Updated: Mar 15, 2021
There are many ways to heal from trauma; this essay focuses on psychotherapy. As a clinical social worker, I work with trauma as both an experience of individuals and as multiple interlocking systems of societal oppression.
Like all people, I hold a collection of identities that shape how I see the world. I am a queer, mixed-race, Puerto Rican, cis woman who holds white privilege. I have never been housing or food insecure, though my family’s intergenerational scarcity mindset and trauma were ever-present as I grew up. Making sense of these identities led me to several communities rooted in social activism and collective care.
I am so grateful to Third Root which introduced me to this “equitable pricing model.” It has been used for decades in many community care spaces, but is not yet used frequently among psychotherapists.
--Georgiana Mora, LICSW
Healing From Trauma: Our Many Stories
Healing from trauma is deeply sacred work. This is true for both the person seeking healing (the client) and the person who guides them (the therapist).
Trauma healing reminds me of an orchestra. In an orchestra, many instruments come together to form one complex sound. A trauma narrative is similarly layered, and one important part of healing involves listening to all of its “instruments,” or stories, individually.
For example, we may spend some time listening to a story about relationships and how trauma has impacted our interactions with others. Then we might center the physical story--how trauma lives in the body through pain, tension, or health struggles. We may also lift up spiritual stories, intergenerational stories, societal stories, and so on.
Just as an orchestra practices section by section, we hold space for each story individually. This deliberate work requires patience, but over time, we will begin to weave their nuances together. We will find the areas of pain and allow them to transform. We will honor components that went unheard or unappreciated for long periods of time. We will tap into the wisdom that each story holds in order to embrace our unique, sacred selves. And finally to fully connect and create as members of our communities.
The Inaccessibility of Trauma Care
Ask almost any one who serves as a guide through these stories, and they will affirm that access to healing is a human right. They will also affirm that our mental health system is anything but accessible. Rather, it is grounded in systemic oppression.
Those with financial resources (which are often linked to white supremacy, intergenerational trauma, and other systems of oppression) are able to find treatment that centers their dignity. They are able to select the clinician, modality, length of treatment that fit their needs.
Those without financial resources face completely different circumstances. Many of the most effective trauma treatments, like EMDR, Brainspotting, and Somatic Experiencing, are closed off to them. They are regularly asked to sacrifice their needs in terms of who they see, the type of treatment they receive, and the frequency with which they receive it to be able to afford treatment at all.
This forces therapists to decide how they will divide their time between clients with and without financial privilege. Therapists who choose private practice often attempt to bridge the divide through “sliding scale” or “pro-bono” work, where they offer lower-cost services to a select number of clients.
While these methods are helpful, they’re also imperfect. They substitute the therapist's energy for the financial accessibility, which often leads to burnout. Burnout may in turn lead overwhelmed trauma therapists to opt out of sliding scale and pro-bono work entirely. It may also trigger the therapist’s own trauma history, forcing them to sacrifice their wellness in order to support others.
It also ignores the ability and responsibility that those with financial resources have to participate in collective care.
A better system is needed. That’s where the equitable pricing model comes in.
The Equitable Pricing Model
An equitable pricing model embraces every human’s right to heal. It acknowledges our vastly different relationships with and access to financial resources and tells us we don’t “earn” our right to treatment by trading a certain dollar amount.
By allowing individuals to select their own rate based on their resources, it embraces the fact that healing is a human right. The model doesn’t represent an opportunity to “get the best deal” or “save some money,” but rather a chance to reject financial hoarding as the definition of success.
Equitable pricing is also rooted in trust and compassion. Each person within this system is encouraged to honor their own financial and psychological needs, which no one else can accurately measure. They are asked to choose their plan not only with compassion for others, but compassion for themselves.
The clinician is able to offer guidance regarding their own assessment of market rate, above market and reduced rate etc. In this way, the clinician is still able to center how they value their work and time.
This model also benefits financially privileged individuals by allowing them to invest their money in collective wellbeing. When a person chooses to pay the above market rate, every time they pay for their own individual service, a portion of their funds go to the treatment of others experiencing financial hardship. This is a simple way for those whose identities have afforded them financial privilege to share wealth with others (as opposed to traditional therapy, which simply recirculates a client’s money among other privileged individuals).
This is an opportunity for mental health and financial health to exist together in a space where people don’t have to choose between quality care and financial stability. An opportunity for all to center their healing in self and community wellbeing.
Are you a psychotherapist using this model? Would you like to know more about it? Do you have thoughts on improving it? Contact me!