My Therapy Practice Is Not 100% Accessible. It Never Will Be and I’m Fine With That.

Jeff Guenther on Apr 16, 2021

A couple weeks ago I wrote a blog post––a funny blog post, if you ask me––about the hard lessons I’ve learned as a therapist during the pandemic. It had the standard “It’s hard to counsel clients who are going through the same thing I am!” to the “I can’t stop looking at the video of myself on Zoom. Make it stop!” All COVID classics, if you ask me. I was going for relatability and I think I nailed it. I also leaned heavily into my biggest gripe of pandemic counseling which is that I can’t wait until I never have to provide online counseling again. Telehealth is not for me. Period. Some of my clients might dig it, but in this case, I’m unabashedly putting my needs before my clients needs once we can all safely get back into the office. Sorry clients!

As one does, I posted it on Facebook, and as expected, I got a lot of likes and comments from other therapists that feel my pain. But along with the positive comments I also got some criticism from therapists about how not providing online therapy will make my practice less accessible to folks in rural communities who don’t have many options for counselors in their area and for people who aren’t physically able to travel to my office. They basically said that I should think about becoming less uncomfortable with telehealth so that my practice can be more accessible. Very fair feedback!

I’d like to say I took the feedback like a champ but I didn’t. I took it like a white privileged cis man who’s continually doing the work. I was defensive, surprised and felt like the therapists giving the feedback were unfairly attacking me. Eventually I took a little time to think about it, and then I sorta came around to the criticism. I wanted to keep going back and forth with them but really, I needed to just log off of Facebook instead.

So, am I going to grow and become more accessible by providing online therapy post-pandemic?

Yeah, that’s still a no from me. An emphatic no. I just can’t do it. Sorry Facebook therapists! I hate providing online therapy. But I am very excited for thousands of other therapists that will continue to provide telehealth services, and I will happily direct clients to those therapists if that’s what they need. I also appreciate the feedback from therapists asking me to grow, but in this case? I choose not to and I think that’s just fine.

This all got me thinking though…

How accessible should my therapy practice be?

While I don’t have the definitive answer, (feel free to scour the inevitable Facebook comments when I post this blog if you want to find therapists who claim to have the answer) I can at least answer this myself. And of course if you’re a therapist, you’ll have your own answer that will make perfect sense to you. But before I can figure out what my answer is, I probably need to parse out what an accessible therapy practice actually is…

Is this something I could Google? Yeah. Did I Google it? A little. But honestly the search results are all over the place. So here’s a list I came up that would make any therapist’s practice a lot more accessible. Keep in mind that I’m not saying you, or I, should be able to tick everything off this list. That would be unrealistic. I’m just listing questions that counselors should ask themselves if they want a truly accessible practice.

  • Are you educated about how people are limited in accessibility to therapy services?

  • Is your office ADA accessible?

  • Is it in a central part of town?

  • Is there free parking?

  • Are there gender-neutral bathrooms?

  • Is the neighborhood safe for all genders, sexualities, ages, body sizes and ethnicities?

  • Is the waiting room safe and confidential?

  • Do you have a separate exit door in your office that doesn’t force the client to walk back through the waiting room?

  • Do you provide online scheduling?

  • Do you provide a free consultation?

  • Do you provide telehealth services?

  • Do you provide online counseling to clients in other states that you’re licensed in?

  • Do you provide an easy way for clients to contact you in between sessions?

  • Do you provide free counseling to some clients?

  • Do you provide very low fees ($10-$40) to some clients?

  • Do you provide sliding-scale therapy?

  • Is your standard rate accessible to the average person in your neighborhood?

  • Do you accept clients that are on Medicare?

  • Are you in-network with all of the insurance providers in your state?

  • Do you provide free workshops to the community?

  • Do you run free or low-fee support groups?

  • Do you provide free information that you give out to the community?

  • Can you speak all the languages in the world?

  • Are you truly competent and highly-trained to provide therapy to:
    • Fat people

    • Black people

    • Indigenous people

    • People of color

    • People in polyamorous and open relationships?

    • Addicts/people in recovery

    • Vegans

    • People struggling with eating disorders

    • Sex-positive folks

    • Sexual outsiders

    • Queer people

    • Trans and non-binary people

    • (This list goes on forever, but you get the idea.)

  • Can you provide therapy to folks with different religious backgrounds?

  • Do you know everything there is to know about all the religions?

  • If you’re white, have you worked on your white privilege?

  • Are you anti-racist?

  • Do you treat all the disorders?

Reading through that list, it may seem like I’m being ridiculous. I am. But I’m also not. If you want a truly accessible practice you gotta be able to provide all those things and more, which of course, is unrealistic.

You may also be thinking I’m still being defensive for when I was called out online about not being accessible enough. Yeah, you might have a point there. But honestly, if you call me out for not being accessible because I hate doing online therapy, I could probably list 40 ways that you’re not accessible to everyone in your community. Which brings me back to the question: how accessible should my therapy practice be?

For me, the answer is, it should be as accessible as I can be. If I have hard stops then I need to honor those. If I’m a bad therapist online then I’m not going to provide online therapy. If it’s too expensive to move to an office that has an elevator then I’m not going to move. But if I can provide low-fee counseling, gender-neutral bathrooms, free parking in a central spot in town, while being competently trained on a handful of issues I’m passionate about treating, then that’s what I’m going to do. I will also promise to keep looking for ways I can be more accessible and challenge myself to grow without stretching myself too thin.

On top of that, how about I promise to provide a free profile to every single therapist who wants to sign up for a national therapist directory that is progressive and inclusive?

Look, it’s impossible to be 100% accessible to every potential client. But you probably can be more accessible to more clients, so that’s something to think about. And hey, I’m just as excited as the next therapist to judge other therapists who are charging $250 per session in San Francisco. That is sooooo much money!!! But guess what? How are those therapists going to pay their ungodly high office rent if they don’t charge that much? How are they going to pay for their overpriced apartments and homes? It’s fun to shame therapists on social media but ask yourself if you’re being performatively woke before you make that comment public. And if you’re a therapist that wants to charge as much as the market can bear, you don’t give a shit about ADA accessibility, and you only want to cater to super-rich celebs in Los Angeles? DO YOUR THING! Those celebs need a TON of therapy. I salute you. There will always be thousands of other therapists who are more accessible than me and the next therapist. If I can’t meet your needs, I promise you there are other therapists who can. In fact, you can start your search for a more accessible therapist than me at the top of this webpage by entering your zip code. ;)

Jeff Guenther, LPC, is a therapist in Portland, OR. He has been in private practice since 2005. Jeff is the creator and owner of Portland Therapy Center, a highly ranked therapist directory. Jeff, and his team, have launched a new progressive therapist directory, TherapyDen.

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