Clinical Contribution by Israa Nasir, Anise Health Director of Clinical Strategy
For cultures where fighting over who gets to pay the dinner bill is normal, it's no surprise that talking about money can be a sensitive subject. Sometimes we reach for the bill as a way to show care, love, or respect. But sometimes, grabbing the check is driven by the instinct to show you’re not struggling and hide actual hardship. It’s shame.
That shame is something Asian Americans can carry over into other aspects of their lives, like health.
Many Asian Americans grew up watching their families delay care or skip it altogether to cut costs, learning early that taking care of yourself was something you did only after everything else was covered.
So it makes sense that when people consider therapy, the first question is often whether they can afford it. Years of watching and living patterns of shame around money talk makes it feel impossible to bring up directly with a therapist. But that conversation is exactly what can keep you in care instead of out of it.
Budgeting is part of life, and is a strength. There are three big benefits to talking about it with your therapist.
Worrying about whether you can continue care creates added pressure and anxiety. These feelings can work against the goals you’re trying to achieve in therapy.
“You don’t want to feel like therapy’s a burden,” says Israa Nasir, a clinically trained therapist and Anise Director of Clinical Strategy. “That impacts how positive the experience is in therapy.”
A positive experience in therapy isn’t about having a good time or it being easy. Having a positive experience directly influences therapy’s effectiveness when it comes to your goals.
Nasir explains, “If therapy does become a financial burden, you’re likely to become resentful. You might feel shame, so it can activate a lot of narratives.” These difficult emotions can block healing, reinforcing habits like silent endurance, that can actually be addressed through therapy.
Society treats money talk as taboo. But that’s not the case in therapy: “The biggest issue people have sometimes is they don't realize that they can actually talk about whatever they want in therapy,” says Nasir.
Therapists are trained to have conversations about challenging topics, including ones that are uncomfortable. Your session is a space that’s dedicated to you. Your ability to be open and honest about what you’re going through is part of the process of making progress.
Let’s be real: many of us go to therapy because we’re learning how to speak up for ourselves. The realization that we’re allowed to have needs (and even wants!) and can talk about it is often one that happens in therapy.
“If you’re somebody who’s uncomfortable with talking about money or negotiating at work, this is a great place to practice those skills in a really low-stakes, safe environment,” says Nasir.
Having a conversation about your budget builds your muscle to bring up difficult but important topics. Practicing that skill in a safe space that still has real stakes means that you’re more prepared to use it in another context. You’re reinforcing the idea that something that matters to you is worth bringing up.
“You are making future decisions for yourself easier,” Nasir explains. “You are becoming better. That’s the whole point of therapy, right? It’s for you to be assertive, for you to not abandon yourself, for you to communicate your needs and to stay regulated while doing it.”
Before you make any decisions around changing how you currently do therapy or rule it out—if you haven’t started sessions yet—have that conversation with your therapist. You might learn that you have more options than you realize.
Your therapist might have sliding scale payment options, which means that your session costs are adjusted to your financial situation. If they have sliding scale costs, you could continue attending sessions with little interruption to your usual routine.
A conversation could also surface other resources, such as mutual aid funds or community resources that can help you cover the costs of your therapy. Some therapists are plugged into these kinds of resources and can point you in the right direction.
Employee Assistance Programs or EAPs might be options, if you have access to these benefits and your provider accepts them. A similar option, if you have health insurance, is to use an HSA or FSA to pay for some of your sessions.
Depending on how your progress is going, you and your therapist might agree on changing the cadence of your sessions. Your cadence is how often you attend sessions.
When you’re first starting therapy with a provider, it’s usually best practice to start with weekly sessions so you can build the therapeutic relationship and a foundation for your progress. Meeting regularly and more frequently means you can start working on the skills and habits that support your well-being.
Later on, you might decide you want to switch to doing sessions every other week or meet at a different schedule. Again, you don’t have to make that decision by yourself. Communicating your financial situation to your therapist means you can discuss if it’s the right call based on the severity and intensity of what you’re working on in therapy, and it also means your therapist has a better picture of how your finances might be affecting your mental health, too.
Whether or not these other options are available, you can also choose to set aside a budget for therapy.
If you decide that therapy is a priority for your mental health, Nasir talks about considering it a non-negotiable expense.
“Therapy is not forever,” Nasir says as a reminder. “This is not a forever cost that you’re going to have to bear. However, you can have an upfront startup cost and plan for it, like you do with your rent or groceries. These are your non-negotiables.”
Drawing that line can pay off in other ways. “Wellness compounds over time. For example, if you’re struggling with anxiety, that’s probably impacting your work and your social life. If you front-load and take care of your mental health, it can have a compounding positive impact on your life, for example, maybe you become more assertive and get that promotion or can talk about your finances with people in other areas of your life.”
If budgeting for therapy is one of your strategies, start by thinking about it in the long-term, not just the immediate costs. Be intentional about setting aside six months as you reallocate other expenses in your life.
This discussion can happen in a therapy session, too: You and your therapist can go over your expenses to figure out what to prioritize for your health.
While you should feel empowered to bring this discussion up anytime, two main moments can prompt it: when you start to feel financial strain or when you’re first starting sessions with a therapist.
If you’re feeling nervous about bringing this up with your therapist, Nasir recommends doing a brain dump first on a piece of paper. Getting these ideas out of your head can provide direction and help you manage your feelings about it.
Start by organizing your thoughts by theme.
Notice how you’re feeling. For example, are you worried that talking about budget could upset your therapist? That’s relational. Do you feel ashamed about your finances? That’s emotion-based. These thoughts affect you but they’re happening internally.
Take your organized thoughts to your therapist. You can even bring up some of the feelings you noticed during your writing process.
Be specific. You point out the current costs of sessions and what you can afford. You can also state what you’d prefer to do about your care moving forward, like your session schedule, so that you’re aligned on goals.
Nasir suggests using the formula of presenting the problem.
Name the constraint with your therapist, including those negative feelings. “Any feelings you have about it, like ‘I’m embarrassed’ or ‘I feel bad.’ You can even say, ‘I’m sorry’ upfront but you don’t have to be sorry. Get it out of your system. Then say, ‘what are my options?’”
You can ask about some of the options mentioned earlier, including doing a budget review. And if you find negative feelings surfacing during the conversation, you can continue to bring that up. Therapy is a space for you.
“Remember, every time you make a difficult decision to bring up something in conversation that’s important to you, you are growing,” Nasir reminds us. Therapists are used to having uncomfortable conversations, including ones about budget. “We know this, and we’re here for you. You have to remind yourself that you are deserving of your own consideration.”
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Asian Mental Health