The Therapy Pay Gap: Why Black Women Are Hit Hardest

When a female colleague mentioned she was raising her therapy rates because a white male counterpart—with less experience—had higher rates, I was astonished. She shared the figure, and it was jaw-dropping. At the time, my rate was half of what she was planning to charge.

The colleague tried to persuade me to increase my rates, too, arguing that I deserved higher compensation for my expertise and experience. I considered her arguments and realized she was right—yet something still held me back. Was it imposter syndrome? Was it a lack of self-worth and self-confidence? We had similar educational backgrounds, work experience, and similar career paths. The only difference is that she is white and I’m Black.

In 2014, I started private practice full-time to work with clients who share my intersectional identities, but the journey has been fraught with obstacles in a profession that often marginalizes people like me. My identity as a Black woman shapes my experiences as a therapist and helps me create safe spaces for Black clients facing systemic barriers and cultural stigma, though I struggle to balance affordable care with fair compensation.

This tension underscores the need for intersectionality, as the interconnected wage gap for Black women therapists and financial disparities for Black clients significantly impact mental health care accessibility and quality in the Black community.

The Wage Gap Among Black Women Therapists

The wage gap between Black women therapists and their white counterparts starkly reflects broader systemic inequities within the mental health profession. Even with equivalent education, training, and experience, Black women therapists typically earn significantly less than their white peers.

Research consistently shows that Black women in the mental health profession, like many other fields, earn significantly less than their white peers. Data from the American Psychological Association (APA) shows the median salaries were higher for male psychologists ($91,000) compared to female psychologists ($80,000), and for White psychologists ($88,000) compared to racial/ethnic minority psychologists ($71,000) (APA, 2015). Comparatively, white male therapists earn the highest salaries, while women and racial/ethnic minority counterparts earn less.

Financial Barriers for Black Therapy Clients

Many Black women therapists and Black clients struggle to balance affordable care with fair compensation.

Source: Alex Green / Pexels

Black clients seeking therapy often face significant financial and psychological barriers, making high out-of-pocket rates difficult to afford. Even middle- to high-income Black clients struggle with therapy costs, preferring to use insurance or third-party payers.

High costs and limited insurance coverage are substantial challenges, with the Kaiser Family Foundation noting that Black adults more frequently cite financial barriers as a reason for not receiving mental health services.

Additional costs such as transportation and time off work can further strain resources. The National Alliance on Mental Illness highlights systemic economic disadvantages and discrimination, underscoring the need for affordable, accessible mental health services. These factors leave Black clients with minimal support for their long-term well-being.

The Intersection of Wage Gap and Therapy Accessibility

The wage gap that Black women therapists face affects the rates they can charge for their services. Despite earning less than white counterparts, Black women therapists may feel pressured to keep rates low to attract clients within the Black community, who may struggle with financial barriers to mental health care. This pressure makes it difficult for Black women therapists to achieve fair compensation for their expertise and time.

Balancing fair compensation with affordable therapy for Black clients is a delicate act. Some Black women therapists understand clients' economic hardships and strive to provide accessible services, often through sliding scale fees, accepting insurance, or reducing rates, which limits their earning potential. This balancing act highlights systemic issues perpetuating economic and mental health disparities within the Black community.

How to Address the Impact

Over time, this inadequate compensation, combined with the knowledge that they are earning less than their white counterparts, can take a significant toll on Black women's mental health, fueling stress, anxiety, and feelings of worthlessness. Financial strain can cause health problems and burnout, possibly leading to reduced quality of care. At work, Black women often feel like imposters, constantly needing to prove themselves.

Race and Ethnicity Essential Reads

Does Black History Matter for Black Americans’ Wellness?

Is Racial Colorblindness a Good or Bad Thing?

Financial hardship limits access to therapy, creating a vicious cycle where economic struggles worsen mental health and vice versa. Cultural stigma around mental health in Black communities compounds these challenges. Financial disparities are a major hurdle for Black communities seeking mental health care.

Addressing the wage gap requires comprehensive policies focused on equity in education, fair hiring practices, pay transparency, and robust anti-discrimination enforcement, along with addressing broader societal issues such as access to affordable healthcare (National Women’s Law Center, 2022).

While making mental healthcare more affordable and accessible may seem daunting, individual therapists can take concrete steps to make a significant impact.

As a Black woman therapist, I set rates that support my needs and offer a sliding scale for clients facing financial hardship. I partner with community organizations to offer workshops and healing circles for Black audiences, empowering individuals and dismantling stigma. Investing in passions outside my career grounds me in my values. Prioritizing self-care helps manage stress and avoid burnout, while ongoing professional development keeps my skills sharp and marketable, reinforcing my value in the field.

Black women therapists can achieve financial freedom and make therapy accessible through sliding scale fees, pro bono services, and group sessions. Community outreach, nonprofit partnerships, and insurance advocacy support low-income clients. Tele-health services and financial literacy education reduce barriers, while mentorship and support networks enhance professional development. Engaging in policy advocacy promotes equitable pay and comprehensive insurance coverage, benefiting therapists and clients.

Conclusion

A therapy renaissance is unfolding within the Black community. In recent years, there has been a notable increase in the number of Black individuals seeking therapy as mental health awareness grows within the community. Social acceptance of therapy is rising, encouraging more Black people to prioritize their mental well-being and seek professional help. The rise of first-time therapy users is sparking conversations about healing and restoration across many different Black communities.

Many of these individuals specifically seek Black therapists. For some Black clients, having a Black therapist helps build trust and recognizes the importance of cultural humility in their healing process, especially given the historical exploitation of the Black community by medical and mental health institutions.

In the end, the conversation with my colleague about fees became a turning point. "I want therapy to be accessible," I declared, "not a luxury, but a lifeline. Why should people who look like me have to choose between mental health and financial security?”

My practice is a reflection of that belief. Yes, my rate will eventually increase, but my worth isn't solely defined by a number. It's intricately bound to the collective healing of my community.

With each client, I see reflections of my family—my sister, my mother, my father and my ancestors. With each session, I contribute not just to their well-being, but to the generational healing that ripples outward. Through this intersectional lens, I support not only them, but also the therapist I strive to be.