A Revolutionary Approach to Clinical Services
Let’s talk about the elephant in the therapy room: money.
As clinicians, we’re taught to be accessible, compassionate, and ethically bound to do no harm. Somewhere along the way, that message has been twisted into a silent expectation that we should sacrifice our own financial stability to meet every client’s need—regardless of our own.
We’re one of the only professions where offering a sliding scale is seen not just as generous, but expected. All the while, insurance companies reimburse us on the lower end, demand extensive documentation, and even issue audits and clawbacks—often without recognizing the labor behind our care.
And yet, many of us keep doing it. Why? Because we care. Because we know the systemic barriers our clients face. Because we want to be part of the solution. But what if being part of the solution doesn’t mean undercharging or overextending ourselves?
What if we could serve our clients AND ourselves—ethically, effectively, and sustainably?
Understanding Clients Through the Lens of Maslow’s Hierarchy of Needs
The deeper I dive into trauma-informed, culturally responsive care, the more I realize: not all therapy clients are coming in at the same starting line. And if we’re treating everyone with a “one-size-fits-all” weekly therapy model, we might actually be doing harm.
Let’s revisit Maslow’s Hierarchy of Needs—a psychological theory that organizes human needs into five levels:
Physiological Needs: food, water, shelter, sleep
Safety Needs: stability, employment, health, safety from harm
Love & Belonging: relationships, community, connection
Esteem: self-respect, recognition, achievement
Self-Actualization: purpose, fulfillment, personal growth
A client who’s in survival mode—unsure where their next meal is coming from or how they’ll make rent—is operating from the bottom of the pyramid. They need stabilization, not deep trauma processing. Their nervous system is in survival mode (fight, flight, or freeze). What helps them most in that state is support that strengthens their locus of control, emotional regulation, and daily functioning—not high-insight psychodynamic work.
On the other hand, a client who is securely housed, employed, and relationally supported may have the cognitive and emotional bandwidth to work through grief, trauma, identity, or legacy burdens. They are more likely to benefit from weekly or biweekly therapy.
Mental Health As a Ladder
I always explain to clients: “Imagine mental health being a ladder and every rung is a different level of care. Sometimes we need to go up the ladder and other times we need to go down the ladder.”
I let my clients know I am always assessing to determine whether I am still within their scope of care and if not, I will make it my business to guide them to the next level of care or therapy modality that would fit best for their needs.
It’s about informed decisions, empowerment, and a deep focus on the client’s needs. That’s one way we, as therapists, can liberate ourselves from the pressure and expectation of being all things to everyone.
Therapy Isn’t Always the Answer—And That’s Okay
We need to normalize the idea that not every client is ready—or needs—to sit in therapy weekly. Some would benefit more from:
Peer support groups
Case management
Group therapy
Trauma-informed yoga or somatic movement
IOP/PHP-level care for stabilization
Workshops that focus on executive functioning and life skills
And here’s the game-changer: when we properly assess and refer out, we’re not “giving up” on the client—we’re elevating their care.
That mindset has shifted everything for me—and for my clients. Because the goal isn’t to keep them in therapy indefinitely. It’s to equip them with the tools and support they need at the right level of care.
Stop Over-Functioning: Your Job Isn’t to Be Everything to Everyone
One of the greatest disservices we do as a profession is under-treating clients by offering standard talk therapy when they truly need more intensive support. And at the same time, we may over-treat those who no longer need weekly care but feel guilty for stepping back.
Our ethical code doesn’t just ask us not to cause harm—it asks us to avoid overtreatment, burnout, and misuse of services. Many of us attended graduate programs that didn’t fully prepare us for this nuanced work. We left under-informed or miseducated, navigating systems that never taught us about levels of care—or how our own money trauma might keep us looping in scarcity and overgiving.
What if we reclaimed our role as gatekeepers of care rather than catch-alls for suffering?
As therapists, we can liberate ourselves from the pressure to be a one-stop shop. That’s not ethical. It’s not sustainable. And it’s not in the best interest of our clients.
Let’s Expand, Not Just Multiply
If we want to see a shift in this field, it starts with redefining the model. As one of my former directors once said: “If we hired 100 counselors, we’d need 100 more.” That line stuck with me.
What if the answer isn’t always more therapists—but more informed models of care? What if we re-educated clients on what therapy actually is and empowered them to climb or descend the ladder when needed?
When we approach therapy from this layered, ethical, and informed lens, we build a preventative care model. One where clients don’t wait until crisis to reach for support, and therapists don’t carry the weight of fixing everything.
Let’s re-educate our clients. Let’s reframe mental health support as multi-tiered. Let’s build a continuum of care that acknowledges where our clients are and meets them there.
Because here’s the truth: Not all therapy is created equal. And not all therapy needs to be done 1:1 in a 50-minute session.
A Call to Clinicians: Rise Up the Hierarchy
My hope for our profession is that we, too, get to rise up the hierarchy of needs. That we shed the guilt, shame, and burnout of being underpaid, overworked, and emotionally exhausted. That we heal our own money wounds. That we feel supported enough to say, “This client needs something beyond what I offer—and I trust myself to guide them there.”
That’s revolutionary care, sustainable practice, and clinical integrity.
Are you a mental health professional seeking to align your practice with ethical and sustainable approaches? Contact us today to learn more about our clinical supervision services and how we can support your journey.
