Piggy Bank

Years ago, I remember being frustrated and angry when my analyst raised his rates to $139 per session.  I wasn't making anywhere close to that as my hourly wage and felt that the high cost of therapy was turning the process into something that was too heavily focused on immediate results and taking focus away from process and relationship which are really the keys to successful therapy.  I wish my analyst had explained to me the business model of the field as I think it would have relieved a lot of the pressure and, frankly, the resentment I was feeling at the time.

Much like my analyst, I plan on raising my rates in the near future to keep up with the ever rising cost of living in this city which is increasingly pushing out talent and choice in a variety of fields.  It's something I have to do in order to maintain any kind of reasonable lifestyle that will allow me to care for myself in a way that allows me to care for my clients.

The article below does a pretty good job of explaining the monetization of therapy.  (If it were up to me, we would live in a society where 1. Therapy and the exchange of money were not intertwined or 2.  We lived in a society where people were getting their needs met in their social and cultural circles and we didn't need specialized individuals to perform the type of work western therapists undertake.)

The two main costs of doing business this article seems to overlook are the fact that we have to pay for own health insurance and that we also have no paid sick or vacation time.  Cancellations are also a factor unless we choose to charge a client each time they miss a scheduled appointment and we are not able to rebook that time slot.  That, however, is the topic of much debate.  Unlike other medical providers or even lawyers, we have an ongoing relationship with clients that often necessitates weekly sessions for long periods of time.  That's a game changer, in my mind, when it comes to the way we structure our fees and ways of doing business.  That's a lot of money and time invested on the part of our clients and it's reasonable to assume they will need to cancel from time to time, sometimes last minute.  I think it's a personal decision and a business practice decision each individual needs to assess for themselves based on their working model as to whether they charge for cancellations and under what circumstances.  In my opinion, sometimes it's best not to do so for the sake of the relationship, the therapeutic process, and client retention.  Sometimes, if the problem is chronic and one is consistently losing revenue and not making therapeutic process during a very sought after time slot, charging for cancellations may be necessary.

One thing to keep in mind, even when working with therapists out of your network (I choose to remain so, mostly for the sake of my clients), is that your provider will likely cover some of the cost of your session.  I have clients who pay as little as $37 per session to see me weekly in spite of my not being on any insurance panels.

Here is the Talk Space blog post entitled How Much Does Therapy Cost and Why Is It So Expensive, in it's entirety.  At the end, I'll provide a link to the article's location on the Talk Space site.

How Much Does Therapy Cost? (And Why Is It So Expensive?)

empty bank expensive therapy

Seeing a therapist in an office is not affordable for most Americans. This is unfortunate for people who have looked past the stigma of therapy and committed to living happier lives but can’t afford the therapist’s rates. The average therapy session costs $75-150 an hour, and good luck if you live in a place like New York where the range jumps to $200-300.

People who rail against therapy accuse therapists of being greedy, but therapists actually have valid reasons for their high prices. Nonetheless, don’t believe you are stuck paying for therapy you can’t afford. Learning why it is so expensive is the first step toward searching for alternatives and paths to affordable therapy.

Becoming a Therapist Costs a Ton of Money

Think about how expensive it is to hire a lawyer. Clients are hiring someone with years of schooling on the subject in which they invested hundreds of thousands of dollars. It’s the same deal for a therapist — most therapists have postgraduate education and many have a Ph.D. —  but misconceptions about therapy prevent people from seeing it this way. Remember, you are not paying to chat with a friend. You are hiring a mental health professional.

Therapists Don’t Get Paid for Every Hour They Work

When people work a typical 40-hour week, their company pays them for every hour they work. Therapists, on the other hand, can only bill for the time they see clients.

Most therapists cannot manage 40 clients a week, said therapist Sarah Lee. If they fill up all their time with sessions, they would not be able to organize their clients’ information, market themselves and perform administrative duties such as negotiating rates with insurance companies.

Imagine if your company only paid you for 25 of the 40 hours you worked each week. You would need to increase your hourly rate to break even.

Then there are the cancellations, the many cancellations.

When therapist Angela Essary worked as a community mental health counselor, she booked 12 sessions a day but only saw five of those people. 

“It’s a big commitment for clients and there can be lots of no shows,” she said.

Who Pays the Rent for that Nice Office with the Comfy Couch?

expensive therapist office Betty Draper Mad Men couch

Think about how much your rent or mortgage payments cost. OK, now double that and add some more for good measure. This is what many therapists — at least those not affiliated with an online therapy network or firm —  have to do because they have no company to pay for the spiffy office they host clients in. Some buildings don’t even cover their utilities. Then there are office supplies such as the tissues they keep handy and office phones. It adds up.   

The office often costs more than their home’s rent or mortgage payment. They could save money and lower prices by inviting you to their homes and hosting the session in the living room, but that wouldn’t be the most ethical thing.

Therapists Pay More Insurance Too

Getting sued and not having any protection set up in advance is terrifying. Therapists use liability insurance to avoid tread water during lawsuits in case a client sues them. It also helps them maintain their licenses. It’s yet another cost they can’t use a company to buffer. 

Therapist Bradley Foster told Talkspace he pays roughly $600 a year for insurance premiums and dues for therapist organizations.

That’s only one kind of insurance. They may have insurance for their office in the same way people buy renters or homeowners insurance.

Those Certificates on Their Walls Have a Sort of Interest to Pay

framed degrees in therapist office

Therapists don’t stop their education once they receive those fancy degrees you see framed on their office walls. Maintaining a license or certification means investing in annual training such as continuing education fees [CEUs]. Therapists need to keep up with advances in their field the same way doctors need training on new medical technology and treatments.

Some therapists are able to have companies or firms cover their CEUs while others spend more than $1,000 a year on them, said Talkspace therapist Jennifer Fuller Gerhart. Here are some other training and certification maintenance expenses she and Foster mentioned:

  • professional development courses (not necessarily part of the CEU and can cost around $400 per course, according to Foster)
  • therapy-related books for self-study or homework for clients
  • state-licensure fees of up to several hundred dollars a year, varying depending on the state
  • fees for additional credentials tend to cost several hundred dollars a year
  • fees for professional association memberships
  • insurance billing services or payments to an assistant or billing specialist ($500 to $1,000 or more)

Therapists Need Therapists

A good therapist will stay calm during sessions and not show how much the client’s issues are impacting him or her. Still, it’s not like that stress magically evaporates. They need a therapist to deal with it and, as we’ve been discussing, that can be expensive. Also, therapists are normal people, and anyone can benefit from therapy.

And a Supervisor

Most therapists have a supervisor who helps them treat clients, address ethical issues and ensure they follow the rules of the bodies that licensed them. This supervisor is often a more experienced therapist who charges even higher rates.

Therapists pay supervisors directly if the latter are in private practice, Gerhart said, while agencies pay the supervisor if he or she is part of one. These fees can be additional or included in the supervisor’s salary. Online therapy networks pay their therapists for supervision services as well.

Click here to access this blog post on Talk Space's site.