be in therapy because they have issues, which is why they became therapists. You are a better therapist if you’ve done your therapy, and it used to be mandated that all therapists start and maintain therapy throughout their training and into their practice. It is no longer mandated. Any idea why? Probably because if that were a mandate, we wouldn’t have as many therapists, and they couldn’t afford to go either.
Therapy has always been expensive at the high-end, but affordable otherwise. Not so anymore. When I first moved to the city I live in currently, there were over 12 places that offered sliding-scale free therapy. Now there are two. Of those two, are there year-long waitlists and the ‘sliding-scale ’? That’s at least $70 a week. For a person bringing up children, working a low-income job, or struggling with multiple bills, $70 isn’t doable. It wasn’t for me.
I spent many years as a therapist who needed therapy. I didn’t get it, and I began to understand how broken the system was, the more I worked on it. Sure, some other countries are worse, and some are better, but overall, planet Earth isn’t doing right by those seeking mental health support. Not only are we still mired in the judgement and shame of ‘needing’ therapy and all the insults levied at that ‘need,’ but we’re also fiscally incapable of putting our money where our mouth is and realising that counselling and therapy are preventative. Every time there is a mass shooting, we trot out the therapists and we promise to do better, but we’re cutting therapists at universities, therapists at schools, access to therapy through work, and especially, therapy for the economically fragile.
Realistically, though, many of us are economically fragile. It doesn’t mean we always look at it or act it, but we live paycheck-to-paycheck because of life’s unforeseen circumstances and the increasing need to support others, alongside ourselves. Who has spare money anymore? Well, we see lots of shows and read lots of articles about all the money circulating, and all the rich people who can afford things, but how many of us really CAN afford what we want? Let alone what we need?
It’s not healthy for therapists to have no access to therapy. If you are a therapist working for a company, it usually goes something like this: Basic 40-hour work week. Get to work early to prep, because you need to know who you are seeing, what they are expecting, and what the game plan will be. Make phone calls to those who have reached out, because part of your job is social worker-based. Then you see clients who are booked for you, and with no regard for how challenging it is to see client after client for eight or nine solid hours. You’re doing a disservice to the clients by working this way, but that’s the expectation of the job. If you don’t like it, leave.
After work, you haven’t finished. You must do client notes. You might have to do some billing queries, and you likely will need to follow up with phone calls and some social-work outreach regarding questions posed to you throughout your working day. Add those hours up and you’re not working 40 hours a week; you’re working 60. If you thought $15 an hour wasn’t a lot at 40 hours a week, try dividing it by 60 hours. All this after doing a BA and MA in your Psychotherapy training as a minimum, ideally a PhD. Then two years’ worth of usually unpaid extern/internship. Who can afford to be a therapist? Usually not someone who was or is working class. Who can be a therapist? Usually those who can work for themselves, which means having even more money to run an office, operate a billing system, pay for a receptionist, assistant or auto-assistant, as well as pay for getting on billing-boards to receive clients, advertising and getting liability insurance, as well as paying for ongoing training required to keep your license. I say again, who can afford to be a therapist? Usually not someone who was or is working class.
Thus, when I had no money and was in therapy and let my therapist know I was no longer able to pay what I was, instead of offering an affordable reduction, she expressed her condolences, and our sessions ended. Technically, she broke a cardinal therapist rule: don’t leave your client out in the cold, but realistically, can you blame her? If she takes on clients at drastically reduced rates, she becomes a poor worker, too. Did she sign up for that?
The therapists I have seen during my time working in the profession have not been great. The vast majority, excluding one, were affluent or supported financially; they didn’t have much empathy for people who struggled financially because they saw being a therapist as a business and because they hadn’t personally experienced financial hardship. Not being able to see a therapist when I was working 60-hour weeks did seem a little ironic, but at least I had friends with whom I could process, who also needed support.
I am just one person, but I know of at least ten fellow psychotherapists, all with PhDs, all highly trained and committed, who struggled because they could not afford to be in therapy whilst being therapists. Imagine, then, what the general population must experience? One colleague worked two jobs, for a total of 70 hours a week, supporting both his elderly parents, his sick wife, and despite this, had nothing left over to pay for a therapist. He was suicidal for years because he carried such a heavy load and had absolutely no outlet. Another ended up quitting the profession despite it being her dream job, because she couldn’t handle working such long, stressful hours for a pittance, only to come up short on mortgage payments every month, as a single mom of two children.
What happens when you don’t have people to do that with?
This matters because without liberal access to psychotherapy, we see an uptick in suicides, in addiction behaviour, violence, depression and challenges with working and maintaining. People are not robots. They need help. If the system that operates therapy doesn’t work, if it fails them, then we all fail. Perhaps for some, I remember hearing this in a prosperity church once, there is this idea that people without enough money are responsible for their situation. That wasn’t my experience. Most people, I know, without enough money, work hard, as I do, but they simply don’t have what those who judge them have.
In such an unequal world, should we expect empathy or assistance from those who have no obligation to help us and are not able to understand our circumstances? I think the government has a responsibility to its citizens, but as America is not a socialist country, that’s never going to happen. Let’s face it, socialism isn’t always an improvement either, if the UK, France and Australia’s mental ‘healthcare’ systems are anything to go by. I remember when I lived in Canada, they had no individual primary care doctors, as most had fled Canada because they could earn more elsewhere. You had to go to an urgent care clinic and see a different doctor each time. Their mental health wasn’t much better. When I worked at the rape crisis centre in Canada, I remember people coming in saying, “Listen, I haven’t been raped, but I’m desperate to see a therapist, can I see one anyway?” They would be turned away, because whilst there was compassion for their situation, there weren’t enough resources for even those who had been sexually assaulted.
This might sound negative and like a bashing on the mental health system (and it is), but I’m not criticising the hard-working counsellors who do try to make a difference. I’m saying that if a system is to work, it must ensure its workers are taken care of. A burned-out therapist is a danger. A therapist who has too large a caseload is a danger. A therapist who is in this situation will eventually leave, and you will lose another one. Something must change.
The solution should begin by recognising that there still exists a need for all therapists to be in therapy whilst they train, so they can understand what it is like to be on the other side, to truly empathise with their clients. All therapists should have access to affordable therapy, regardless of income, and we should try to encourage therapists from all walks of life, including lower-income to train by giving them the financial incentives to do so. If we don’t represent our community, we’re not effective. But if we price our community out, we’re damaging our profession even more.
I did burn out, and I am sure that if I’d had access to a therapist at various times, it would have massively helped. I learned the hard way that I had to cut back on my hours, which meant I earned even less. For me, it wasn’t tenable, though I still hold much respect for the profession. I would ask, what good is any profession if we can’t protect its people? And if we make it so hard for those of us who are not born into high-income brackets to train and become advocates for people like us? There are, after all, more of us than those at the top of the gravy train.
Picture design by Anumita Roy
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