"Paying for Therapy... in this Economy?!" Overcoming Financial Barriers to Access Mental Health Support in Alberta

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I am not going to tell you "money doesn't matter and you have to put your mental health first"; that is not practical advice and in my clinical experience, financial stress can negatively impacts folks mental health. Financial limitations can be a reason people do not access therapy as soon as they want to, as much as they want to, or at all. With the increased cost of food, increasing housing costs, inflation, and now the recent tariffs, many of us have less and less flexibility in our budgets. Paying for therapy that you can't afford may make things even more difficult. Yet, simply not going to therapy isn't the best option either. Therapy exists is to help people make positive changes in their lives, reduce distress, strengthen relationships, and feel in control of their life.

So what are the options?

If you have a good insurance see a psychologist privately

If a psychologist is covered by your insurance, or mostly covered and you can afford the co-pay, I would recommend accessing therapy through a psychologist in private practice. Of course I may be biased as a psychologist myself, but that doesn't change that the psychologist designation has the most rigorous registration process compared to the other common therapy designation in Alberta, requires a broad knowledge base, and requires a long period of supervised practice to become fully registered. Check your insurance coverage first, to find out what is covered. Only some private practices offer direct billing, so you want to make sure to check with your insurance that the therapist you are seeing is covered before you .

Seeing a therapist privately will give you the most flexibility in deciding who you want to see, finding someone who specializes in your presenting concerns, not having a session limit. Also as someone who has experience working in a non-profit and private practice, the quality of service in private practice is likely to be higher, due to the amount of time that your therapist has to do work and prepare between sessions, the length of the relationship and rapport that private practice offers, and that your therapist can work primarily with folks who align with their areas of interest and expertise.

You can find a private practice therapist through www.psychologytoday.com, and use their search functions to find someone that is a good fit for you. You can also ask to see if the people in your life can recommend someone for you, or even just do web search for psychologist in your area who focuses on the issue that you are experiencing.

If you can't afford the going rate for a private psychologists or don't have enough insurance coverage, don't panic! There are other options! There are also many qualified professionals that offer wonderful and effective services outside of the private market, and likely thousands of clients who have benefited from therapy that happens outside the private market.
See someone who charges less per session

If you have insurance but don't have enough to cover the private rate for registered psychologist, check your policy to see how much coverage you have, and what type of professionals are covered. Social workers, Canadian certified counsellors, and registered provisional psychologists all often charge less per session. If you find someone who has these designations you want to work with, you may be able to save some money or have your coverage for therapy stretch longer.
Ask about a sliding scale

Ask a therapist you are interested in if they have a sliding scale, or look for therapists who offer a sliding scale. When therapists are building their practice they often will offer less expensive services through a sliding scale to those unable to pay full cost. Also, the ethical codes for psychologists urges that therapy should be accessible to all people. Even when not looking to build a practice therapists may offer a sliding scale to someone who can't afford their services. They may not advertise that they offer this, so if you are interested you may have to ask.
Make your work pay for it

If you are employed (or have a member of your direct family who is, such as your spouse or common law partner) check and see if your employer has an Employee Assistance Program (EAP) or an Employee and Family Assistance Program (EFAP). These mental health programs may allow you to see a therapist through the program for a predetermined number of session for free. These programs do not require that you have an issue related to to work. EAP therapists can often help with an entire spectrum of presenting concerns.
Although the therapists are paid by your company, they are still bound by the rules of confidentiality, and should not let anyone at your company know you are accessing therapy or the details of the therapy. The exceptions to this are the same as any counselling appointment; if there are any safety risks, your provide written permission, or some legal problem leads to the therapist or the case notes being subpoenaed. If you are worried about maintaining your confidentiality while seeing a therapist through an EAP or EAFP, talk with the intake worker for the EAP or your therapist through the program to see exactly what information your employer has access to related to your therapist. If you don't have any room in your budget for therapy and you don't have access to an EAP or EAFP, there are still options!
Go through the healthcare system

Talk to your doctor about your mental health concern, and see if they can refer you to therapy through Alberta Health Serviced (AHS). If the issue you are going through is negatively impacting your life, talking to your doctor about it may be a good idea, even if you have access to therapy outside of AHS; You can discuss if there are medical interventions that may be helpful outside of therapy, such as medication, psychoeducational courses, or talking with a behavioural health specialist.

If your doctor does refer you to a program but there is a long wait list, get on that list! The time is going to pass anyway, and there are other options you can access while you are on the wait list.

If you don't feel comfortable talking to your doctor about your mental health or you don't have a family doctor it may be time to look for a (different) family doctor. You can visit albertafindadoctor.ca to see what doctors near you are taking on new patients.
Look into non-profit resources

There are many non-profits in Alberta that will provide therapy for free, uses a low sliding scale, or has a pay-what-you-can price. You may have to make some compromises when accessing therapy through a non profit, such as not having the option to choose your therapist or

To find non profit counselling options you can call 211 or go to their website: https://ab.211.ca/
Work with a counselling student

Just like any other profession, there are folks who are new to the profession; who are in training and less experienced. Many sites around the province charge affordable (or free!) rates for clients to see a student who is completing counselling practicum. These sites can be AHS, non profits, or private practices students work under the supervision of an experienced Social worker, Canadian Certified Counsellor, or Psychologist (depending on the program they are working in).

Other benefits of working with a student are that they are often motivated to provide good service, they will often research and put a lot of energy into become knowledgable about their client's stated issue, and they are under supervision so you often get the knowledge of the supervisor at the price of the student. One of the biggest drawbacks of working with a student is that they only provide services for the duration of their practicum, so they can't work with you indefinitely.
Shop around

Accessing affordable counselling isn't only about finding low cost services, it is also related to finding services that are a good value for the time and money you are investing into therapy. Scientific evidence indicates that having a good working relationship is as important of a factor of therapeutic success as the model (DeAngelis, 2019). This mean that therapy works best when you find someone who is a good fit for you.

If you are accessing therapy through the private market one way to try out multiple therapists for a low costs is to seek out therapists who have a free consultation. These are usually 10-30 minute meetings that are for the purpose of seeing if the therapist is a good fir or you. There is never any obligation to book a session with a therapist after a free consultation! Seeing therapists for initial consultations will allow you to meet multiple people and save your money until you feel like you found someone who you feel good about.

If you are going through a EAP or non-profit and you may not have the opportunity to choose your therapist at the beginning. In this case you still have the option to ask to switch therapists. If after a few sessions you can tell it isn't a good fit, talk to your therapist first and see if they can make any changes. If you don't feel comfortable doing this or don't think a change would help, you can ask the therapist or the agency to see if there is another service provider that you can try out. Remember, providing support for a client is part of our job, and sometimes that means making changes to accommodate a client's preferences or simply referring to another therapist because we are not the right fit.

I believe that no one in Alberta ever has to make financial barriers stop them from accessing therapy. Good luck in your mental health journey! I hope that some of these options work well for you!

References:

DeAngelis, T. (2019 November). Better relationships with patients lead to better outcomes; A good relationship is essential to helping the client connect with, remain in, and get the most from therapy. Monitor on Psychology. 50(10), 38. https://www.apa.org/monitor/2019/11/ce-corner-relationships

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