Why is therapy so damn expensive?
Look, I get it. When I first explored getting my own therapy as an adult, I was flabbergasted by the cost. $150-200 a WEEK? It seemed completely unreasonable. Weekly sessions would be a FOURTH of my monthly income. Now that I own a private practice myself, I understand the cost, and *ahem,* allow me to explain.
Things I had never really considered prior:
Therapists have to pay for their own rent/mortgage plus rent for the office building. In the Bay Area, that generally adds at least another $1000 to monthly expenses.
The path to becoming a therapist involves several YEARS of training, during which we are paid very little to nothing. We often are taking out loans, dipping into savings, and working multiple jobs at a time to stay afloat. We hardly ever get any benefits working these training jobs. We have to recoup some of that cost somehow.
Obtaining and maintaining a therapy license requires a lot of things and they all cost money. We have to pay and travel to take the multiple tests required (let alone the cost of preparation programs, and God help you if you have to re-take the test). We also have to pay for biyearly license dues, memberships in associations, malpractice insurance, marketing, running an electronic health system that protects patient privacy, trainings we must take every year, consultation to ensure we are providing good care. But wait, there’s more: furnishing and decorating an inviting office, maintaining supplies, buying books, paying for Internet, getting gas to get to work, and professional clothes all add up, too.
We have no benefits! The only way we can get Health Insurance is through a partner or paying out-of-pocket for an outrageously expensive plan. Also no PTO. If we take time off, we lose money. We cannot contribute to unemployment, either.
Now, this is a big one. Probably the biggest. Taxes. Over ONE THIRD of what we make goes to taxes. We pay federal AND state estimated taxes every quarter and again during tax season. If your session is $180, we get $120 of it (minus the 3% cut the credit card company takes).
We can only see one patient per hour (unless we’re running a group). Most other healthcare providers can see multiple patients per hour, but you get a therapist’s completely undivided attention.
There is also all the administrative work to do for which we are not paid: scheduling, consultations, progress notes, writing treatment plans, research, billing, training, advocating for patients, talking to parents/teachers, attending meetings, and coordinating care with other providers.
It may come as a surprise, but listening to and holding people’s darkest pain can take a physical and mental toll on us. We MUST prioritize self-care to be effective therapists. We are STRONGLY encouraged to be in our own therapy (I am) and it’s crucial we find other outlets for stress. This is especially crucial considering many therapists have mental illness of our own. This can cost a lot as well.
Further (maybe I’m just complaining now):
We have SO much training. I am not saying every therapist is perfect or even good, but we have had a lot of education and experience. Our (typically expensive) graduate programs are 2 to 4 years long full-time, and during out last year of school we are thrown out into the field working with the highest-need patients. My very first experience of doing official therapy with a real patient was in Juvenile Hall, in a tiny room with a two-way mirror, and the handcuffed patient was so traumatized he was selectively mute.
We then go on to accumulate 3,000 hours of training working with different populations and age groups. Again, this is for very little pay (I sobbed with joy getting my $0 to $25 an hour raise after I graduated, doing exactly the same work as before with the previously incarcerated).
Then, we wait months for approval to take our 4-hour clinical exam. Once we pass (and if not, it’s 6 months until one can take it again), we are finally officially licensed . Finally then, we can apply for higher-paying jobs and/or open a business of our own.
We receive NO education on opening or managing a business in grad school, so we then must take additional courses to learn this.
DOESN’T THAT SOUND LIKE FUN?
But really, this is not an attempt at pity, nor a “shut up and stop complaining about it” (because we should complain about it; see next post). It is rather something that can inform patients when they wonder “THIS MUCH MONEY TO TALK WHY??” I think the greater context helps.