Over the years I have worked with a number of students who were struggling financially but budgeted rigorously so they could attend weekly sessions at our lowest rates throughout their studies. For many of them, therapy was transformative. It set them on a positive path into adult life, with careers, relationships, and a sense of confidence and well-being that had not seemed available to them before.
None of that would have happened at a standard private practice fee. So many of our clients who have benefited from our services over the years would never have been able to access transformative mental health services without the sliding scale.
The math most people are quietly doing
Mental health is a cornerstone of well-being, and access to good care matters more than ever in an era of anxiety, loneliness, disconnection, and social media overload. Access is usually where the story stalls.
There have been so many cutbacks in the public sector since I finished my graduate studies, and the waiting lists keep getting longer. I have heard of people waiting twelve to eighteen months to be seen, and then receiving a cap of ten to fifteen sessions. Universities cannot keep up with demand either. Most offer only a handful of sessions per student per year and refer out for anything ongoing.
That leaves the private sector, where fees can put therapy out of reach for most people.
I want to be careful here, because this is not a criticism of private practice therapists. Like lawyers, physicians, and other highly educated professionals, therapists complete years of graduate training and keep investing in supervision and professional development for the length of their careers. It is entirely reasonable that they charge accordingly. But the honest consequence is that even people with good insurance can often afford only a few sessions before their coverage runs out, and meaningful, lasting change frequently takes longer than that.
So, the person doing the math at their kitchen table has three options: wait a year, get a handful of sessions, or pay out of pocket at a rate that strains everything else. A sliding scale is one attempt to close that gap.
What a sliding scale actually is, and what it isn’t
A sliding scale is a payment model in which the fee is adjusted according to a client’s income and ability to pay. At MTC, individual therapy fees start at $65 per session and scale up across household income brackets, with a separate scale for couples and family work. Our fee range is published on our website, and we go through the scale in detail with anyone who contacts us, because people should know what therapy will cost them before they commit to anything.
It is not lower quality care. Same training, same supervision, same clinical rigour, same ethics. The difference is financial access, not clinical value.
It is also not charity. It is not a discount for clients who have proven themselves deserving, and it says nothing about anyone’s worth. It is a structural adjustment to a structural problem.
That distinction matters, because financial access in Canada is shaped by inequities rooted in racism, colonialism, ableism, classism, transphobia, and other intersecting systems. The communities most affected by trauma, including Black and Indigenous communities and other people of colour, disabled people, 2SLGBTQIA+ people, migrants, and working class families, are frequently the least able to afford private therapy. Equal fees and equitable fees are not the same thing, and financial hardship is far more often systemic than personal.
This is also why we do not ask anyone to document their hardship. We trust clients to assess their own financial reality.
The hard part
I would be doing my colleagues a disservice if I made this sound simple.
Sustaining a sliding scale over years has been a real balancing act, because the other half of the equation is making sure our therapists earn a living wage and can build careers they are able to stay in. Many therapists carry their own student debt. Many therapists from marginalized communities face financial precarity of their own. And the mental health system offers almost no institutional funding for this kind of work, so practices absorb the cost themselves.
That is the honest reason most practices either do not offer a sliding scale or limit it to a few reduced fee spots in an otherwise full calendar. It is rarely indifference. It is arithmetic.
How we make it work: our interns
Our internship program is the engine behind most of our sliding scale services, and I want to describe it plainly, because the word “intern” carries assumptions that do not match who these clinicians actually are.
Our interns come from diverse backgrounds and training paths, including master’s and doctoral internships in mental health and licensure internships completing the requirements of a Quebec professional Order. Many have worked in other industries and bring a wealth of previous work and life experience to their practice, arriving mid career and following a long held wish to become therapists. Others were practicing psychologists in their countries of origin and are completing supervised hours toward licensure here.
All of them are rigorously supervised and supported. We do not simply assume it is working, either. Every client is invited to complete an evaluation at the end of treatment, and time and time again our interns receive top marks. Clients report significant gains and real satisfaction with the care they received.
This is not a compromise we tolerate in order to keep fees low. It is a training model that produces good therapy and widens the door at the same time.
Why we keep talking about money
Money is uncomfortable to discuss, particularly across differences in race, class, and privilege. Keeping fee policies vague does not spare anyone that discomfort. It just shifts the burden onto the person who has to ask.
Transparent fee structures reduce shame, reduce gatekeeping, clarify expectations, and name a structural reality that everyone in the room already knows is there. Financial clarity is part of trauma informed, anti-oppressive care.
In a better designed system, mental health care would be universally funded and freely available. We are not there. Until we are, a sliding scale is one small, practical intervention inside a larger inequitable system, a way of holding the door open a little wider.
That is why it has been one of our core values since day one, and why we intend to keep it that way.
If cost has been the reason you have not started therapy, our fee range for individual, couple, and family sessions is on the Montreal Therapy Centre website, and we are glad to walk you through where you would fall on the scale. You are welcome to reach out with any questions.
Marital and Family Therapist / Psychotherapist | Montreal Therapy Centre