Why Is Therapy So Expensive?

Therapy can be living-saving and... extremely expensive. Especially for private pay. Why is it so expensive? Let's break it down and see if we can uncover the reasons why sitting on a therapist's couch for 50 minutes can cost anywhere from $100-$300 per session (private pay rates, CA).

There are many factors at play when it comes to a therapist's rate. Some of these factors include:

1. Their level of experience

2. Their level of education/training

3. Their specialty

4. The cost of living (e.g. therapists in High Cost of Living areas usually charge more)

5. The size of their practice

6. Their marketing budget

Education and Training

First, let's look at what it costs to become a therapist in the first place. All therapists must graduate from a 4-year university with a bachelor's degree AND get either a Masters or Doctorate in counseling psychology, social work and/or a related field that allows for them to seek licensure in their state. That means, at least, 6 years of post-graduate education, full-time. Per US News the average private school costs $38,185 per year and public in-state $10,338. So the cheapest way to get the required education to become a masters-level therapist would be $62,028 with a public school. Sometimes public schools are impacted and/or therapists choose private schools for the educational quality. A private school education would set a masters-level therapist back $229,110 for 6 years of education. If they had to borrow all of that, then their monthly loan payment be for 6 years of private education: $2,297 per month for 10 years. If they chose to go to public school for all 6 years, their loan repayment every month would be $400 for 10 years. These costs are for education only, they do not account for living expenses while studying for 6+ years.

After graduating from their master's or doctoral program, all therapists must complete many hours of internship. During this time, they are considered "associates" or "post-doctoral interns" and they generally don't command the same level of salary as a fully licensed therapist does. Although a therapist can accrue all of their internship hours in 2 years, it generally takes much longer than that due to the specific requirements of the types of hours needed, etc. It's hard to quantify the opportunity cost of being an intern but you can expect intern/associate therapists to be making 50% less than their licensed counterparts. In fact, many intern/associate therapists work for free due to a lack of paid opportunities to accrue hours.

After many years of accruing hours, a therapist must complete a final licensure test (actually two, law and ethics and clinical) to become fully licensed. There are fees associated with this and ongoing license renewal fees as well as continuing education. It's safe to say that the cost of renewing a license and completing continuing education could cost around $1000 every two years.

Specialty

Therapists usually take ongoing specialized training and training is not cheap. For example, Somatic Experiencing, a very well-known therapy costs $10,000 to become certified. To keep up-to-date most therapists engage in training throughout the year (average cost ranging from $200-$2000 per year or more). Having a specialty can require thousands and thousands of dollars to become certified and maintain certification.

Cost of Doing Business

The cost of running a counseling practice will vary based on if the practice is telehealth-only vs in-person, how much marketing is required to get enough people aware that the practice exists, etc. Factors such as the cost of living come into play here because renting an office in San Francisco is much more expensive than in Rockford, IL. Therapists also need to purchase health insurance for themselves and contribute to a retirement plan. The number of clients a therapist sees also factors into their rate. If they can only see 10 clients per week, they may need to charge more per client than if they could see 35. Seeing fewer clients per week means you most likely will get more individualized attention and care from your therapist.

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So these are all of the upfront costs of becoming a therapist and these costs contribute to the rate your therapist charges but the main reason therapy is expensive is because it's valuable. Therapists are providing high-value service to their communities. The most expensive tool in your therapists' toolbox is themselves. When you are paying for therapy, you are paying for all the years of education and training your therapist has as well as their gifts as a therapist. Being a therapist is not easy. It requires your therapist to pay close attention to what you say, how you say it, and how they can best respond to you to help you on your healing journey. Those of us who have had damaging and/or disappointing interactions with therapists know that finding a good therapist is invaluable.

Here's a breakdown of the costs I covered above:

Let's take a hypothetical therapist, Juana who went to a mix of private and public schools for her undergraduate and graduate degrees. She has to pay $1200 per month for her student loans. She also rents a therapy office in Portland, Oregon for $600 per month. She doesn't accept insurance and pays about $500 per month in advertising costs to promote her business. She pays about $2500 per year to become trained in Somatic Experiencing. Her bare minimum monthly cost for running her practice is $2,508 ($45,496 per year). But wait, she also needs to purchase health insurance for herself. Let's say health insurance sets her back another $1000 per month. Contributing to a retirement plan? She's going to have to retire eventually. That's another $1200 per month. So now the cost of being in private practice is $4708 per month. A quick review of psychologytoday.com shows that the average therapist charges about $130 per session in Portland, Oregon. Juana decides to charge $130 per session. She plans to see 20 clients per week for 48 weeks per year (giving her 4 weeks of unpaid vacation), she would make $124,800 before taxes. Take 30% out in taxes and you have $87800, take out the cost of running a private practice ($45,496) and she is left with a yearly salary of only $42,304.

At first glance, $130 per session sounds like a lot of money. As you can see, once you factor in all of the costs associated with being in private practice, $130 doesn't sound so lofty anymore. This may not change the fact that $130 is not affordable to you (the client), right now.

If you can't pay your therapist's private pay rate, there are many options out there that can help reduce the cost of therapy. A few of these are:

1. https://openpathcollective.org/open-path-therapists/ Open Path is a nationwide network of mental health professionals dedicated to providing affordable, in-office, and online mental health care to clients in need.

2. Ask for a list of therapists covered by your insurance

3. Check your local community mental health clinic

4. App-based therapy such as Talkspace and BetterHelp can be more affordable than traditional therapy