I’m a therapist and my patients need me now more than ever, but I’m struggling too
by Gabby Landsverk
- A therapist who provides accessible mental healthcare is now struggling to pay their bills during the pandemic, dealing with more expenses and fewer clients under a new teletherapy system.
- At the same time, they’re working with clients who have lost jobs and are experiencing similar financial stresses.
- It can be hard to balance their own personal losses while helping clients manage theirs.
- They are also having a hard time finding an affordable therapist themselves.
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In this As Told To, Insider’s series of edited conversations about unique experiences, Gabby Landsverk talks to a licensed clinical social worker who works at a mental health collective in Baltimore. Just like their clients, the therapist, who asked to remain anonymous to protect client-patient confidentiality, is struggling to make ends meet since lockdown began.
This conversation has been edited for clarity.
I didn’t start working here or get into this to make money. Our system is altruistic, and wonderful, but it does make it really hard to live a sustained existence.
When we closed our office in mid-March because of the coronavirus, the number of clients I was seeing dropped by more than half.
I’ve applied for unemployment, although I have yet to see any of that money. Now, I have to stagger my billing so I can time my income to pay my bills.
I have had to negotiate with my landlord just like I’ve talked to my clients about negotiating with their landlords.
I’m also trying to find (and afford) a therapist myself, so I can work through what I’m feeling right now, to process the challenges and changes of the pandemic.
I believe in accessible mental health
The model we work with is unique – it’s a generous sliding scale, and we try to accept every insurance, which is not common with private practice. There are a lot of asterisks to the payment scale and we try to negotiate any time a client can’t pay.
But the end result is that not many people end up paying the top of the scale, which is $150 per hourly session. That’s the minimum of what someone in private practice might make per hour.
And then you have insurance, which reimburses at a lower scale, and there are snags with that too. So you might be missing hundreds or even thousands of dollars a month.
As a collective, we use a fee-sharing system. All money goes into a pot based on clinical hours, group hours and other administrative work. Once our income is accounted for, our base operating costs per month have to be paid. Whatever is left is plugged into a spreadsheet, and we’re all paid based on our hours.
Those expenses include an office that we’re paying for and can’t use. We’re also paying to have it cleaned right now, so we can eventually go back and have a hygienic space. Our telehealth system costs money too, and there’s added costs for clients paying online, and processing claims, so it adds up. We also have to make sure we’re paying down the expenses we generated before the pandemic, including a computer we bought to modernize our system.
We aim to try to pay everyone no less than $40 an hour. It sounds like a lot of money, but you can only see so many clients a week or do so many administrative tasks, so it doesn’t end up being very much in the end.
I want to let my clients know they aren’t alone, but it’s not about me
During this, being home and seeing and experiencing many of the same challenges makes it hard to maintain being a therapist and a human. It’s hard to see clients struggle financially and struggle in a similar way.
Disclosure, or sharing things about myself and my personal experience with clients, can be helpful as a therapist to let clients know they’re not alone in what they’re feeling.
But I also have to be careful not to say anything just to soothe myself. I speak to clients more often than my own friends and family. When those topics come up I have to be very careful about what I’m saying.
When I’m with a client, nothing I say about myself is for me. If I notice I’m wanting to say something about my personal experiences because I’m feeling affected, I might refrain and spend some more time with that thought.
It’s really a balancing act. The more time you spend with someone, the more you know them and you can acknowledge that rapport, so I leave space for clients to ask questions and give as much information as is necessary to help.
And in some ways, having similar stresses can add to the sessions. For instance, I try to practice all the things that I recommend to my clients. That way, I know I’m not just talking, I know it works for me.
I try to maintain a loose routine, to take time for a lunch break. I also make sure I avoid doing things like doing work in my bedroom, so there’s a physical boundary between my work stress.
When I’m not working, I try to have things scheduled that are very different than what I was doing at work – hanging out with friends while socially distancing, or driving out of the city to go for a hike. I’ll go for a walk around Lake Montebello or visit the arboretum – those things are free to do, and that’s a big plus.
I probably go outside more than I did before the pandemic; I’m doing more physical exercise like jump roping, and that helps. It’s something I plan to keep up.
I’m also struggling to find a good therapist I can afford
It is never a bad idea for a therapist to seek their own support and I am working to do that.
But it’s really hard to find a therapist! As a black queer therapist in Baltimore, it’s especially hard to find a therapist who is a person of color and queer identified, or at least literate in those identities.
I’ve run up against people not returning my emails or phone calls, and places are full. At work, I make an effort to return every phone call, and I do get it – responding to potential clients can be tough, especially during this time. Lots of us also have extremely long waiting lists. There just aren’t enough therapists.
But I don’t understand why other practices don’t have a system. As someone who works in accessible mental health, I think it’s so important to support not only current clients, but anyone seeking mental health care.
And ultimately, as I know from working with clients, cost is also a factor. Some providers do not accept insurance because the hassle of getting paid or pursuing a specific level of licensure is time consuming and reduces their income making potential.
My top choice for a therapist is out of my price range. It is hard for me and most of our clients to come up with $100 or more a session.
Things may never go back to normal, but maybe that’s not a bad thing
Since the beginning of the pandemic, things have become a little more financially secure. People have been trickling back – I think they expected to be able to come back sooner but have realized we’re in this for longer. I now have 13-17 clients a week, although my ideal number would be closer to 30.
We’re really attached to the idea of making mental health accessible in Baltimore, and it’s something we’re still really committed to. I think we’re realizing we need something better in terms of how much we minimally pay ourselves.
But I’m confident that my colleagues and I can collectively come up with some creative solutions to make sure that we can live comfortably and still serve our clients. Teletherapy might become a really great way for many of us to see more clients on a more consistent basis, which means more money in the pot and greater access to care.
I think things will permanently change, but not all changes are bad changes. We’ve existed for about four decades, so we certainly are going to adapt with the times.
Read more:
This psychologist charges $500 an hour for ‘mirror therapy.’ Here’s how it works.
How to get the most out of long-term virtual therapy when you’re living and working from home