How Much Do You Charge For Therapy?

Health. We wish it for others, we pray for it, we hope for it, we give it great lip service...."Health is the most important thing!" we say.

And yet, often it becomes the last thing on our priority list (and therefore our action list).

And forget about mental health. That is so rarely on the list until there is a crisis - if then!

So many of us wait for that tooth ache, that heart attack, that loss of identity and meaning in life before we take action for better health. There are many reasons why and here I will only address one. But one that comes up often. Money.

In terms of mental health, people don't even know where to begin. When they finally reach the point of wanting to get counseling, coaching, and/or therapy, what now? Crossing that line from "I'm thinking about it" to "I'm going to do it" is powerful and needs to be supported in its momentum.

Here's the more traditional approach:  Start by calling your insurance company. Find out what kind of coverage you have and who you can see. Many therapists will offer a free phone and/or face-to-face consult so that you and s/he can decide if you want to proceed in your collaboration together. Ideally, meet with more than one therapist to get a feel for their style and how you feel in and after a session with them.

But here is my favorite part: you have other options. More and more therapists are walking away from managed care and offering therapy practices that better suit our clients. We are untying our own hands. 

Did you know that many therapists will adjust their fee to what you can afford so that you can cut out your health insurance company from your mental, emotional, and psychological well-being?!

As I tell my clients all the time, therapy should not be an added stressor to your life. Many therapists today have been serving our community long enough and have been open to some pretty raw feedback from clients to know that things need to change. Using technology to connect to clients is one option but that's for another posting.

Here's the advantage to paying out-of-pocket on a budget that suits you:

1. NONE of your information goes anywhere (unless there is a safety issue where you or someone else is in danger and then we must report it by law). If you work with insurance, your identifying information is used, well, to identify you. If your therapist just contracts with you and not your insurance company then your information is locked up in their filing cabinet and in their minds forever. All paperwork is then shredded after the required time depending on your state's regulations.

2. No medical diagnosis needs to be submitted to anyone or placed on your records. Let's face it, insurance companies will only pay for medical diagnoses such as depression, anxiety, bipolar, etc. A therapist will need to put one of those labels on you to get paid. Sometimes the diagnosis is not accurate. Sometime you are not struggling from a medical diagnosis at all but still want to meet with a non-judgmental professional.

3. There are no limits to the number of sessions you can have. Some insurance companies will only authorize 10-12 sessions. Understand that they are in the game to save themselves money. You are in the game of self-care and growth. A therapist is in the game of unconditional positive regard for your experience and making a living. Who should get first priority? You. Always.

4. No hassle. There is no need to fill out paperwork, constantly prove that treatment needs to continue based on the client's "illness" and progress being made, submit paperwork, wait for payment, followup continuously for payment, etc. Sometimes that will be your therapist's headache and time taken away from excellent clinical care. Sometimes it will be your headache if you need to pay your therapist in full, file for reimbursement and wait. Or... you opt for door #2 where you meet with your therapist, pay at the end of the session the fee you negotiated together, and you go on with your life.

5. Creativity in care. I don't want to blow your mind here (or maybe I do) but therapy can be multidimensional and extend outside the "mmm-hmm" of a therapist sitting on a chair across the room from you while you talk through every thought and experience. Therapy works when a therapist can be fully present in witnessing the client's experience and thinking outside the box to what will help that person find their focus, direction, clarity, acceptance and joy. Will the insurance company pay for therapy over a HIPAA compliant video conference or a phone session? Will the insurance company pay for somatic techniques or meditative techniques? How about biofeedback? Spoken word? Will the insurance company pay for nature trail walks instead of office sessions? If it works for you to reach whatever goals you set for yourself in meeting with your therapist and it does not put you or anyone in danger (aka violating the ethics of that professional), then it works!

So, how much do I charge? How much can you afford?

Action items:

1. Ask the therapist you want to work with if they offer a sliding scale.

2. Look at sites like Open Path Psychotherapy Collective ( for a list of therapists who have agreed to open a few time slots in their schedule to offer reduced-fee sessions ($30-50/session).

3. Be aware that some therapists even keep 1-2 sessions/week available for pro bono work (free sessions) for clients whose financial situation changes but it continues to be clinically relevant to keep the work going.

4. If you already agreed to pay a certain amount and now you find that you cannot, DON'T LET THAT BE THE REASON YOU STOP THERAPY. Talk to your therapist about it.

Assertively, openly, and honestly communicating an issue in your heart is part of your treatment. Don't back off now.