Dear Therapist:

I have a friend who is really struggling and after many conversations he has finally agreed to go to therapy. We did a lot of research and have found some therapists that would suit him. Unfortunately he cannot afford to pay for therapy. I have offered to pay for therapy but the therapist does not want to allow us to do so. He says he believes that it is important for the patient to pay for therapy themselves and that it is not a good idea to have friends subsidize it. I would like to get the panels opinion on this and what other possibilities you think there are considering that this person does not have other good options?

Response:

There are a couple of reasons that a therapist might be hesitant to accept payment from someone other than the patient.  Many therapists believe that a person is more invested in the therapy process if he is responsible for all aspects of treatment.  When therapy is essentially free, the patient can develop a nonchalant attitude toward the treatment.  When someone pays for something, the sense of value with regard to the item or service tends to be better retained.

Another reason that a therapist may not like the idea of accepting payment from a third party relates to confidentiality—not necessarily from a legal perspective, but from a therapeutic one.  If you were to be billed every time your friend saw the therapist, you would be in the loop as far as frequency and dates of treatment.  This could be uncomfortable for your friend, and possibly lead to a rift in the therapeutic relationship.

I notice that you didn’t mention the possibility of giving the money directly to your friend.  I don’t know if this is due to the fact that you don’t know if you can trust him, or if you don’t want to go behind the therapist’s back.  If you do trust your friend, you likely recognize that circumventing the therapist’s policy is a bad idea.  It would mean beginning what should be an open, honest, and trusting relationship with a lie.

There might be other options that can be discussed with this therapist.  Might he be willing to accept the money from your friend, knowing that you gave him a lump sum with no strings attached?  If not, would he (and your friend) be okay with a loan?  You mentioned that you found multiple therapists that would suit your friend’s needs, but you spoke of only one who objected to your proposed payment arrangement.  If this particular therapist is not willing to work with you, perhaps another one would. 

Although there are legitimate concerns related to third party payment, it comes down to the advantages and disadvantages within each specific situation.  For example, if your friend is the type to be dedicated to the therapy process regardless, and is very open with you about everything in his life, the concern is not as compelling.  If he will wind up without therapy—or with subpar therapy—unless you help him financially, there is a case to be made for working something out with your friend and a therapist. 

-Yehuda Lieberman, LCSW

  psychotherapist in private practice

 Brooklyn, NY

 author of Self-Esteem: A Primer

 www.ylcsw.com / 718-258-5317