The demand for therapy has skyrocketed in the past few months, because well, we are in the middle of a pandemic and many other social issues. For the first time ever, many people have had to sit with themselves for days on end. They have had time to think about things they had never considered before. They have been confronted by feelings that make them feel uncomfortable. Therefore, they are recognizing their need for outside professional help. 

Myself along with many of my colleagues across the country are at capacity, either scheduling clients two weeks out or referring to other therapists. The need is as real as ever. Yet, despite the need, the understanding of mental health and therapy is not common knowledge. Because of this, my colleague and I wrote a piece for Medium and did an IG Live. With the hopes we would educate people about the therapy process from start to finish, we understand that it can be overwhelming. 

An investment that will improve your life and the lives of those you love for generations to come

Therapy is an investment of both time and money that you will have to be consistent about for a while before you see the results.  We are used to instant gratification. We want what we want now, but that’s not how therapy works. There’s no magical approach that can fix a broken heart or help you overcome years of abuse in just one session. 

The investment that you make is an ever-giving gift to yourself and those you love the most. The results of therapy will literally outlive you by improving the quality of life for the generations to come. I know this sounds corny and all, but I see this every day with my clients and I’ve seen it in my own life. There’s no price tag to overcoming bulimia, repairing a marriage, being in recovery from heroin, and improving your strained relationship with your adult children. 

No amount of money in the world can pay for healing AND money is a real factor when considering therapy.  Both are in fact very true.  Recently, I have come across posts on social media that promote the idea that therapy is only for the wealthy and inaccessible to those who don’t make loads. If I am transparent, these posts make my blood boil, because, in a time of desperation when people need help, they most definitely don’t need to be misled with erroneous information. In the US there's therapy available at no-cost for those experiencing financial hardship, and a variety of prices for those who have the ability to pay. 

How does a therapist determine their fee? 

Let’s talk about how therapists come up with their fees in private practice.  Therapists in private practice seeing private pay clients (clients that pay out of pocket) and clients who use out-of-network benefits through their health insurance have the freedom to set their own fees.  Fees vary vastly from city to city and state to state. When a therapist opens shop and decides on their fees they need to consider a handful of things:

1. Their degrees and post-graduate training: The more years a therapist spent in school and the more specialized training they’ve received since graduation, the more they will charge. Why? Because schooling is expensive and post-graduate training that allows us to be experts is also expensive. In addition, we have to spend years under the supervision of a licensed therapist. Most of us had to pay for these supervision hours, as well. 

2. Business expenses: Therapy is a business as much as your dentist’s office or your favorite clothing store.  Regardless, of whether your therapist has brick and mortar or is totally online there are a variety of expenses involved in keeping the proverbial lights on. Including a HIPPA compliant email systems, renewing their licensure, paying for continuing education courses required to renew their license, and taxes. The list is long but I won’t bore you. 

3. Cost of living: Therapist live a life outside of their business. They have homes, cars, need groceries, get sick, and need to go to the doctor, and also like to take vacations. Meaning, they need to make enough to actually make a living. The cost of living varies throughout states and the country, so that is why a therapist in NYC might charge $300 a session, and another one in Arizona might charge $75 a session. Therapists like anyone else deserve to be paid their worth and to have a standard of living that fits their needs. 

But can I afford therapy?

Therapy is accessible to all, but private pay isn’t.  You can find a therapist in community agencies and universities that provide therapy at no to low cost. They are able to do this because they are employees paid a stable (although typically incredibly low) salary. Some of them are students needing hours for graduation or licensure. Usually, therapy in these settings is short-term and you might be assigned a therapist instead of you choosing one. This doesn’t mean that the therapy they provide cannot positively impact your life. It just means you can’t be as selective and that the therapy process can’t be as individualized as in other settings. 

 If you have health insurance you can inquire about their mental health coverage for in-network and out-of-network providers.  Based on what your policy states, you will then be able to choose a therapist. Your choice will be wider if you have out-of-network benefits.  Therapists who take insurance in-network are directly contracted with the insurance and are often at capacity because of the high demand. Using insurance also means that your therapist will have to diagnose you within the first session. Your insurance will be made aware of your diagnosis and will have access to your charts in the case of an audit. Your insurance will also determine the frequency and length of therapy. When they think you’ve had “enough” therapy, they will stop paying. At that point, you will need to pay out of pocket if you want to continue. This does not mean you should not use your insurance to pay for therapy, but I want you to be aware of the very real restrictions that come with using it and this is usually the reason why therapists choose to not take insurance or only take selected ones. 

Private pay means you pay out of pocket and everything about your treatment is determined by you and your therapist. You both decide how often you meet and for how long. You choose if you want a mix of individual, couple, and family sessions.  No diagnoses are needed and your information is held at the highest standard of confidentiality. You have total freedom over your treatment process! This is also the most costly option and not accessible to everyone’s budget. Some therapists have the ability to provide some reduced fee slots or packages (pay for 5 sessions and get a 20% discount).  Therapists who offer reduced fees will have it written in their websites or directory profiles, you can always request a brief phone consultation or email them inquiring. Be mindful that those slots are not always available because the demand is high. Open Path Collective is a membership program that helps make private pay therapy more cost-friendly for its users. You pay a one-time fee to become a member and then can choose to work with one of the therapists available in your area at a much lower fee.

Therapy IS Accessible

I’ve written this whole blog to educate on the financial and business side of therapy and also to help you understand that therapy is accessible to everyone. There’s therapy at different price points and you need to consider which one you can afford. I am biased and love providing private pay services, this does not mean that other therapeutic services are ineffective. I have worked at community agencies, university clinics, and taken insurance in private practice. I think I've done good work overall with those clients. I also know we could have probably, in some cases, done better or more speedy work, if we had more flexibility in the way we designed treatment.

Even if therapy is limited to a specific number of sessions or if you can’t see your therapist as often as you’d like, I believe that some therapy is better than no therapy.  Therapy is something you can come to at different points in your life to work on different issues. The choice you make about therapy today might be different from the one you are able to make in a year. My suggestion is that you start today where you can and go from there.

I am also aware that other factors are involved inaccessibility, like for example finding a therapist that speaks your language, is from your same cultural background, has your same spiritual beliefs, or identifies with your sexual orientation. Therapists that are more niched and have very specific specializations are harder to come by and are usually private pay because the individualized services they offered are not typically covered by insurance companies. As a Latinx bilingual therapist of color, I get this. I would still urge you to seek the therapy you are able to invest in today with the best therapist you can find within your budget by doing some research. 

Again some therapy is better than no therapy, you don't have to tackle everything at once. You can touch on more niched areas later on.