Why is it so hard to find a therapist?

Therapists are in short supply but it’s more complicated than that. 

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

The numbers don’t add up. Over one-third of Americans live in areas lacking mental health professionals. This limited workforce cannot address the needs of the 40% of Americans who reported symptoms of anxiety or depression during the pandemic. That’s over 100 million people, and does not include those struggling with other mental health conditions, like insomnia, one of the most prevalent conditions among U.S. adults. 

However, the dearth 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.  

And while early in the pandemic, telehealth was hailed as a solution to the mental health crisis because experts believed it would substantially increase access to therapy, 5% of people who’ve used telehealth during the pandemic are 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.   

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. As a clinical psychologist myself, I’ve spent many hours with patients trying to convince them to stay in therapy. 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 that they feel comfortable with and has the right expertise to address their specific issues. 

In fact, the search for a therapist can be even more onerous for people of color. As a Black woman, I’ve written about how difficult it’s been to find the exact right therapist fit. 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 with other marginalized groups and white Americans. While it’s not clear why exactly 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 ~$20,000 a year). Just 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 minoritized people from affording these hefty fees and higher education itself. The fact that the average white family holds eight times the wealth of the average Black family is just one example that illustrates 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. To add to this, 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. Rather, we must look to innovative treatment options that can help increase access to the exact type of therapy a human would deliver, freeing up resources for our valuable providers by offering accessible care to a broader number of people. Ultimately this can prevent provider burnout and improve the mental health of traditionally underserved populations.   

Technologies like digital therapeutics effectively deliver cognitive behavioral therapy (the gold standard of therapy), without needing intervention from a therapist or the time of our valuable mental health professionals. In fact, controlled studies of Big Health’s digital therapeutics for anxiety and insomnia, Daylight and Sleepio respectively, have helped nearly three-quarters of patients make significant clinical progress1,2 to combat these conditions. 

As the pandemic rages on, our mental health crisis isn’t going to solve itself and it’s clear that implementing telehealth or training more therapists is not the whole answer. Rather, we must invest in transformative technology like digital therapeutics and similar treatment 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.

  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.
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About the Author

Juliette McClendon, Ph.D.

Juliette McClendon, Ph.D.

Director of Medical Affairs, Licensed Psychologist

Dr. McClendon is the Director of Medical Affairs at Big Health. She is a clinical psychologist by training; her work emphasizes evidence-based practice, culturally responsive care, and mental health equity. She received her PhD in Psychology from Washington University in St. Louis and a BA in Psychology from Harvard University. She completed her post-doctoral training at VA Boston as an Advanced Women’s Health Fellow. Dr. McClendon studies the impact of stress on racial/ethnic disparities in health. Dr. McClendon has over a dozen peer-reviewed research articles focusing on the impact of stress on health disparities, the impact of racism and discrimination on mental health, and identifying intervention approaches that can mitigate the impact of racism and discrimination on health.

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