Why is therapy so expensive? And ways to support your financial wellness

Therapy is incredible. It is also incredibly expensive. And it can feel like a game trying to make it less so. Can you go every other week? Find someone who meets your needs in a few sessions? What about your insurance? The underlying conflict is real: you want and maybe need to focus on your mental wellness, yet it seems to be obtainable only for the rich.

As a mental health professional engaged in my own therapy, it is helpful for me to understand why it is so damn expensive, as well as creative ways to make it work during different seasons of my life. Here are the top reasons why therapy is expensive in the United States, and ways to support your mental and financial wellness.

Mental health care is part of a sick care system

In Thomas Insels’ book Healing: Our Path From Mental Illness to Mental Health, he properly names our mental health care system as a sick care system. In other words, mental health care reacts to serious problems and aligns to the medical model of: patient gets sick, is diagnosed, receives focused treatment within a timeframe, is cured, and lives happily ever after (until the next problem). Our mental health does not work this way. Our health requires daily attention for us to prevent problems and live healthily. As for therapy, it is one of many tools to support the process of living a healthier life.

In addition to our lack of prevention, our medical model was built to serve people with the means to pay for it. If you cannot pay for it, then the stress of medical debt can become a reality. And for those who are insured, it can still require out-of-pocket expenses due to insurances not covering care appropriately.

Insurance doesn’t cover therapy appropriately

Many therapists do not accept insurance for different reasons. Perhaps the top reason is that insurances pay a low rate for services, and require clinicians to focus time on proving treatment vs. providing treatment. Additionally, insurance companies:

don’t cover preventative treatment
require a diagnosis
at times will deny a diagnosis
don’t guarantee full confidentiality of diagnosis
dictate a specific timeframe for treatment, like number of sessions and frequency
pay therapists low rates per session, which requires therapists to see 2-3x as many clients to make a living
struggle to have available therapists who can take on new clients
require a high amount of proof, like paperwork and phone calls, to justify the therapy

Being a grounded, compassionate therapist requires care

There have been times I have left my own therapy sessions feeling lighter and more hopeful, knowing my therapist may not feel the same. While it isn’t my job to worry about my therapist, I care and could not help but to wonder, “How does she so brilliantly hold 20+ people’s histories, traumas, fears, and stresses every single week?” Like my therapist, many professionals are doing everything they can to remain compassionate and passionate about those they serve, even within a system that does not always support them. This requires a lot of care for mental health professionals, including:

Seeing an appropriate amount of clients per week. The range is often 15-25 client-facing hours per week. However, it can range for each professional depending on factors such as life circumstances, the type of treatment they provide, etc.
Engaging in daily self-care, including our own therapy as well as other modalities.
Ensuring we have paid time for breaks, including vacations and sick leave.
Ensuring we’re able to live month-to-month, especially in high cost living areas.

Being a well-trained, effective therapist is expensive

Outside of maintaining the front lines of mental health for others and ourselves, therapists undergo high costs to become a licensed professional. And these high prices are often met with low pay once working in the field. The cost of being a therapist includes:

a minimum of a Master’s degree or higher (often accompanied by loans)
post-graduate, pre-licensed jobs are often low-to-no pay (takes minimum of 2.5 years to gain hours and become licensed)

PLUS yearly, required fees that maintain our state license as well as special certifications, like:

Continued Education courses (CEs)
Trainings, workshops, resources/books, etc.
Pay for consultations with other professionals
Pre-licenses pay for weekly 1:1 and group/triadic supervisions

PLUS costs for running a business, including:

Marketing and advertising
Malpractice Insurance
Office space and equipment (+ additional rent/utilities, if in-person)
Fees such as credit cards, EMR systems like SimplePractice, banking, payroll taxes, general taxes including for self-employment, etc.
Private benefits, leave, vacation, etc.
Financial uncertainty during the natural ebbs and flows of low caseloads, due to client holidays, vacations, economic downturns, etc.

Additionally, therapists are often paid for the time they are in a session, yet half the work includes admin time, such as returning calls/emails, consultations, intakes, paperwork, billing, marketing, trainings, and any crisis management.

Ways to support your mental and financial wellness

Photo by Polina Kovaleva

The unfortunate reality is mental health care lives within the medical model. This requires us to advocate for our needs, and/or find someone who can. Here are a few things to look into to help reduce costs…

See what your insurance covers in and out-of-network

In-network: As mentioned above, insurance companies come with challenges. However, there are still therapists who take insurance and (despite what some may believe) it is worth looking into. Here are a few challenges you may face:

finding an available, grounded therapist (due to high case loads)
limits to finding a therapist you connect with
insurance may only allow a specific number of sessions/frequency
requires a diagnosis

Out-of-network: Some insurances will cover out-of-network therapy up to a certain percentage, and/or they will cover X% of therapy once you’ve hit your deductible. For example, I get 60% of my therapy covered through Anthem Blue Cross PPO, once I’ve met my deductible. This means I pay for my sessions > my therapist sends me a monthly super bill > I submit the super bill to my insurance > my insurance sends 60% payment to me. A few things to keep in mind:

you pay out-of-pocket first (you may not be able to afford this)
you often still pay a good amount for therapy (if your insurance doesn’t cover 100%)
takes time to submit to your insurance
similar to in-network, insurance may only allow a specific number of sessions/frequency and requires a diagnosis

Bottomline: if you have insurance, it is worth calling and seeing what they can do!

Talk to your employer

Some employers provide benefits and perks towards your personal and professional growth, such as gym memberships, continued education/trainings, therapy or coaching sessions, HSA/PSA accounts, employee assistance program (EAPs), and more. In regards to therapy, employers may offer benefits for tech services, such as Lyra and BetterHelp, that offer cheaper options. While many therapists are not fans of these apps and services (for a number of reasons, including paying therapists low wages), they are okay as a gateway experience into the world of mental wellness. Keep in mind: you may not see long-term success with these platforms and it may require you to eventually budget for traditional private practice care. Nonetheless, it is worth exploring and advocating to your HR department about the value of ongoing mental health coverage.

Explore sliding scale therapy

Almost every professional and/or organization provides a limited amount of slots for sliding scale and pro bono work. Sliding scale is for people who cannot afford services and may struggle to meet their basic needs. Additionally, some mental health professionals incorporate a “pay it forward” donation-based community model, where those with financial resources can support those who are unable to access care. If you are experiencing financial burden, then sliding scale is worth asking about. Things to keep in mind:

sliding scale is not meant to be a way to negotiate for a lower price. You may not qualify if you have disposable income, for example.
if you qualify for sliding scale, ask for a trainee or associate therapist at a clinic or organization you’re interested in (they tend to have lower rates and can be equally as effective as licensed therapists)
ask your current therapist or future therapist if they have any sliding scale slots available (work on a payment plan that balances their fee with your income)

Explore other modalities and tools

Again, therapy can be incredible AND it’s not the only tool for supporting your mental wellness. A few other ways to support your well-being can include exercise, building routines, acupuncture (often covered by insurance), good friends, other therapeutic modalities, spiritual practices, pets, and nature. Additional options:

Group therapy supports people in making changes and is often cheaper than 1:1
Support groups bring together people with a specific, aligned problem and provide ways to cope (e.g. 12 steps, grief, cancer, etc.)
Create a self-help book club with friends
Check out resources like mental wellness blogs, books, podcasts, courses, etc.

These options will not replace the experience you’d get with 1:1 weekly therapy, especially if you are dealing with an immediate or specific need such as trauma, but they can be areas to explore during different seasons of your life.

Explore your priorities and budget

If you really need to prioritize quality therapy, it is worth reflecting on the value of therapy as an investment in your overall health and relationships, for years to come. I encourage you to consider ways to reduce spending in less important areas, such as nice-to-have shopping, eating out, travel, etc. For example, in the past, I have prioritized therapy as equal to my basic needs of food, shelter, and physical health (and do not regret the investment). At other times, I have reduced my spending on traditional therapy, increased my engagement in other modalities, and prioritized my spending on things that better connected me to family, friends, and neighbors. Good mental health happens through connection and relationships with others, after all.

Reflection

Photo by me, Alli.

Through creating this post, I’m reflecting on my continued desire for preventative mental health care to be accessible to all and not just to those who can afford it. I am sorry if you are currently feeling lost and are unable to find the appropriate support, especially due to your financial situation. My hope is you are able to consult with a clinic, a professional, family member, neighbor, or friend who can guide you in finding a solution that best supports your mental and financial health. May you be well. May you be healthful.