Updated: Oct 5
Why is Psychotherapy so #&@%% Expensive
Reduced stigma, acceptance of mental health as part of whole-person health, and increased prevalence and severity of mental health and relationship challenges have led more individuals to seek help through psychotherapy. One significant barrier continues to hinder access to mental health care for many: the high cost of psychotherapy.
Where do the rates come from? In a nutshell, it costs us a lot to provide therapy, and therapy provides a great deal of value to patients/clients.
Therapy’s value proposition
An embattled couple came to me for their first session, and after introductions, the husband rolled his eyes and said, “Okay, how much is this going to cost me?” The wife offered a good partial answer: “Considerably less than a divorce.” Of course, beyond that, people come to therapy in order to become more effective, satisfied, and fully realized in all parts of life: Relationships, love, friendships, career, community, and even spirituality.
How we feel – how satisfied with life – is the most valuable thing in the world. How we show up for the ones we love is part of that, as is our overall health, our performance and progression in the realm of work, and our participation in our communities. This is the value of therapy.
Costs therapists bear in the process of being there for patients:
Extensive Training and Education
Psychotherapists, undergo years of rigorous education and training to provide effective therapeutic services. This includes completing bachelor's degrees, often followed by master's or doctoral degrees, and accruing supervised clinical experience, and in my case, preparing for and passing both written and oral exams. The significant investment in education and training naturally translates into higher costs for patients. Further, therapists are required to keep up to date by taking ongoing Continuing Education, and bear those costs.
Licensing and Credentialing
To ensure the quality and safety of psychotherapy services, therapists must obtain and maintain state licensure and professional certifications. These requirements involve ongoing fees, continuing education, and adherence to ethical standards—all of which contribute to the overall cost of psychotherapy.
Overhead and Administrative Costs
Running a private practice or working within a healthcare organization involves various overhead expenses, including rent for office space (even working virtually requires a quiet, dedicated space), insurance, administrative expenses, and technology infrastructure. These costs are passed on to clients in the form of higher fees for therapy sessions. Unlike hourly employees, independent therapists fund their own 401Ks, pay their own Social Security contributions, health benefits and other insurance, and fund their own sick or vacation days, as well as the many other benefits most workers and professionals receive.
Limited Insurance Coverage
Of course, insurance companies pay therapists as little as they can get away with. Despite increasing recognition of the importance of mental health, insurance coverage for psychotherapy remains limited for many individuals. High deductibles, copayments, and restrictive networks often leave patients with substantial out-of-pocket expenses, discouraging them from seeking the help they need. For this reason, many therapists do not work with insurance companies. It is not uncommon for insurance companies to deny payments for services, to limit the number of sessions they will reimburse, or to require voluminous paperwork, utilization reviews, etc.
Meeting the demand
I am working on ways to work with a few insurance companies because I feel it is an ethical imperative to provide some “affordable” slots to make therapy available. The demand for psychotherapy services has surged in recent years, driven by increased mental health awareness and the challenges brought on by the COVID-19 pandemic. Unfortunately, the supply of qualified therapists has not kept pace with this demand, so some patients are seeking briefer or less frequent therapy sessions, which also increases costs per session
Most psychotherapists specialize in specific areas, such as trauma, addiction, or eating disorders, requiring additional training and expertise. I have taken (and continue to take) advanced certification classes in Cognitive Behavioral Therapy, Gottman Couples work, among others, and these are not reimbursed by anyone.
Most therapists either continuously or intermittently attend their own therapy sessions (yes, it costs us a lot too) to take care of ourselves so that we can be present to focus on your issues, rather than being distracted by our own. Therapists’ intellect, focus, and emotions are the instruments we sharpen continuously through self care – therapy, exercise, meditation, consultation and support groups. Without self care, we can’t provide good therapy to you, and while some jobs can be worked and compensated for 40 hours per week, most therapists limit the number of hours of therapy they do in order to maintain high quality.
We are working on systemic solutions
Advocating for better insurance coverage for mental health services is crucial. Policymakers should work to reduce out-of-pocket expenses, expand networks of mental health providers, and ensure that insurance plans include mental health as an essential component of overall healthcare coverage.
Continued research and development of novel approaches, such as psychoeducational group therapy, “brain hacks” that we learn through neuropsychology research, talk therapy techniques, and evidence/measurement based therapy – as well as providing self help tools, including tech-enabled tools, all hold promise in helping more people at affordable rates.
The widespread adoption of teletherapy during the COVID-19 pandemic has shown that remote mental health services can be effective and cost-efficient. Expanding access to teletherapy can make therapy more affordable by reducing travel burden (including time away from work and family, child care costs, transportation costs), especially in couple therapy. Not every patient/client is a candidate for teletherapy, but it’s something to discuss with your provider.
Governments and organizations should allocate more resources to mental health initiatives, including subsidizing mental health services and offering financial incentives for therapists to work in underserved areas.
Education and Training Reforms
Efforts to streamline the education and training requirements for therapists could reduce the financial burden on practitioners and, in turn, lower costs for clients.
Conclusion: A call to action
The high cost of psychotherapy is a complex issue with no single solution. It is the result of a combination of factors, including extensive training, licensing requirements, limited insurance coverage, self care, and capacity. To make psychotherapy more affordable and accessible for all, stakeholders must work together to advocate for reforms, expand teletherapy options, and allocate more resources to mental health initiatives. By addressing these challenges, we can move toward a future where mental health care is both effective and affordable for everyone who needs it.