Well, I'm glad you asked...
The question of why therapy is so costly is common and, oddly, often wrought with emotion. It seems like a fairly innocuous topic of conversation. Do you have intense emotions when you buy a loaf of bread or get your haircut? Do you argue with the proprietors and tell them that they are wrong for the prices they have set? The answer should be NO (let’s not discuss the current cost of gas). Yet for myself, and I’m sure countless other mental health providers, customers are frequently hostile, aggressive, blaming and shaming when it comes to discussing session rates. Even as a therapist 'in the know', I still flinch when I hear the fees for establishing a therapeutic routine!
Of course, any time we start to talk about money, passions can flare. Money can be a highly sensitive topic that brings up feelings of shame and guilt; many people were simply taught to steer clear of it altogether. I vividly remember being told that you never speak of politics, religion or money ‘in company’ – lest you fall into an intensely awkward argument where your tipsy uncle eventually storms out of the dining room and quits sending Christmas gifts (and no one wants that!).
These views range from “money is the root of all evil” to “rich people are better than everyone else”. The amount of money in your bank account becomes a direct reflection of your self-worth. We judge ourselves and others by how much we have. When this is the case, it stands to reason that discussing the cost of therapeutic services will provoke deep emotions. On top of this, we’ll sprinkle a little anxiety, depression or PTSD (what is bringing YOU to therapy?) and it is a great recipe for a disastrous conversation and lack of understanding.
I am not saying that therapy is cheap or that you just don’t understand finances. This is merely an overview of some conflicts that I experience as a provider. Hopefully, we can all learn to separate emotions from finances and self-worth, giving us just enough space to fully comprehend why good therapy costs you a pretty penny – and why it is worth it.
YOU GET WHAT YOU PAY FOR
Remember the old adage, You Get What You Pay For? I recall hearing it most often as I drove home from the local barber college, crying hysterically and shuddering every time I caught a glimpse of my Lloyd Christmas haircut in the rearview mirror. My friend, Jennifer, would talk me off the ledge, reminding me that it would grow back quickly and chastising me for never spending more than twelve dollars on a hairstyle. “Well, what did you expect?”, she would say through my tearful hiccups.
Similarly, I have one pair of handcrafted leather cowboy boots that I dropped a couple hundred dollars on. At the time, it was an ungodly amount for a struggling student, but they were gorgeous, and I NEEDED them. That was 15 years ago, and they are still gorgeous and comfortable and useful. I have spent well over their original cost on crappy shoes over that time. Wouldn’t I have saved money if I had just invested in a few expensive, well-made shoes instead of tossing out dozens of poorly crafted inexpensive shoes in that same time span?
On the flip side of this, we find that things with low estimated value do not elicit the same sense of reverence. I love my boots, but I let a puppy chew on my plastic slides. Things that are free can easily be seen as having no value. I will shrug my shoulders and toss aside a t-shirt given to me by a bank promoting a credit card. But the $25 tee I searched for like a treasure? I am wearing that bad boy ‘til the pits stain yellow. My investment fuels my commitment.
INVESTMENT PROMOTES COMMITMENT
Early in my career, I was contracted with the local mental health department. The amazingly dedicated and compassionate providers that worked for the county had become burned-out and overwhelmed and looked to farm out referrals to local private practices. I was one such provider that took on these referrals and felt happy to do my part in ‘giving back’ to my community by working with a new population. What I found was quite interesting; they didn’t show up.
In the years that I worked with this population, I experienced more ‘no-show’ appointments than ever before – or since. When asked, every client had a legitimate reason for not attending sessions consistently. There is a host of valid excuses for bailing on a session; I get that! BUT, clients that have invested their own hard-earned income into paying for a service, are much more likely to treat that service with a certain level of care and respect. Knowing that I am on the hook for a hefty chunk-o-change should I not attend a scheduled appointment, definitely motivates me to get there! Hence, therapists' no-show fees.
SO, DO YOU MAKE A LOT OF MONEY?
I could. I want to.
But will I?
As a child I had a rock stand. Not Kool-Aid or lemonade - rocks. It wasn’t greatly lucrative, but it was pure profit. I’d find a pretty rock and I would sell it. What an ingenious business model. No overhead! Why doesn’t every business run this way?
Unlike my rock stand, my current private practice provides an experience in a way that is most conducive for your emotional growth (at least that is the intent). It takes investment on my end to provide you with what you see on your end. The price of therapy reflects the price it costs to do business.
While I could push myself to earn more money by obtaining further degrees and certifications, seeing more clients during the week, writing a book or putting on lectures and seminars, I am happy with how many people I currently work with. My schedule allows me to spend more time with my daughter while earning enough to pay my business and personal bills. I earn just enough to do this and put aside a small amount for savings (and taxes!) while not charging an outlandish fee for service. And I am really proud of the balance I have struck.
WHAT AM I REALLY PAYING FOR?
Therapists do not set their rates based on greed. In fact, most therapists that I know feel guilt every single day because they believe they should be doing more for their clients. I wrestle with the thought daily of accepting insurance so that I can expand my services to people in need. (The reason for this is a whole ‘nother discussion topic!). Every provider I know is a caring, generous, kind and authentic person. They did not go into this field to get rich.
Like teachers and firemen, therapists genuinely want to help. But does that mean that they should be expected to do their jobs for free or at a sacrifice to self and home? Absolutely not. Yet many customers assume that the bleeding-heart mentality of a helping professional means that they should give you something for nothing – out of the love in their heart. Well, you ain’t payin’ for love. You are paying for a highly skilled and educated service.
I am a Master’s level therapist with a state license to practice. That required a huge investment on my end and I am drowning in student loan debt. Licensing requires yearly fees as does the thousands of dollars I pay for continued education and specialized training to keep my skills fresh or certifications valid.
While many therapists switched to strictly online sessions during the pandemic, I found that many clients wanted to get back to the face-to-face intimacy of individual work, so I maintain an office space. While I could save thousands of dollars a month in rent and utilities, I love my workspace and know how much my clients appreciate the safe, comfortable environment I have provided.
The office utilities are typical, if not expensive, but it is the hidden utilities I did not bank on; HIPAA approved software for telehealth sessions, notetaking and payment processing (who also take a 3% fee for every payment I accept), along with the various insurances required for being in practice. I have to rent a PO box and pay for my website, domain name and various marketing costs. I also purchase books and tools and journals to dole out to my clients should they need an extra prompt between our sessions. It all adds up to a mighty high price tag for me – which means I have to earn a base amount to simply keep the lights on, so to speak.
You, my lovely clients, help me to keep those metaphorical lights on by agreeing to pay my required fee for service. I am grateful to you and like to think that it is reciprocal; you help me to feed my family and buy new shoes (moderately priced, of course), and you get the very best up-to-date and genuinely compassionate treatment that money can buy. It’s a win-win!
THE PRICE IS RIGHT
The takeaway is this:
When searching for a therapist or setting your own rates as a provider, remember my motto:
Good shoes aren’t cheap & cheap shoes aren’t good.