Brewing Hope - Let's talk about money


Money. For most of us a seriously uncomfortable subject, and in many modern families more taboo than sex. Even therapists have trouble with it sometimes. Ellen notes that one of her sex therapy professors said as much in class – “I’m completely comfortable talking about sex. Money, not so much.”

So let’s talk about money.

(photo credit Mikesh Kaos)

A common question we hear (though not always to our faces) is: “Why is therapy so expensive?” (So common there are over two million hits on a Google search). Often following is the qualifier: “It’s just talking.”

Here are a few thoughts from us on therapy and money.

Why is therapy so expensive? What are clients really paying for?

Susan: There’s a lot more than an hour of talking that goes into therapy. One of those things is schooling. Licensed and pre-licensed counselors and therapists have to have at least a master’s degree, some a doctorate, and for many that means paying off student loans. Another is the time spent – probably three years of post-graduate work after a four-year bachelors program; 3,000 hours or two to six years of supervised work; and prepping for licensing exams, and specialized training and perhaps internships. There are always associated costs – malpractice insurance (not as exorbitant as MDs, thank goodness!), fees for the exams and applications, continuing education, and so on. Never mind the usual business overhead, like rent and office utilities and supplies and so on.

In setting our fees we take into consideration our setting (location, type of practice, what other local therapists charge), our experience, our training, and our costs. We also take into consideration the reasons we became therapists in the first place, our clients.

Andrea: I try to be fair and sensitive, both meeting my clients’ needs but not undervaluing therapy or myself. I want to help clients see therapy not just as treatment but also a preventative and an investment. Therapy can be beneficial to alleviate stress, anxiety and depression from taking their toll and creating further more serious physical and mental health symptoms that can be very costly.

Why don’t you take insurance?

Susan: Insurance is a touchy subject these days. We know that taking some insurances would make things easier for many people to get therapy. For clients, it reduces cost in the short term. However, one of the biggest drawbacks is the control the insurance companies exercise over the therapy process. Companies (or boards and reviewers, sometimes without any psychology experience or knowledge) set guidelines for what diagnoses are paid for, what treatments are accepted, and so on. Insurance companies can share your medical files with others for review without your consent, so there is no guarantee of confidentiality. Once we assign a diagnosis (one that will be reimbursed, that is), it stays on your file and can hinder your life in the future, for instance in getting certain jobs. And let’s be honest – the paperwork is a nightmare!

Ellen: I agree. Especially about the paperwork. The time it would take to do all the credentialing and billing that insurance requires would mean I would have to raise my fees, which sounds counterintuitive to me.

How do you discuss money with clients?

Andrea: I feel, as with any issue that is difficult, the more we can be open and honest in our dialogue, the more it reduces anxieties and stress about the issue.

Ellen: Money, like sex and, of course, a lot of other things, is a frequent issue that comes up in therapy, and I'm comfortable talking about it in that context. Like the professor mentioned above, I'm less comfortable talking about money with clients when we are talking about fees for therapy. Even though I truly believe I am worth what I charge -- and I have the experience and training to back it up -- still, I know it can be perceived as a lot of money. Sometimes I shy away from asking clients to sacrifice for therapy, even though I know they'll be receiving something of true value for it."

Susan: I have always found that helping clients take ownership of their therapy, including discussing fees, helps them feel empowered and aids the therapy process immensely.

If you have questions about fees, insurance coverage, or ways to afford therapy, please contact us through our website or our Facebook page. We’d love to talk!

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