Why Is Therapy So Expensive?
You finally decided to seek out therapy and work through the depression, anxiety, trauma, disordered eating, low self-esteem, or whatever else has been preventing you from living a full, productive life. You researched experts in your area, scoured their websites, and finally picked one that seemed like a good fit. In your first conversation, the therapist tells you their hourly fee—likely somewhere between $75-$250 or even more per weekly session, AND they don’t take insurance—leaving many clients to wonder, why is therapy so expensive?
This subject is rarely discussed in therapy sessions even though the issue of money is always present with us in the room. It may seem like your therapist randomly picked a fee, but if you’re like most people it feels uncomfortable to ask where this number came from. My hope is to break down and demystify therapy fees a bit so you know what you’re truly paying for.
Education and Training
While there are many paths to becoming a therapist, most require at least a master’s degree and several thousand hours of clinical work under the supervision of another licensed provider. Like many professions, student loans loom large for most therapists.
Many clinicians also pursue post-graduate training in different specialities (such as eating disorders) and treatment modalities (such as Cognitive Behavioral Therapy, Psychodynamic Therapy, Acceptance and Commitment Therapy, etc.). The fees to maintain our licenses and obtain required continuing education credits quickly add up as well.
There is also a lot of work related to your therapy that happens outside of session. As a specialist in disordered eating and body image, many of my clients track their behaviors and feelings related to food and exercise, which I review in between our weekly appointments. For complex cases, I consult with peers and other healthcare providers, as well as read and research heavily on best treatment practices.
After each session with every client I write a clinical note. Of course therapists must also field calls and emails about scheduling and handle billing and bookkeeping (or pay someone else to do these tasks—which costs money!).
That’s not to mention the overhead costs associated with running a therapy practice. In addition to rent and office supplies, many therapists purchase specialized software for billing and notes. We also pay for professional liability insurance and some additional types of insurance to protect ourselves and our businesses.
Marketing costs such as building and maintaining a website, headshots, paying for listings in online databases—it all adds up. Memberships to professional organizations that help keep us up-to-date in the field can total several hundred or thousand dollars a year. Remember that reading and research I mentioned? Academic books and articles are pretty pricey, but necessary to provide the best treatment.
Insurance vs. Private Pay
For many therapists, it is a big decision whether or not to take private insurance. Many, like myself, opt not to work with insurance companies because of the lack of privacy for clients. Insurance companies require you to be labeled with a diagnosis which becomes part of your permanent record. The insurance company can also request updates on your progress in treatment in order to decide whether to approve you for more sessions.
When you pay out-of-pocket for therapy, you get to pick the provider who is best for you. Together you can decide together how long treatment lasts and what it looks like.
Therapy is an Investment
Therapy is so much more than just listening to someone vent. It’s an active, collaborative process informed by the therapist’s training and experience. If you consistently show up for your appointments, roll up your sleeves and tackle the hard stuff, you get much more than just 50 minutes’ worth each week—you get a lifelong transformation.
Of course, none of this negates the fact that the lack of access to affordable, quality mental health care is a huge problem. Many therapists like myself offset this slightly by offering a sliding scale to a limited number of clients who can’t afford the full fee, but this does not even begin to address the systemic issue.
Hopefully this helps clear things up a bit, but if you still have questions about your therapist’s fee, you should absolutely talk to them about it!