Why is it so hard to find a therapist?

If finding a therapist feels like a logistical, financial, and emotional nightmare, you’re not alone.

Therapy is an incredibly helpful treatment method for many — but it’s not one that everyone has access to. Over one-third of Americans live in areas lacking mental health professionals. This limited workforce cannot address the needs of over 40% of Americans who struggle with insomnia or anxiety alone. That’s over 106 million people and doesn’t include those experiencing other mental health conditions.

However, the shortage of therapists is just the tip of the iceberg. A provider’s location can matter just as much, if not more, especially if you prefer in-person therapy. The distribution of therapists scattered around the country is highly uneven. Take states such as California, New York, and Massachusetts, which, according to 2018 data, are home to the highest number of licensed psychologists in the country, with 16,900, 13,470, and 5,660 therapists, respectively. But if you live in South Dakota, Wyoming, and Alaska, therapists don’t even number 200.  

During the pandemic, telehealth was hailed as a solution to the mental health crisis because experts believed it would substantially increase access to therapy. However, 5% of people who used telehealth during the pandemic were new to therapy — indicating that while telehealth is certainly more convenient for patients and providers alike, it falls short of significantly increasing access. The same patterns of inequity we find within the brick-and-mortar mental health system exist in telehealth.

Besides these factors, why else can it be hard to find a therapist?

Cost can be one prohibitive barrier. Many therapists don’t accept insurance because the reimbursement rates can be low, and despite the significant increase in demand, many therapists are vastly underpaid. Without insurance footing the bill (or the majority of it), people can shell out thousands of dollars out of pocket each year for weekly sessions. I personally have had to pay out of pocket for the therapist I preferred after searching my insurer’s network for a significant amount of time with no luck.  

But even if someone’s insurance covers their therapy or they can pay for it themselves, scheduling can pose a roadblock. Many therapists only see patients during working hours. If someone’s work doesn’t allow them to take time off for regular appointments, therapy isn’t a feasible option.  

Other people are also very hesitant to speak with a therapist. Research suggests that a quarter to half of US adults prefer a digital option to manage their mental health conditions rather than an in-person therapist. If we can offer individuals what they want when they need it, we can engage many more people in high-quality, effective mental health care.

We shouldn’t make people jump through a seemingly endless series of hoops to find a therapist they feel comfortable with and who has the right expertise to address their specific issues.

The search for a therapist can be even more challenging for people of color. As a Black woman, I have personal experience with the difficulties of finding a woman of color therapist who was the right fit for me and offered live sessions. If you’re a person of color looking for a therapist of color who also understands your cultural background, you may find yourself in an exhausting and sometimes fruitless search. Just 4% of psychologists are Black, and 86% are white. This racial imbalance can impact people of color because they may prefer a provider of color or may simply not feel comfortable or even safe disclosing personal information with a provider who doesn’t share their cultural or ethnic background.

What’s more, we know Black Americans are disproportionately more likely to be diagnosed with schizophrenia and psychotic disorders compared to white Americans. While it’s unclear why this happens, there is evidence that racial bias plays a role in misdiagnosis. The consequences of this are serious: Individuals may be unnecessarily prescribed high-risk antipsychotic medications, may not receive the medications they need, or may be unnecessarily hospitalized, which in itself can be traumatic and worsen mental health.

To understand why it’s so hard to find a therapist of color, you have to first follow the money. The costs to become a licensed psychologist falls on the therapist in training and includes obtaining an advanced degree, costs to become licensed, and working for low pay (an average doctoral clinical internship pays about $20,000 a year). The test alone to become a licensed psychologist is over $600, not to mention testing center appointment fees. The racial wealth gap is a significant barrier that can stop many people from affording these hefty fees and higher education. The fact that the average white family holds eight times the wealth of the average Black family is just one example of why becoming a therapist is out of reach for many people of color and those from low socioeconomic backgrounds.    

But it’s not only the money

People of color often experience bias and discrimination within higher education. This can dissuade them from seeking advanced degrees or continuing them once enrolled. Additionally, cultural competence — the ability to treat individuals from diverse backgrounds effectively — isn’t a standard in many clinical psychology programs, let alone a requirement.

Given the shortage of therapists, especially those of color, the answer isn’t to exhaust the supply of available providers. Instead, we must look to innovative treatment options that can help increase access to types of therapy a human would deliver, freeing up resources for our valuable providers by offering accessible care to more people. Ultimately this can prevent provider burnout and improve the mental health of traditionally underserved populations.

We know that traditional therapy is an effective treatment for those with a variety of mental health conditions. But access challenges offer opportunities for other modalities to serve as an additive to care in order to increase utilization. Technologies like digital treatments effectively deliver cognitive behavioral therapy (a gold standard of care for both insomnia and anxiety) without needing intervention from a therapist or the time of our valuable mental health professionals. In controlled studies of our digital treatments for insomnia and anxiety, Sleepio and Daylight, respectively, nearly three-quarters of participants made significant clinical progress to combat these conditions.^1,2 While digital treatments have their limitations as well, such as the need for an internet-enabled device, they can be an effective adjunct to care for those unable to access or afford traditional therapy or who may otherwise not seek treatment.

As the mental health crisis continues to worsen, it’s clear that implementing telehealth or training more therapists is not the whole answer. We must also invest in transformative technology like digital treatments and similar modalities that enable us to expand access to clinically validated care for everyone in need.

Sleepio and Daylight are available as an adjunct to usual medical care for insomnia disorder or generalized anxiety disorder, respectively, for adults ages 18 and older, without FDA review under their COVID-19 policy.

DOC-1521 Effective 05/2023

1. Carl, J. R., Miller, C. B., Henry, A. L., Davis, M. L., Stott, R., Smits, J. A., … & Espie, C. A. (2020). Efficacy of digital cognitive behavioral therapy for moderate‐to‐severe symptoms of generalized anxiety disorder: A randomized controlled trial. Depression and Anxiety, 37(12), 1168-1178.
2. Espie, C. A., Kyle, S. D., Williams, C., Ong, J. C., Douglas, N. J., Hames, P., & Brown, J. S. (2012). A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application. Sleep, 35(6), 769-781.