One of the questions I get asked most often by prospective clients is whether I take insurance. It is a completely fair question, and one that I have spent a lot of time thinking about throughout my career. In fact, the answer to why I don’t take insurance has less to do with insurance itself and more to do with some of the values that have guided my professional life for nearly two decades.
Before becoming a therapist, I was a music teacher. I started teaching in 2008 and quickly fell in love with the process of helping people grow. What I enjoyed most wasn’t necessarily teaching scales, technique, or performance skills. It was building relationships, understanding how people learned, and helping them move toward goals that felt meaningful to them. Early on, I seriously considered pursuing a teaching credential and working within the public school system. The more I explored that path, however, the more I realized that it wasn’t the right fit for me.
What I valued most was flexibility. I wanted the freedom to tailor my approach to the student sitting in front of me rather than follow a predetermined plan that might not reflect what they actually needed that day. I wanted the ability to adjust, pivot, slow down, or go deeper when it felt important. I wanted to respond to the human in front of me rather than spend my energy responding to a system.
Looking back now, I can also see that my neurodivergence likely played a role in that decision. The idea of navigating layers of bureaucracy, rigid schedules, administrative meetings, and institutional constraints felt draining in a way I couldn’t fully articulate at the time. What energized me was the relationship itself and the opportunity to support meaningful growth.
Years later, I find myself facing a surprisingly similar question as a therapist.
One of my deepest values is accessibility. I believe mental healthcare should be available to everyone. I believe people should be able to access quality therapy without having to make impossible financial choices. I understand why insurance exists, and I understand the relief many people feel when they are able to use their benefits to receive care. In many situations, some support is better than no support at all.
At the same time, I have ultimately chosen not to build my practice around insurance companies, and that decision comes from both clinical and ethical considerations.
The simplest way I can explain it is this: the type of therapy I provide often does not fit neatly into the framework insurance companies were designed to support.
Insurance companies understandably want measurable outcomes. They want diagnoses. They want treatment plans. They want documentation that demonstrates medical necessity and quantifiable progress. Those requirements make sense within a medical model that is largely focused on symptom reduction.
The challenge is that much of the work I do is not solely about symptom reduction.
Many of the people who find their way to my practice are seeking long-term attachment-focused work. They are trying to understand patterns that developed over decades. They are healing from complex trauma, relational wounds, identity-based stress, chronic shame, or experiences of never feeling truly safe in connection with other people. The goal is often not simply to reduce anxiety from a seven to a four, or to improve a depression score on a questionnaire. The goal is to create a different relationship with themselves, their emotions, their history, and the people they love.
That kind of work can be difficult to capture within the language insurance companies typically require.
Some of the approaches that have profoundly shaped my work, including Emotionally Focused Therapy, experiential therapies, and parts-oriented approaches, do not always fit comfortably into a model that prioritizes symptom tracking above all else. That does not mean they are ineffective. It simply means that human healing is often more complex than what can be measured on a spreadsheet.
I also think frequently about privacy. Many of the clients I work with hold marginalized identities or navigate complex personal experiences that they do not necessarily want documented within larger systems. In order to bill insurance, therapists must provide diagnoses and maintain documentation that meets insurance requirements. While that process is routine, it is not always something clients fully understand when they begin treatment. For some people, this may not feel particularly significant. For others, it can matter a great deal.
There is another piece of this conversation that I think therapists are often hesitant to discuss openly, and that is sustainability.
Being a therapist is my profession, but it is also my livelihood. Like many therapists in private practice, I pay for my own healthcare, retirement, continuing education, consultation, licensure costs, office expenses, and business overhead. I did not enter this field with generational wealth behind me, and I do not have a safety net that allows me to ignore the financial realities of running a practice.
Beyond that, I believe therapists deserve to be compensated fairly for the work they do.
Therapy is not simply fifty minutes of conversation. It involves emotional labor, clinical judgment, ongoing training, consultation, documentation, and the cumulative impact of sitting with grief, trauma, conflict, loss, and suffering day after day. The work is deeply meaningful, but it is also demanding. The reimbursement rates many insurance panels offer often fail to reflect that reality, particularly in high-cost areas like Los Angeles.
For me, accepting those rates would not simply affect my income. It would affect my ability to pursue advanced training, maintain a sustainable caseload, and continue providing the level of care I want to offer my clients.
None of this means I am indifferent to the accessibility crisis in mental healthcare. Quite the opposite.
One of the tensions I hold constantly is that I believe therapy should be more accessible than it currently is. I wish high-quality, specialized trauma therapy were available to everyone who wanted it. I wish people did not have to navigate waitlists, financial barriers, inadequate coverage, or systems that often seem designed to create obstacles rather than access.
At the same time, I have come to accept that I cannot solve that problem single-handedly by accepting a system that I believe would compromise the way I practice.
Instead, I try to hold both realities at once. I offer sliding-scale spaces in my practice because I believe financial flexibility matters. I advocate for broader access to mental healthcare whenever I can. And I continue to hope for a future where clients can access specialized, relationally focused, trauma-informed care within systems that adequately support both therapists and the people they serve.
Until then, I have chosen to practice in a way that feels aligned with my values. The same values that led me away from institutional teaching years ago continue to guide me today: autonomy, flexibility, responsiveness, and the belief that meaningful healing happens when we are able to fully attend to the human being sitting in front of us.
Warmly,
