Why does therapy cost so much?
- LJacksonPsyD
- Sep 29, 2020
- 4 min read
First off, therapists don't go into the helping field for the money... and often we aren't even comfortable having to put dollar amounts on "helping people." That's what we want to do, after all. But like everyone else we still need to earn a living. After working for universities for the last 20 years for a salary, I wondered about the amount that other mental health providers were charging in the Raleigh/Durham/Chapel Hill area. There was a large range, but none of it was cheap. Here, once starting a practice, are my thoughts about why therapy seems so expensive.
With a salaried position it didn't matter if I had to work late, or if I was on-call all night; I had perform my job requirements, whether it was a short and sweet week due to a holiday, or I put in 8 hours on a weekend to get caught up. On the flip side I also got paid a predictable amount of money even when clients didn't show up, when I used vacation and sick leave, had employer supported health insurance, retirement, and other benefits.
Opening a small business took a lot more time and steps than my naïve estimate predicted. First applying to licensing board for a small business license, then applying for a license through the state, both with fees. Other costs included liability insurance, medical records and scheduling system, web page, HIPAA compliant email, video therapy platform, phone and fax number. Those have recurring monthly fees. I needed a laptop and printer. Then I figured out the small business taxes I need to withhold include income tax, Medicare, and unemployment taxes (the latter two my employer took care of previously). I'm also responsible for my health insurance and retirement savings (the last sounds like a reach for now). Office space costs, plus furniture for the therapy office as well as the waiting area. Therapists don't do good work if they're doing therapy every hour. And for what people pay for therapy they want someone who is present and doing good work. Therefore, good providers can't do therapy 40 hours per week. We have to do clinical notes, provide invoices, return calls and email and other routine business tasks. And providers who are In Network with insurance carriers also need time to diagnose and file insurance.
Like most professionals, I went to school for a long time. I left my undergrad with no loans thanks to going to a state school, scholarships, working while in school, and help from my parents. I also went to a state school for my Master's degree. I worked during that time and graduated with some loans. In earning a doctorate I didn't go to a public university. (Getting into Grad school could be a whole other reflection.) I loved my doctoral program (Graduate Institute of Professional Psychology at the University of Hartford). It was a great program and I had really valuable and rich training and education. Paying for school via loans (while working part time at B&N and sometimes as a Teaching Assistant), living expenses in CT, and then, as required, moving to work full time for a year as an Intern at an Intern's salary (I think it was $18,000), I accumulated a lot of debt during those five years of doctoral studies. A whole lot... like more than my first mortgage. When I graduated I started the type of job I wanted to do working at a university counseling center for something around $32,000. I know I'm in my late 40's, so that would have been more money than it is now, but lets just say the education was valuable, and expensive. The salaries started low, and working for the state income took some time to grow.
When my spouse and I went through a "collaborative" divorce I had a lovely lawyer. She was fabulous. Meeting with her was $300 per hour. I met with a Financial Advisor in the process, he was also wonderful, and charged $300 per hour. An accountant we used charged more than that per hour. I know that that's a reasonable cost for people in those professions. They went to graduate school and have expertise in things I really don't know much about. It still hurts a bit to pay the bill each time. Now I should be looking for an accountant and a business advisor for my practice and am dragging my feet because I know how much they cost. I'm sure I won't regret it, and will say it was worth it, but it's a big commitment and it can pinch when things are tight.
I have seen therapists on and off for years. I think that it's my responsibility to do my own work, and get support, and be held accountable so I can be more helpful to others. I have both paid out of pocket and gone through insurance. There are pros and cons to both, but it's felt more manageable since I've become a single mom to use my insurance. I'm really glad my therapist offers that option. I would probably pay her out of pocket if I needed to at this point, since I have a good working relationship with her and it adds a lot of benefit to my personal and professional life. I've had to let go of worrying about being "diagnosed" and having a paper trail around my mental health, which goes along with using insurance.
I've applied to a few of the most common locally used health insurance companies to be an "In Network" provider. I don't know how long that process will take. Insurance reimburses less than mental health providers make out of pocket and as I'm starting up I could use the extra income, but I would like to be more accessible. Some people will find therapy more helpful and worthwhile than others. And if you pursue therapy I truly hope you will find it valuable. But given this small business journey I can say I now understand why therapists charge what they do.
Lari
Here are some other opinion web articles on the cost of therapy:
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