NOTE: This article was originally published in Therapy: A Sneak Peek Inside, a column in Binah Magazine.

I have a hard time charging for my services.

A client comes in to my office. And very soon it’s obvious that the fee for each session is difficult to come by. And inside, it hurts me because I know that it may take a few weeks, even a few months, and sometimes a few years, to address the issues that bring the client into my room. I know that money is needed for yom tov clothing, for a night out with a spouse, for a birthday present for a child. And often, if I feel the client may be receptive, I gently say, “You know if money is tight, you can go to an agency and obtain a therapist there. It won’t cost you anything because they will take your insurance, your Medicaid or Family Health Plus. Or at the minimum, it will be affordable if you don’t have any insurance at all.”

But for the most part, my clients refuse to even entertain the idea.

Sometimes, when approached by a rav, a principal, by a concerned neighbor, I encourage them to try to convince the shul member, the student, the family, to find a therapist at an agency, so that the Bikur Cholims, the neighbors, the school, should not have to be burdened with therapy that can be obtained for free. And I don’t think I have ever been successful.

But now, I have a forum, and I will try once more to educate our community to therapy done in clinics and agencies versus that in private practice. And even though I may get angry letters from colleagues, from the agencies themselves, or even from my own clients, I must speak out.

I can speak because I worked in an agency before I went into private practice. And I was a very good therapist there and helped many people. And they got my services for free.

Here is what I can tell you about an agency:

There are many rooms and many therapists, and there is a waiting room where you wait until your therapist calls you into the room. And if you come pretty much on time, then the wait is also pretty short. Although yes, your privacy is compromised because there are other people sitting there and they may see you.

And it is true that therapists in an agency can be less experienced than those in private practice. And sometimes you may get an intern (a student therapist who is still in school, before graduation), and that intern may leave at the end of the school year if they need to move on to another internship or because she/he was offered another job someplace else. True.

But I can tell you that as an intern and then as a new therapist, what I lacked in experience, I made up for in voracious reading and accessing constant supervision. I made up for my inexperience with my idealism and desire to help. And when I was an intern, legally, I informed my clients of my status, and none of them turned me down. Although it is in your right to request not to be assigned an intern and your request must be honored.

For the most part, the most important aspect of therapy is the relationship between client and therapist. Without the therapeutic alliance, no intervention can be successful (unless pure CBT is used); so yes, the intern and new therapist may know less, but armed with her ongoing education, access to frequent supervision, and an awareness of her limitations, she can still deliver adequate, and even superior therapy if she uses her most important tool which is the therapist’s self.

And really, there are quite a number of dedicated, seasoned therapists working in a clinic, apart from the new ones. Wonderful, professional therapists, who sometimes also have a private practice apart from their work at the clinic!

A crucial benefit of receiving therapy in an agency is the umbrella under which a client is treated that there can be collaborative work among therapists treating different family members, community and government resources can be accessed, and there is a system of checks and balances that protects the client.

A drawback is, as we said earlier, a drop less privacy, and also extensive paperwork that is required on each client. After each session, there are notes a therapist must write, and there are treatment plans that must be written up. Both of these are done in private practice, but not necessarily in such detail (but that would depend on the individual therapist as well). Treatment plan can be verbally agreed upon and notes legally need not be lengthy. But in any case, you can ask to see, or write those notes together with your therapist at an agency; to have some measure of control of what enters your chart.

As a therapist in private practice, I have noticed that paying a therapist each week sometimes facilitates improvement in functioning much more rapidly than when no payment is required. But I have also noticed how the drop-out rate is also higher when parents refuse to continue paying for therapy and the teen or couple is left hanging, with more damage done than good when therapeutic relationships are severed prematurely. People stay in therapy for a shorter duration, almost as soon as they obtain relief of their symptoms; when at an agency, they will continue longer to obtain the complete benefits of therapy because they are not pressured with payments.

I would be remiss to address the obvious: therapists in private practice often have specific areas of expertise and skills that make their services invaluable. Yes. However, sometimes in an agency, there are specialized therapists as well. You need to ask.

If money is not an issue, then yes, seeing a therapist in private practice can be preferred. But if money is difficult, paying a therapist weekly, especially when multiple family members need therapy, then the relief of not having to pay facilitates change in ways that the pressures of paying can undo.

I have seen both sides of the coin. There are no easy answers. But there are good questions you can ask to make your decision the right one.

My book, Therapy, Shmerapy, can be found in bookstores or online