Fees | Sara B Milly

Fees

Context and intentions

My practice is held for clients for whom standard therapy rates would be an obstacle.*

I draw on my financial privilege to offer time, energy, and experience at below-market rates to clients who are committed to their own well-being and the well-being of others. Money is only a small part of the worth our engagement together has for me and, I believe, the communities we move in.

At the same time, I charge more than material costs because your payment contributes energy and capacity both to my work and to the wider community. I donate a significant portion of proceeds annually to organizations supporting BIPOC, trans, and other marginalized clients and clinicians to engage in liberatory and body-informed therapy or related healing practices. For 2023, these organizations were: The Embodiment Institute, Therapy Center of Philadelphia, National Queer and Trans Therapists of Color Network, and REBUILD.

Process

I am out-of-network for insurance. If your insurance allows you to afford therapy at market rate, please seek support elsewhere.* My fees are on a sliding scale. When a client and I decide that we’re potentially a good fit, we work together to identify a fee that feels meaningful and fair to both of us. This rate can and should be revisited if/whenever the client’s financial circumstances may change.

Fee assessment

The following sliding scale is intended to give a rough sense of what to expect in terms of fees, and as a shared starting point for reflection. The tiers are overlapping and flexible, and they likely won’t fit any one person’s experience exactly.

All of our different experiences around financial in/security and bounty/ scarcity shape how we perceive and make sense of our current financial capacity. This can naturally lead people with similar present conditions, who have different experiences and histories, to assess their current capacity very differently, which can unintentionally reinforce unjust disparities. I offer the shared reference points below in the hope of supporting a more equitable flow of resources. I’m very much still learning, and the fee scale is a work in progress. Constructive feedback is welcome.

Sliding fee scale

High

(below market)

$80-100

You don’t have health insurance, or your insurance doesn’t contribute enough to therapy costs for you to afford a standard rate, and most or all of the following apply to you:

Your household income** is average or below for Philadelphia or the area where you live (e.g., roughly $55,000 for a 1-person, $85,000 for a 2-person, $95,000 for a 3-person, or $105,000 for a 4-person household in Philadelphia in 2023).
On balance, you’re positively to neutrally impacted by your social location; for example, race, gender, level of formal education, class background, sexual orientation, age, ability, ethnicity, country of origin, etc.
You may have some savings.
You have completed college and may hold other advanced degrees.
You have stable housing.
You may have some debt, but it doesn’t keep you from meeting your basic needs (for example, food, housing, health care, and transportation).
You have some expendable income (for example, you can buy coffee or tea at a shop, go to the movies or a concert, buy new clothes, books, or similar items each month).
You can afford an annual vacation or time off.
You have family or others you can turn to for money or access to resources in times of need.

Middle

$40-70

You don’t have health insurance, or your insurance doesn’t contribute significantly toward therapy costs, and most or all of the following apply to you:

Your household income** is less than average for Philadelphia or the area where you live (e.g., under $50,000 for a 1-person, $80,000 for a 2-person, $90,000 for a 3-person, or $100,000 for a 4-person household in Philadelphia in 2023).
You experience discrimination, including in hiring and pay level, based on one or more aspects of your social location; for example, race, gender, level of formal education, class background, sexual orientation, age, ability, ethnicity, country of origin, etc.
You have little or no savings.
You may stress about meeting all of your basic needs, but you still regularly achieve them and have at least a little expendable income.
You’re able to afford some new items and you need to thrift others.
You have student loans in repayment status.
You may be currently paying some money each month to support one or more children, family members, or chosen family.
You can take occasional days off and a vacation annually or every few years without financial burden.
You may have family or others you can turn to for money or access to resources in times of need.

Low

$30 and below

(close to or below material costs to maintain my practice and ongoing training)

You don’t have health insurance or it doesn’t cover therapy, and many or all of the following apply to you:

You’re unemployed, under employed, or make a much lower income than others in your area.
You experience intersectional discrimination based on more than one aspect of your social location; for example, race, gender, level of formal education, ethnicity, class background, sexual orientation, age, ability, country of origin, etc.
You have no savings.
You haven’t completed college or are the first in your family to attend college.
You frequently stress about meeting basic needs and don’t always achieve them.
You rent a property that doesn’t meet some basic needs (for example, it’s unsafe, not properly maintained, the location isn’t close enough to your work, it isn’t big enough for everyone you live with, etc.) or you have unstable housing or are unhoused.
You have no, or very limited, expendable income.
You rarely buy new items because you’re unable to afford them.
You have significant debt and/or are currently accruing survival credit card debt.
You’re supporting children, have other dependents, or provide financial support for other family members or chosen family members on an ongoing basis.
You can’t afford a vacation or to take time off without financial burden.
You don’t have family or others to whom you can turn for money or access to resources in times of need.
You have medical expenses not covered by insurance.
You have a chronic illness or disability.
You have immigration-related expenses.
You’ve been denied work due to incarceration history.
You do illegal work for survival.

*Spots at my full market rate of $150 are occasionally available to clients for whom I might be a particularly good match. Please contact me if you would like to explore this option.

**Household income here means salary, contract work, off the books, partner/spousal support, financial assistance from friends and family, and any other sources that consistently contribute to the ability to meet expenses, for all members of your household combined.

With gratitude for conceptualization, content, and wording to Alexis J. Cunningfolk of Worts and Cunning, Chynna Haas, Accountability Mapping, and Mariana Pardes.

Household income estimates are based on statistics from Philadelphia HUD, Federal Reserve Bank of St. Louis, U.S. Bureau of Labor Statistics, and citydata.com.