Reader,

Last week I invited you to question whose ethics we practice.

That conversation began with one of the very first questions ever submitted in Community Liberation Sessions:

Last week, I questioned the framework.
This week, I want to wrestle with the question itself.
And my answer is probably unsatisfying: it depends.

On the surface, offering a sliding scale seems like an obvious act of justice. Lowering financial barriers matters. Therapy can be expensive, and many people have been systematically excluded from accessing appropriate mental health care.

At the same time, I don’t think accessibility begins and ends with price:

• Universal healthcare would improve accessibility.
• Living wages would improve accessibility.
• Disability justice would improve accessibility.
• Immigration justice would improve accessibility.
• Affordable housing would improve accessibility.

Sliding scales matter. They are simply one response inside a much larger landscape of systemic inequity.

So if you’re considering offering reduced fees to a community experiencing systemic marginalization, I think the question becomes bigger than “Should I?”

It becomes: “What kind of support am I actually offering?”

Because affordability is only one part of care.

Another part is whether someone feels understood.
Whether they have to explain racism, transphobia, ableism, migration, colonialism, fatphobia, or religious discrimination -to name a few- before therapy can even begin.

Whether the clinician they’re seeing understands enough to avoid recreating the very harms that brought them to therapy in the first place. And whether the clinician understands themselves enough to not fall for saviourism.

That doesn’t mean therapists should only work with people who share their identities.
It does mean we should remain deeply honest about what we know, what we don’t know, where we need consultation, and when someone else may genuinely be a better fit.

That honesty is part of ethical practice too.

One of my concerns is that financial barriers can inadvertently narrow people’s choices.
Sometimes people don’t choose the care that best fits their needs.
They choose the care they can afford, and that isn’t a personal failure.

It’s what happens when survival shapes healthcare decisions.
And when that happens, I think we carry an additional responsibility.

Not to become everything for everyone.
But to be transparent about what we can offer, where our limitations are, and when another clinician, elder, community healer, cultural practitioner, peer specialist, spiritual guide, advocate, or organization may be able to support someone in ways we cannot.

Because informed consent isn’t only about risks and confidentiality.

It’s also about helping people understand the scope of the care we’re able to provide.

For me, that’s what this conversation is really about.
Not whether sliding scales are ethical.
But whether we’re willing to practice with enough humility to recognize that reducing one barrier doesn’t automatically remove all the others.

Accessibility matters. But so does accountability.
And liberatory practice asks us to hold both.

I’m curious: Have you ever realized that the “help” you wanted to offer wasn’t actually the help someone needed? What did that teach you about practicing with humility?

Hit reply and let me know. I read every response, even if it takes me a little while to write back, and I genuinely appreciate the reflections you trust me with.

With much liberatory care,

Silvana

​​Liberatory Letters | The Practice of Liberation | Decolonize Your Practice​

PS.
​These are exactly the kinds of conversations we bring into Community Liberation Sessions. Not to arrive at universal answers, but to think together about the tensions, contradictions, and ethical gray areas that rarely fit inside a code of ethics. If you're craving a space where complexity is welcomed instead of rushed toward certainty, I'd love to have you join us.
​Community Liberation Sessions (last one of the year):
​BIPoC clinicians: Aug. 5 — 1pm PT / 4pm ET
​White clinicians: Aug. 6 — 1pm PT / 4pm ET

PPS.
​This month in The Practice of Liberation, I’m asking a question that has been following me for years: What if the diagnosis isn’t the whole story? I wrote about my own experiences of being diagnosed with depression, and how much of that depression was a reaction to systemic oppression.
If you’ve ever wondered where the line between mental health and social conditions actually lives, I think this letter will stay with you.
Subscribers also receive reflection prompts, a 10-minute embodied practice, and this month’s book recommendation. And you get access to all previous POL issues.

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