How Did We Come Up With Our Sliding Scale?

Sliding Scale Therapeutic Conversations

In the interest of economic justice, we offer our therapeutic conversations at a wide sliding scale range, from low-resourced access to ‘pay it forward’ rates. While building out this sliding scale, we took into account a number of factors: reality of labour under late-stage capitalism, ethical considerations, industry landscape, and more. Here’s some insight on that process.

Let’s situate this contextually:

If you've tried accessing counselling services, you may have noticed that a single conversation from a licensed counsellor or therapist will cost between $120 (on the lower end) and $220 for a 50-minute appointment, plus taxes.

You may also know that even the extended health benefits that people might have through work or school often only cover a portion of that, for a capped amount (usually between 2-8 conversations per year). For those without extended coverage, these costs can bar access to important and needed supports.

To be clear, the $120-$220 per appointment is often necessary for most practitioners to maintain a sustainable practice. Within context, it is a fair value for this work: one 60-minute call equates to approximately 2-3 hours worth of work in addition to the time spent in-session.

That being said, it feels deeply unethical for practitioners and community members to be positioned in a tug-of-war for resources that makes mental & emotional health a commodity available only to those who have the circumstances to pay up to $220 per hour with some kind of regularity.

As a response, we do what we can to offer accessible and sustainable services to folks within 2SLGBTQIA+ communities via a sliding scale model. This becomes a little sticky when it’s not done under a non-profit umbrella with government funding (read more about why we chose a ‘for-profit’ model here), because behind the scenes, it’s just us. Three queers in a trench coat, walking a tightrope strung between the non-profit industrial complex and the expectations of making profit under late-stage capitalism.

So now, the reveal you’ve been waiting for: how exactly did we calculate our sliding scale for therapeutic conversations?

We offer three permutations or variants on the ubiquitous 50-minute-hour: a 60-minute conversation, a 90-minute conversation, and a 115-minute conversation. We decided on these variants because that’s what most of our previous solo-practice conversations fell into—different containers for different work.

If we settled on the same sliding scale for all three, like we did for our solo practices, it’d get confusing pretty quickly with multiple practitioners. So we embarked on a classic: building a model in a spreadsheet that crunched the numbers for us.

In this spreadsheet, we wanted to know the following:

• What each sliding scale rate translated to, taking into account that a) 30-40% of each payment goes to taxes and expenses (the cost of doing business strikes again) and b) each appointment correlates to approximately 2 hours of administrative work;
• What our hourly projected ‘wage’ would be for each hour of labour (including administrative work) based on each sliding scale rate;
• What was fair pricing and tiered payment scales, given the above calculations.

We then calculated the following based on $10-increments of sliding scale rates:

• $/minute of active service;
• projected 30% deductions (taxes, expenses)—this is likely to be an under-calculation, but we’ll update this once we have the data to back it up;
• $/hour of actual labour including 120min of administrative labour per appointment (of any length).

Our calculations and what we did with them:

Our calculations (which you can check on the spreadsheet here—we kept it in a PDF, but if you contact us we’ll be happy to send you the working version) came up with some useful data across all services.

Fundamentally, we used $/minute-of-active-service to create our ‘boundary lines’ between sliding scale tiers.

This is calculated directly from [the sliding scale rate paid] and [the minutes of active service], and does not factor in approximate projected deductions and implications thereof (ie., percentage of taxes/expenses, hours of admin labour), which felt the simplest and fairest way to break things down into tiers. We

• the lowest sliding scale rate equals $0.83-$1.33/min of active service;
• the middle sliding scale rate equals $1.39-$1.91/min of active service;
• the full-cost sliding scale rate equals $2.00-$2.50/min of active service;
• the pay-it-forward sliding scale rate equals $2.52-$3.04/min of active service.

What does this translate to for us as practitioners?

If you’re interested in our calculations of ‘what that means for us’, whether that’s for your own business and sliding scale or for a little more ‘behind the scenes’ intel, here’s how those sliding scale tiers break down into an estimate of hourly pay:

• the lowest sliding scale rate correlates to $11.67-$26.81/hour of actual labour;
• the middle sliding scale rate correlates to $21-$39.32/hour of actual labour;
• the full-cost sliding scale rate correlates to $28-$50.04/hour of actual labour;
• the pay-it-forward sliding scale rate correlates to $37.33-$62.55/hour of actual labour.

You’ll notice that these ranges overlap a fair bit—this is because if each appointment correlates to 2 hours (or 120min) of administrative labour, the lowest range for a 60-minute conversation looks slightly different than a 115-minute conversation. This is also a relatively generous estimate calculated from 30% deductions for expenses and taxes and a maximum of 2 hours of administrative labour. We’ll have a better idea of what the actual correlations of appointment:hours worked:deductions look like after our first year.

Hopefully, that sheds a little light on the rationale behind our sliding scale for therapeutic conversations. We hope that this structure will help us sustainably offer community support services. This is, of course, all a projection: we’ll be updating our projections after our first year of business.

Over and out,

Emily & the Groundfire Team