Why is Therapy So Expensive?

There’s no other way to slice it: therapy is expensive. In a world where financial stress already applies a steady strain on our mental health, finding the extra means to commit to regular therapy sessions can feel like an impossibility. And, unfortunately, this poses a sort of cruel irony: the people who are arguably under the greatest amount of stress, who would benefit most from quality mental health treatment and support, face the greatest obstacle to accessing that care. 

Being a Therapist is Expensive

On the other side of the equation, many therapists are also struggling financially. To commit oneself to becoming a licensed therapist, one must complete four years of undergraduate study, and at least another 2 ½ to 3 ½ years of master’s or doctoral-level education. While completing this education, pre-licensed therapists are expected to manage close to full caseloads while training under supervision as unpaid interns. 

For many burgeoning professionals, this often means balancing the demands of family, their academic requirements, and their clientele, all while maintaining sources of income to make this waiting period sustainable. 

And then, when therapists graduate and obtain their first level of licensure, they find themselves encumbered by student loan payments, while earning lower associate rates as they work to complete ~3,000 hours of supervised practice to become fully licensed. During this time, therapists are expected to maintain their licensure status through completing continued education credits (which often cost money), while also being faced with the reality that if they’d like to serve a niche population or offer specialized services, they will need to invest in further training. 

The Sustainability Problem

Within this context, many therapists look for ways to make their profession more sustainable. While many therapists choose to accept insurance, this decision can pose a multitude of issues impacting both therapists and their clients, such as: inconsistent or low reimbursement rates, which often require therapists to see large caseloads to make a reasonable living, which can become unsustainable or lead to burn-out, compromising patient care; income clawbacks; requiring a diagnosis to receive coverage; putting a limit on the number of sessions covered or the modalities that can be used; requiring access to patient notes; and more. 

Alternatively, many therapists opt to bypass insurance panels entirely and offer self-pay rates. In doing so, therapists are granted greater autonomy over their rates and the services they offer, allowing for a modest caseload that optimizes for greater individual attention to each client’s case. 

However, this decision necessarily makes therapy more expensive. While many self-pay therapists offer out-of-network billing, sliding scales, pro bono slots, and other tools to make therapy more accessible, many clients, understandably enough, prefer to use the health insurance they already pay for. 

There is No Right Answer

All this is not to say that there is a correct way of doing things. Every therapist must decide for themselves what direction is sustainable for their business (and personally), what aligns with their ethics, what accurately reflects their training and expertise, and what is feasible in the area they practice. 

While many therapist business coaches provide blanket, universal recommendations online—often to raise rates significantly—there is no replacement for evaluating these factors and optimizing for them individually and in creative ways. 

The only incorrect way to go about things is to shame other therapists for their rates. The healthcare system is broken, and any decision we make about how to offer care necessarily involves compromises and optimizations that impede other things we all care about.