No One Gets How Hard It Is to Reach a Therapist’s Office

I could barely make my appointments, yet two to three times a month, I showed up to counseling fighting symptoms having taken a $7 cab ride through Cumberland’s Willowbrook Road. My goal was to avoid a mile-long hike—or full-blown overheating, but since I hoped to save money, I missed a string of appointments. To this day, I have no memory of being officially terminated.

My transportation woes placed me in a category with millions of U.S. adults. More than 1 in 5 adults in America face transportation barriers to accessing health care. The issues, according to the Rural Health Information Hub, include long travel distances, limited public transportation, and stigma—only locals who fear being identified at a behavioral health clinic understand.

Transportation barriers also affect behavioral health clients indirectly. We see this in the rise of workforce shortages. In 2025, there are fewer mental health workers in rural communities, yet approximately 37% of the population live in areas with limited clinicians. Adding to the to-and-from conflict is the prevalence of low-income families. Who can afford to travel to biweekly appointments? I was fortunate enough to live within minutes of my provider’s office, but in small towns, reaching even nearby locations is impractible. From unpaved roads to narrow, gritty shoulders, to lengthy distances between bus stops, the facts of life force people into expensive ridesharing options. Such alternatives shrink therapy participants’ bank accounts and make attending sessions a nightmare that never seems to go away.

And it’s not only about money. Some clients experience guilt as their attendance fluctuates. Take the perceived failure to prioritize counseling, then add in a difficulty coping with long transits. Suddenly, therapy participants may begin blaming themselves, especially if symptoms reappear. They may worry about their cancellations disappointing their therapists. The risks create fear that limits their potential.

Yes, clinics offer resources. Mobile options exist. But recipients may be skeptical. They may have boundary issues or be overwhelmed by in-house conflicts. They may need separation because at-home options stir up anxiety. But a behavioral health clinic meets the needs of dozens of clients. Adapting to those without transportation isn’t a priority.

There are, however, opportunities. Comprehending therapy is important. Mental health literacy helps clients realize the consequences of not finding transportation. Sessions are administered in four separate phases: assessments and intake, process and intervention, change, and maintenance. In the first phase, individuals learn about their emotional conflicts, so skipped appointments add to the length of treatment (consistency is essential to therapy). As for intervention, transportation troubles hit harder. Cognitive-behavioral therapy is a time to identify negative thought patterns, but this process takes weeks. Here, confusion results from missed appointments, an outcome that increases the risk of relapse.

The remainder of the process is equally impacted. The change stage is where most hard work happens, but change can’t occur without an engaged, present client. Engagement—and self-awareness—are why clinicians give homework, but unreliable transportation leads to distractions that interfere with growth.

Issues with transportation may arrive during the maintenance phase, and at a time when not acknowledging achievements creates missed opportunities. Sessions with lower engagement. Meetings that need continuity. Frequently, clients are forced out feeling incomplete. Should lining up rides in the future remain impossible, so, too, does the frustration and sense of failure.

Simply, transportation barriers lead to regret. Substantially more so following repeated dropouts. Consequences are rarely identified but appear almost immediately. Some clients face an ultimatum—move or give up. And since cities create transportation obstacles of their own (think: jam-packed streets or pedestrian hazards), more reasons exist for why Americans can’t get to their therapist.

Perhaps all of us stand to gain by understanding the stakes. Gone is the chance to recall intimate details of a session. Gone is the feeling of connection that people draw from multiple appointments. Gone is the feeling of enlightenment that comes when one works routinely with a counselor. Replacing these joys is the belief that therapy is nothing more than talk, resulting in exits and terminations, and more people in need of support.

No one may know how many clients were lost, but dismissing the problem won’t work. In the future, perhaps desperation will, but one can only travel so far for help.

Kevin Brown writes on mental health, addiction, and self-improvement. Read more great stories and follow Kevin’s journey to raising mental health awareness at www.kevinbwriting.com