Why is Therapy so Damned Expensive?

I know that many people looking for therapy balk at the price. When that price is $200 or even $250, I do too! As a consumer of therapy myself (yup, I go to therapy!) I’ve done some shopping around. I’ve tried Betterhelp and I’ve tried some of the more expensive therapists. In the end, to some extent, the old adage is true: you get what you pay for.

Now, before anyone gets upset, I believe that there are a lot of great therapists on Betterhelp and other such platforms. The truth is, though, that your $260 per month ends up making Betterhelp $60 million in profit in 2018, but therapists are only paid, on average, $25-$35 per hour. And that sounds like a lot to the average American, until you understand what your therapist really does.

Let’s break it down by prices just to run a private practice monthly:

Office Space$800.00
Business license$9.00
Liability Insurance$37.50
Business phone$10.00
Secure email$4.20
Website$18.00
Practice Management Software$59.00
Internet$20.00
Professional Association$24.00
Online Directories$30.00
Licensure$9.00
Continuing Education$35.00
Total$1,055.70

These numbers are the bare minimum for a private office in Fort Collins, CO, where I was practicing before moving abroad. Costs only go up from here, especially in other parts of the country.

Another part of the equation is how much work a therapist is actually doing. If a therapist sees 20 clients per week (industry standard to keep therapists on top of their game and giving good therapy) they end up doing a lot of other work outside those hours.

And, I think you are going to be shocked to learn that 1:1 is the typical experience for mental health professionals.  By that I mean . . . for every clinical hour you spend in the office, you can expect to spend another full hour doing the many administrative things that we do . . . the phone calls, documentation, networking, correspondence, billing, scheduling, building / office maintenance, marketing, drafting of new documents / articles, purchasing / restocking of office supplies, maintenance / repairs on office equipment, housekeeping, consultations, formal and informal professional development, taxes, etc

Tamara Suttle

A 1:1 ratio. That means for 20 clients, you are doing 20 hours of other work. That’s a full 40 hour work week, not the easy 20 hours most people think therapists work. Now lets go back to that $35 per hour Betterhelp salary. This only applies to the time the therapist spends with you; there is no payment for the rest of the work we just described. That leaves about $17.5 per hour or $2,800 per month. That’s a profit of $1,744.30 per month.

Are you starting to see why therapy is expensive? I don’t know about you, but I don’t want my therapist making $1,700 per month and worrying about bills rather than our work together. And this is BEFORE self-employment taxes (around $200 per month at this income bracket, with maximum deductions) and health insurance. But Betterhelp makes $60 million a year. Can you hear my saltiness? 😉

As a therapist, it is a very, very difficult thing to ask for a lot of money for therapy. We know it is inaccessible for many people around the world. We have a lot of guilt about charging higher fees. There is even a whole business around helping therapists set their fees and working through this guilt, which tells you how much we HATE this part of our work.

The best part is, though, that a therapist making enough money has more time to give to sliding scale or pro bono work. Many therapists are members of organizations like Open Path Collective that sets fees between $30-$60 per session. I don’t know about you, but I’d much rather pay one of those therapists than give my money to a middle man. And, it’s cheaper than your monthly subscription if you have 4 sessions a month, even at the $60 mark.

Personally, I try to charge a fair fee in order to make sure I am able to be competent and effective while still making it as affordable as possible. It is a tough balance. Some therapists have large families and are the sole breadwinner. They need to make more money. Some therapists don’t have children and can live with a little bit less. No matter what, though, when you look at the full picture, therapists aren’t making as much as you think.

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