Psychotherapy costs a lot. If paying full fee out of pocket for for weekly outpatient therapy, it is usually one of our most significant monthly bills. It begs the question of what makes it worth it, and why therapists deserve to get paid such a high hourly rate.
I am not going to address in this blog the issue of insurance, which you can read about here . I am also not going to address here the issue of making therapy more accessible through clinics and agencies. This is a massively important issue, and one that is dear to my heart and practice, but separate from this topic, which is outpatient private practice therapy fees. Many therapists, including myself, offer sliding scale fees to make therapy more accessible for more clients. But the slide is not intended for folks who can afford the fee, but just don’t really want to pay it. There are a great number of middle/upper income folks who can absolutely afford this type of therapy. For this person, it might help to understand why the cost is so high and why some consider therapy sufficiently valuable.
Okay, first I am going to try to lay out why seeing a psychotherapist in a private practice without use of insurance costs so much. This is less about the value of therapy, and more about why a therapist might expect such a high hour rate.
Therapist Can’t See 40 Hours of Clients
While therapists may work 40 or more hours a week, only part of those hours are billable client hours. If a therapist sole job is working with clients, they still are likely to work less than 30 clinical contact hours a week. Even someone who considers themself to be working full time, may see as few as 5 clients a day.
Here is why. Firstly, a therapists’ hour, or 50 minutes, is incredibly focused. They don’t go grab a cup of coffee, or quickly pay an online bill, or check their messages or facebook, chat with a colleague, or jot down things on their to do lists. Other than seriously focused employees/workers, very few folks work a solid 5 hours during their day.
Even the most devoted therapist, eager to work more hours, has a limited amount of bandwidth/presence/emotional and mental stamina to stay devotedly focused and psychologically available for 7 or 8 hours a day. Therapy simply isn’t a job one can do mindlessly, or distractedly, at least not ethically. We need to be well rested, fed, hydrated, comfortable, mentally fluid/flexible and emotionally grounded so that we can be fully present to think and feel our way through a session.
Personally, I usually only do 20 to 25 sessions a week. That means those are the only hours I get paid for. Sure, I could see more clients if I wanted to get paid for more hours a week, but then each of my clients would get less from me.
What Do Therapist Do in Non-Billable Hours That Benefit our Clients?
I know some folks like to think of therapists as just really good listeners, or validators, brainstormers or supporters. But if we are really invested in this profession, we must be thinkers. And we need to feed our brains. Ethical therapists on their game spend significant chunks of time in any given month reading, taking trainings and furthering their education, participating in supervision groups, getting individual supervisions, participating in their own therapy, going on education retreats/conferences, having conversations with colleagues and friends, journaling about their own internal worlds, examining their dreams for their own material as well as client material, expanding their peripheral knowledge about literature, art, history, science and culture, and of course specifically contemplating particular clients.
Psychotherapy is a combination of science, art, craft, and spiritual exploration. Much like parenting, it draws on the whole of the therapists’ self. It is not a skill that we trot out for sessions. It is a way of being with ourselves, of navigating relationships, of understanding the world, of being present to another’s story and suffering. It is illuminating and exhausting. It is stimulating and depleting. Therapists must be constantly trying to enrich the self as our very selves is what clients draw on for the work. Our conscious and unconscious selves are the instruments of healing.
Fees Incurred by Out Patient Private Practice Therapists
Besides all of this using lots of our weekly time, there are considerable fees associated with these endeavors. This isn’t a “woe is me” list. It is simply an effort to elucidate how therapists come to determine the fees they will need to charge clients in order to make a living at our trade.
Ethically minded therapists are routinely in active on-going therapy. If it isn’t a tool we feel would be valuable for our own lives, we have no business offering it up to others. The implication if we don’t think therapy is for us is that certain people “need” therapy, and others don’t. That is pathologizing and gross. Our own therapists tend to cost even more than we do as we need folks even more educated/trained/experienced as ourselves, warranting a higher fee.
Ethically minded therapists hire someone to supervise them. We might have on-going supervision or simply pay someone to consult on cases every once in a while when we feel blocked/uncertain/confused. We might participate in group supervision. All of these are at a premium cost.
Ethically minded therapists continue their education. We are required to get a minimum of 15 hours of education a year to maintain our license, but some, like myself, usually get 50 to 200 hours of education a year in various forms. Our subject is the human mind/soul/psyche/life. How could we ever know enough? My draw to the field is that there is always more to know, always room for growth, always new means available to try to help our clients find emotional freedom in their lives.
On a more mundane level, we pay for offices, health insurance, liability insurances, association fees, and if we hope to have any retirement savings, we are solely responsible for that.
In my not particularly humble opinion, it depends. If your therapist’s sole activities are supporting, validating, and encouraging you, then no. If you would describe your therapist as something like a good friend or a kind aunt, or a cheerleader, or a sounding-board, then no. Those things are great. We all need them. But we definitely should not be paying top dollar for them.
Are Therapists Really Worth All That?
Most therapists can be fairly supportive and validating, and even kind, but that is not what you pay them for, as those skills are rarely ends themselves. We offer support and encouragement to help create the environment where a client can do the hard work of therapy. Therapy is going into places inside us that are uncomfortable, that we frequently avoid. We use sessions to look for clues inside ourselves to material we are defended against, but which hold keys to the issues that plague us, to the places we feel stuck.
Because much of what traps us in the behaviors, narratives and feelings that bring us into therapy are truths we are reluctant to see, therapy can be very uncomfortable, even dread-filled. A worthy therapist brings things to our attention we would rather not be true. We have times that makes us angry at our therapist, feel frustrated and disappointed in them.
When we feel conflict with a good/worthy therapist is when they really use their skills and talents. They don’t get mad at us, or get defensive, attacking or punishing. They don’t tell us we are wrong. They contain their reaction and instead focus on what is happening for us. They try to understand our response and not lose sight of the clinical material that stirred it up.
When we leave a session with a worthy therapist we don’t always feel great. Most certainly sometimes we don’t at all. We should be leaving some times with new material, a new analysis, a new connection, that is hard, painful, complicated, that we will need to sit with and metabolize over days, weeks and months.
Is Therapy Really Worth It?
People typically come into therapy with issues that have plagued them for years. They have usually tried many things to resolve the behaviors or feelings they feel stuck with. They have frequently even had some success with those efforts, be they meditation, talking with friends, self-help books, a focus on exercise and nutrition, a life coach, etc.
A worthy therapist doesn’t start throwing out suggestions and advise, because by the time folks come to a therapist, they have tried a million things. Anything they could have tried to cut and paste on themselves from a self help book or friends advise, they have tired. Some of it might have well helped, but they are coming to therapy to find resolution to the parts that didn’t work.
What makes the work of therapy so slow is that the answers are inside the client. The therapist has to create the environment and build the relationship that will allow the pair to explore clues in the client’s unconscious to solve the puzzle. The therapist’s education, skill and talent is in recognizing clues, knowing where to look for them, and helping clients tolerate learning hard truths.
So, is it worth it? If you want freedom from what plagues you, it surely is.
Smith is an analytically oriented psychotherapist with 25 years in practice. She is additionally the Founder/Director of Full Living: A Psychotherapy Practice, which specializes in matching clients with seasoned clinicians in the Greater Philadelphia Area.
If you are interested in therapy and live in Philadelphia or the Greater Philadelphia Area, please let Full Living: A Psychotherapy Practicematch you with a skilled, experienced psychotherapist based on your needs and issues as well as your and own therapists' personalities and styles. All of our therapists are available for telehealth conferencing by phone or video in response to our current need for social distancing.
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