Money Matters

From overspending and avoiding bills to hiding a secret bank account from a spouse, many people have a complicated — and often fraught — relationship with money, shaped in part by messages about spending and saving they absorbed as children. Choices around earning, spending and saving can trigger feelings of shame, guilt or obligation, creating a cycle in which every financial misstep feels like a personal failure.

A 2025 NerdWallet survey found 51% of Americans regularly stress about money, with women (56%) more likely to worry than men (45%). For some, money-related anxiety can be especially acute as the new year kicks off, bringing with it not only resolutions and commitments to positive change but also hefty post-holiday bills, annual expenses and unwelcome reminders of the upcoming tax season.

Enter financial therapy. The relatively new field seeks to uncover and disrupt unhealthy money habits that can trap people in cycles of stress and shame and set them on a path toward greater control and confidence with their finances. The field gained traction in the 1990s, then again during the global financial crisis in 2007 and 2008, with the founding of the Financial Therapy Association. Financial therapy combines emotional work with practical strategies for managing finances, using techniques from across disciplines, including psychology, marriage and family therapy, social work, financial planning and accounting.

The Emotions Behind Money

Chicago-based Eric Dean, JD, MBA, LPC, chief operating officer and chief technology officer at Front Door Health, worked in financial services for four years before pivoting to counseling. Early on, most of his counseling clients were people struggling with addiction, depression and anxiety. When money matters kept creeping into sessions, he found a mentor at the Financial Therapy Association and started to offer financial therapy seven years ago.

“It turns out that a lot of people really need help managing the emotions that are associated with money,” he says. That’s especially true today, he adds, given economic uncertainty, job losses and persistent inflation. “There’s just lots of nervousness about the future, about making mortgage or car payments, or if investments will be enough to pay for kids’ college tuition.”

Financial therapists work with individuals and couples on issues such as taking on or paying down debt, managing credit card or student loan balances, reconciling differing money attitudes, and addressing “financial infidelity.” Some have clients come to them specifically for financial help, while others weave it into sessions focused on issues such as depression or eating disorders.

Aja Evans, LMHC, president of the Financial Therapy Association, says financial therapists are vital because people don’t talk enough about money. In some families and cultures, discussing money is considered taboo, leaving people without the language, confidence or basic knowledge to manage their finances effectively.

The Personal Finance Index, a longstanding survey measuring Americans’ financial knowledge, finds only 4% of adults can correctly answer five questions covering borrowing, saving, investing and insurance — and they especially struggle when it comes to understanding financial risk.

“We’re working for money but not talking about the deeper, harder, secretive parts of money,” Evans says. “And that’s so important because with a fluctuating economy comes stress and anxiety. Grocery bills are up; gas bills are up. People are wondering, ‘Am I mismanaging my money, or is this something other people are feeling, too?’”

Shame and guilt around past financial mistakes are the top emotions Evans sees with her clients. Many people come to her avoiding looking at their credit card statements or bank balances altogether because it’s too daunting.

“And it really doesn’t matter how much money you have,” Evans adds. “When you think about financial therapy, you may think about it in terms of a scarcity, but people can feel this way with a surplus of money, too.”

Dallas-based addiction counselor Heather Lowrey, LPC, LMHC, CSAT, says financial conflict with couples, in particular, has become more acute over the decades as the average age for a first marriage has climbed. “Financial conversations that used to happen at 23 are happening at age 35 or 40 when people already have debt,” she says.

Lowrey has worked with plenty of people with poor boundaries who loan money they don’t have. Some people avoid getting into a relationship because of the shame of their debt and come to her to get it under control. “There can be this vulnerability when you open up your bank account to somebody,” Lowrey says, “even more vulnerability than when people start having sex with each other.”

Strategies with Clients

A first step for Lowrey, with both her individual and couples clients, is harm reduction or “stopping the bleeding.” She focuses her practice on issues that include emotional spending and relational conflict around money and financial avoidance, delving into the beliefs and emotions that are driving unhealthy patterns.

“We have a conversation about what a typical week of spending looks like, what behaviors are happening right now that could be contributing to more debt or distress, and I ask about their current level of financial distress,” she says. For example, is a client a few months behind on their rent or their mortgage payment?

For Evans, it’s important to gather an in-depth history from clients that zeroes in on money messages they recall from childhood. Then, together, they explore how those messages might be driving current behaviors around money. For example, perhaps a client maintains a hefty emergency savings account because their mother did and it made them feel safe but it’s getting in the way of the client’s financial goals.

“Once we identify the patterns, we look at what you’re trying to do with your money.” For the emergency fund example, work could entail helping the client figure out what safety looks and feels like and how much money they need to feel safe.

Then she helps clients create a goal-based plan that shifts them out of old patterns, replacing old behaviors with new ones. Evans uses grounding exercises, breathwork, meditation and positive affirmations during sessions, and she works with clients to brainstorm activities they can engage in when money triggers them, such as journaling.

Dean uses cognitive behavioral therapy, psychoeducation and motivational interviewing, an approach that uses empathy and open-ended questions to help people identify and resolve ambivalence about change. He listens to how clients talk about change to discover which of the five stages they’re in (precontemplation, contemplation, preparation, action and maintenance), then helps them move forward or maintain.

“Say you make $1,000 a week and want to save $300 instead of $200,” he says. “How motivated are you to do that? We’re looking at what drives them.”

As a certified Gottman therapist in Colorado, Jennifer Dunkle, LPC, CGT, incorporates Gottman Method Couples Therapy techniques into sessions in which she helps partners navigate differing attitudes toward money, conflicting habits around spending and saving, and problems with power dynamics. “The average therapist more often than not tends to be uncomfortable talking in depth about money,” which makes financial expertise a valuable asset, Dunkle says.

She asks clients to share their own “money story,” the personal history, beliefs and emotions they bring to financial decisions. She may use questions such as “What three adjectives describe your relationship with money?” She says, “This often provides clients with new insights.”

Dunkle explores Gottman communication concepts such as the Four Horsemen of the Apocalypse (four destructive communication behaviors in romantic relationships: criticism, defensiveness, contempt and stonewalling), Dreams Within Conflict (the idea that beneath recurring arguments lie deeper personal dreams or core values that feel threatened) and the Art of Compromise (skills couples use to find a middle ground). The Klontz Money Script Inventory is useful for uncovering underlying beliefs about money, Dunkle adds.

Dean likes to ground his client sessions in values and goals. A couple might disagree about how much debt is too much, but they both have the goal of funding their child’s college education. “It’s about finding ways to connect the couple in spite of their different views,” he says. “The main thing is creating a safe space for couples to talk about these issues because sometimes they’re just not talked about at all. Bringing all those feelings to the table and getting them out can be a big relief.”

Breaking Down the Balance Sheet

Most sessions include a review of clients’ detailed finances, including bank accounts or credit card statements, or budgeting app data. Counselors don’t have to be math whizzes, though, and they don’t give clients financial advice.

“A lot of times people just can’t figure out a system for managing their money,” Dunkle says. “Their finances happen — they’re not in charge of it or planning. It’s reactionary.”

She has clients create a net worth statement, examines spending habits with them after they track spending for a month (without dwelling on the past), and helps them make and maintain a budget that includes saving and allows for enjoyable activities. “I tell people, it’s not about what happened in the past, but what you want to happen in the future.” She refers clients looking for investment advice to certified financial planners.

“I’ve received many an Excel spreadsheet,” says Dean, who reviews his clients’ debts, incomes and assets. “We get the big financial picture and zoom in on areas causing you the most stress. We also talk about areas of your finances you’re proud of.”

Sessions typically include some sort of financial education or literacy as well. “Not everybody knows what a high yield savings account is, for example,” Evans says. She often shares her own history and relationship with money, where appropriate, including how she still has student loans, yet is a successful professional.

“That can be really helpful for people to know,” she says. “But you have to be mindful of your boundaries. Another therapist may not want to share. It’s also really important to understand where you’re at with your own relationship with money.”

Being cognizant of your clients’ cultural backgrounds and family dynamics is also important, she adds. Most of her clients are people of color who come from families in which financial support is not only common but often expected.

Dunkle likes to recommend resources that aren’t shame-based, which is often the case when it comes to money books. Mind Over Money, The Behavior Gap and The Joy of Financial Security are great books for both clients and counselors, she says.

Getting clients over the hump of avoiding their finances and giving them the right tools and enough confidence to get started in managing their money is powerful, Lowrey adds. “Most of the time, I see people stay engaged, get excited, even gamify it,” she says.

Compensation Structures and Logistics

Typically, third-party payers do not cover financial therapy sessions, as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision™ lists just one finance-related condition: gambling disorder. So, financial therapy is mostly cash-based.

Some counselors, like Lowrey, work with employee assistance programs, which are employer-sponsored programs that offer free or low-cost confidential counseling for employees dealing with personal issues such as financial problems.

A crucial consideration for counselors considering adding financial therapy to their services is to hold firm boundaries when it comes to payment, Lowrey says. Because such counselors intimately know their clients’ finances, “it can be tempting to give a discount or to overlook late payments when you know someone is struggling,” she says.

Lowrey holds firm to the idea that if people are coming to her for help, there’s the expectation they’re going to have to pay for her service on time like everyone else. “It’s really the counselor’s job to model those boundaries for clients,” she says. “It’s about valuing yourself as a professional. You can’t help people if you’re not in practice.”

Dean views financial therapy as an expanding field, one that’s poised for more research and evidence-based approaches. “Money is just a huge stressor,” he says. “You’re going to have clients who are struggling with money situations. So it’s just really good to get that experience.”