Why is Therapy So Damn Expensive?

I know it seems expensive. I get it. However, the transformation that is provided by therapy is priceless and life-changing! You might build more confidence, better relationships, job satisfaction, parenting skills, boundaries, processes traumas….the possibilities are endless!

Let’s Compare:

When you pay a contractor to work on your house, you pay hundreds of dollars an hour.  Why? Because they have the licensing, the insurance, the knowledge, the training, their own business expenses, and the tools.  All of their investment saves you time and money.  Therapy isn’t that much different.

Things Therapists Consider When Setting Rates:

• 5-7 years of schooling.  For me, it was a total of about 7 years of school.
• Student loan debt.  My debt for all of my schooling is over 6 figures.  I know I am not alone.  It’s an insane amount for a field that is undervalued.
• 2 years of unpaid internships.  Internships are approximately 15 hours per week for 2 years, which limits how much you can work a full-time job and have a steady income during that time.  During my internships, I had to quit my full-time job to be able to finish.  I lost my income, my health benefits, and my retirement plans during this time.  We lived off of any savings I had and I found a part-time job to supplement.  I also became an extreme couponer (true story).
• Hundreds of hours of supervision.  Therapists require supervision for licensing.  It is, at minimum, 1 hour per week for approximately 2 years.  Some states require more.  For my Maryland license, I had to document 144 hours.  While that is what is documented, there are many more hours that are not documented.  There are times when we just need to debrief after a session or we have questions about services and resources or just need extra guidance outside of scheduled supervision.
• Thousands of hours of face to face experience.  On top of the internship hours and supervision hours, we have to document thousands of hours of face to face time.  This varies per state and per license but generally speaking, this number sits around 3000 hours.
• A hoard of books and reference materials.  I own over 100 therapy books.  Some are textbooks, some are guides, some are workbooks.  Just the DSM-5 (our diagnosing manual) costs about $30 right now.  Some of the workbooks I own cost upward of $75-100 each.  

• Professional memberships.  A membership to the National Association of Social Workers is $236/year.  There are many other memberships available that also cost hundreds of dollars. 
• Licensing fees.  Cost of licensing varies per state but is often well over $100.  Additionally, we are required to have fingerprints done which also costs money.
• Testing.  In order to be licensed, we have to pass a series of tests.  These tests also cost hundreds of dollars.
• Trainings.  We are required to complete continuing education credits (CEUs) during each licensing period.  CEUs can range from a few dollars to hundreds of dollars.  Generally, my go-to source charges about $20/credit.  If we need 40 credits, that is equivalent to $800.  We can also get additional certifications.  Many of these certifications can cost well over $5000 plus they have annual renewal costs associated with them.  
• Credentialing with your insurance (if we take it).  Credentialing can cost money or we can do it ourselves.  Paying for it costs about $200/panel.  If we do it ourselves, it means hours of phone calls and emails to complete it. 
• If we own a private practice, we pay for that too.  Some expenses include: phone service, office rent, internet costs, equipment costs (laptops, etc), an electronic medical record that is HIPPA compliant, a lawyer to consult with, an accountant, marketing, and many other expenses.  We might also have staff that we need to pay a salary to.
• Malpractice insurance.  I wish this wasn’t necessary, but it is.  This can be hundreds of dollars. 
• Sleepless nights of us worrying about our clients and our ability to help you.  Yes, we do think about you outside of your session.  We research ways to help you.  We find you worksheets, psychoeducation materials, and reference materials to share with you.
• Self-care.  We take on emotions from our clients.  The good, the bad, and the ugly.  We need self-care activities and ways to refresh the brain.  

You are paying for much more than the 50 minutes you see us. We also need time before your session to prepare for your session, find worksheets, identify appropriate copings skills and many other tasks. We also need time after your session to coordinate care with other providers (if we have a release of information signed), consultations with other therapists, our own supervision and still many other tasks.

I know therapy can add up. But, I am also pretty confident that therapy can be worth it.