I have been through the torment of searching for therapists who I could afford, or even harder, through insurance. Living in the San Francisco Bay Area is expensive! As a client, I have always been on the bottom of therapists’ sliding scales. Even during my Master’s program for counseling psychology, I resented private practice therapists who charged more than $100. NOW, as a therapist in private practice, I understand why therapists must charge the fees we do. The costs, including business licenses, credentials, insurance, record-keeping, professional association memberships, marketing, consultation, continuing education, and cancelations add up! And, don’t forget about the student loan debt. I am also realizing that therapists spend a significant amount of time outside of therapy sessions on the back end of the business. And, most private practice therapists don’t have more than 25 client hours per week. You don’t want your therapist to have more than 25 client hours per week. There is a lot of mental space and emotional energy required to be a therapist. You don’t want a burnt out therapist who is running on fumes.
Therapists need to spend time and money on self-care, health, and healing. Trust me, you want your therapist to be healthy in mind, body, and soul. You want your therapist to have a therapist.
How to know what you could or should pay for therapy:
There is more than one way to know or decide what you can or should pay. You can start the process by looking at how much the going rate is for therapy in your area by googling therapists or looking on platforms like Psychology Today. One way to also know is by asking yourself what your mental health is worth to you.
Many therapists have a sliding scale (or at least some sliding scale spots) and you can propose a rate to a therapist by looking at your income. I heard that a ‘normal’ amount people ought to pay for therapy is 10% of their income. I have done the math and learned that I myself pay 10% of my income on therapy. I realized that 10% of my income is worth my mental health. For example, if you earn $65k gross annual income would be $125 per weekly session. $65,000 divided by 52 weeks=$1,250/week divided by .10=$125. Or, if you make $40k gross annual income, 10% would be $76/week.
Another way to look at how much to pay for therapy is to think about access. There are many many people who really need therapy but don’t have access. If more folks on a therapist’s caseload can pay a higher rate, then a therapist can provide to more people who don’t have access. But, your current income does not have to be the only factor to consider when deciding what to pay for therapy. Access should include other factors, such as socio economic status, education level, language, ethnicity, citizenship, age, ability, dependents, health, family assets, privilege, spending, etc. Here is an awesome chart created by Ride Free Fearless Money to help you decide where on a therapist’s scale you might land: https://drive.google.com/file/d/1P0dAIxqkv88LwXC1cry8fGw_XvbSCfM_/view.
If you are a person who is on the lower access scale and cannot afford private therapy, there are (not enough but some) options:
1. Cast a wide net and contact a bunch of therapists to see if they have any sliding scale/low-fee slots available.
2. Sign up with platforms like Open Path that will connect you with therapists who will charge you from $30-$60.
3. Go through your health insurance. Be prepared to have to advocate a lot for yourself, because the mental health industrial complex is a fierce part of the capitalistic machine. Many therapists do not take insurance, but some do. If you can’t find a therapist who takes your health insurance, you can advocate for a single case agreement for out-of-network therapy. Or, see if your health insurance covers Out-of-Network therapists so that you can get reimbursed by your insurance company by submitted a superbill that your therapist provides.
4. Find a therapy group and pay a lot less AND reap the benefits of collaborative healing.
5. Find a local clinic (like the Pacific Center or Grateful Heart) or a mental health agency to see if you qualify for low-fee therapy or via health insurance.
6. If you or your child are a student, see if the school offers free therapy.
I would love to hear from you about your experiences or how you have navigated this issue, as well as your feelings and opinions on the subject of why therapy costs so much. Feel free to comment here on this blog or contact me here. I am currently provided virtual psychotherapy and am based in Oakland, California.
Find me on Instagram: @rosinamft