How much do you charge? 
This is a very loaded question, indeed.  I’m going to give you straight answers to how much therapy actually costs, and why.  If you are a consumer of health services, you’ve likely asked it many times between doctors, dentists, and insurance plans.  Therapy is no different, yet it is unique in many ways.  Knowing your role in securing treatment and its cost can help you achieve a win-win.

Why are you writing this?
More than a therapist, I am an advocate.  This post has been a long time coming, and clinicians rarely talk about money on a personal level.  When there’s a good reason to do so, it’s an opportunity for growth.  This post is intended to help:

1. Consumers of mental health services make the best decisions for themselves with fuller knowledge of what they’re getting.
2. Professionals (colleagues and students) to understand the dynamics that exist to create a win-win.
3. Advocates of mental health who fiercely support their neighbor’s mental health and need tools to communicate and steer people to the best option that exists for their current circumstances.

Business theory.
When a good or service is offered, utility and/or providing for a human need or want occurs.  In fact, this is why the term “goods and services” uses the word, ‘goods.’[1]  In less than ideal circumstances, either the service is not provided (or provided poorly), or the exchange is NET negative (i.e., the provider loses money or the consumer can’t afford a service important to them).  
IDEAL: Good Service Provided <--> suitable exchange (money) = both parties win

How much is an average therapy session?  
Here are common rate structures:

• Free (through no copay insurance- highly uncommon- plans or state-run and non-profit services)
• ~$20-75+ for practicum/interns (little training or early in their training, but way more advanced than talking to your friend who “took some psychology classes”).
• ~$50 - $125 for a non-specialized therapist and/or online only therapy
• ~$150-250 per hour in urban areas and/or for specialists
• $300-600+ for clinicians who are truly at the top of their fields (think of hiring a celebrity to do a commercial vs. someone unknown from a talent agency)  [2]

What is a realistic win-win?
We live in the real world.  And while we can seek to change things we can change (see below under the “Systems that be” section), acceptance of what we can’t is a crucial part of mental health.  Work within the reality you exist.  

• Free therapy usually means it has been massively subsidized (or you are paying for it in another way, like insurance or a benefactor).  
  • However, to keep overhead low and have a NET profit to stay in business, they may not possess one or more of the following:
    • Expert level status (10+ concurrent years treating a specific condition)
    • Specialization (more than 50% of cases)
    • Additional amenities:
      • Great location
      • Easy access (right off main roads or highways, downtown, etc.)
      • Telehealth or other options, like home visits
      • A snack bar, great coffee, ambiance
• Interns and Practicum Students for $20-25 per hour can be wonderful for those with little financial wherewithal and/or if you need a listening ear with only some training- but be realistic in expectations.
• Online therapy is a great option that is often affordable and accessible, even possibly accepting your insurance.  Limits are a lack of the in-person experience or in-person exposure therapy with objects or places.  
• Generalists may be more likely to accept insurance or only charge rates in the range of insurance reimbursement.  However, the same limits apply as to the first bullet point.  
• Specialists are great if you have a very specific problem you need to address very specifically (like OCD, PTSD, Schizophrenia, etc.).  If you can afford them, it’s not a bad place to start, and if they’re being honest they can tell you how you can achieve results- even if it doesn’t include them.
• Famous clinicians are so cool!  If you can afford it and want to, go for it!  The Gottmans, Edna Foa, Sue Johnson, Steven Pinker, Daniel Kahneman, Reid Wilson.  

There will always be exceptions to the rule, and the above is no different. For example, some people offer excellent services through charity, passion for helping, faith, or other reasons.  Of course, this doesn't mean that anything is free- these services are simply subsidized through that person and often additional income streams like books and speaking fees.  A great example in Dallas would be the experts Drs. Harville Hendrix and Helen LaKelly Hunt.  They offer free community-based marriage building seminars and trainings (Safe Conversations).  Dr. Reid Wilson offers a free 2 day intensive every year at the Annual Conference of the International OCD Foundation   Many churches and places of worship do the same.  

How much clinicians make.
Income ranges wildly, from those famous clinicians to practice owners to social workers to private practice and more.  I don’t know anyone who’s getting rich off of therapy.  Most of us got into counseling/therapy as a helping profession in the first place.  I told my wife when we were dating I would very likely make less than her as a nurse at a prominent Dallas hospital, and I wanted to make sure she was okay with that.  Let’s just say she didn’t dump me.  :)  The median Master’s Level counselor in the U.S. makes about $50-75k per year.[3]  Besides gross income, clinicians have a lot of other factors that take off the top:

• Overhead/Expenses 
  • Office Rent is usually the largest single expense for most clinicians.  Most folks I know will pay somewhere in the vicinity of $500-3000 per month just for their office space.
  • Telehealth, Electronic Health Records, Marketing efforts, and more add to the expense.
• Degree/Licensure
  • Master’s degrees require college plus 2-3 years full time along with an internship usually an additional 2 years beyond this.
  • Psychologists (doctoral level) have an additional 3-5 years with school and practicum/internship above a master’s degree.
• Ongoing training
  • Base level continuing education is usually around 12-15 hours per year.  Those with certifications or other training (EMDR, CSAT) have their own separate upkeep.
  • Expert Clinicians are generally speaking/writing/training at conferences (1-3 per year for many), which is more time and cost.  Travel costs wrack up easily, and for those heavily invested in being at conferences, it can easily add $5-10,000+ per year in travel expenses and associated costs- all to stay up to date and invested.
• Self-Employment Tax, which Depending on income bracket, is much higher than when an employer covers a chunk of taxes.  Take about 20-35% off the adjusted gross income for total taxes in a year.
• Health insurance.  This may be the biggest expense of all for clinicians if they have to purchase their own health insurance, which can cost around $3,500-12,000 per year- just to have the insurance.
• Limited codes to bill.  Therapists have only a few billing codes they can submit to insurance; many only use one code based on the hour of therapy (90837).  Insurance is not typically known to give raises.  
  • Doctors have, as of this date, literally 70,000 codes to bill!  [Some of my favorites: Y93.D: Activities involved arts and handcrafts and W55.41XA: Bitten by pig, initial encounter, W61.62XD: Struck by duck, subsequent encounter.]
• Cost of living (L.A. and New York and Chicago will see many non-specialized therapists charging $200 or more per hour).
• Number of clients- what is feasible depends greatly, but most clinicians I talk to can see about 15-30 clients per week before they start burning out.  For every client hour, many clinicians have to spend at least an hour for administration, marketing, training, etc., that they don’t get paid for.

I’ll let you do the math.  

So yes, I get it.  Therapy can be expensive.  If my clients say “this is expensive,” I agree.  “Yes, it is.  You are making a sacrifice.  Thank you so much for your prioritization in being here.  My goal is to help you reach your goals and get you on your way as soon as is reasonably possible (unless you want to stay around longer).”

I hope this post is helpful in helping you make a decision or in supporting others considering decisions for therapy in our current world.  Remember the old truism: “you get what you pay for.”  Or maybe what somebody else pays for.


References:
[1]  https://en.wikipedia.org/wiki/Goods
[2] How do I come by those figures?  They’re rarely published, but it is my personal experience and through research and conversations behind the scenes. This makes it subjective, but I hope it helps.
[3]https://www.salary.com/research/salary/posting/counselor-salary, https://www.payscale.com/research/US/Job=Licensed_Professional_Counselor/Salary



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$1.6 Billion.  That's 1,600 x 1 MILLION Dollars.  For the person who won roughly that amount in South Carolina (and the rest of us):

Would it surprise you that your emotional well-being really doesn't improve by becoming wealthy?  There’s been a host of research in recent years that look into happiness and money.  Possibly the most commonly known one is the National Academy of Sciences study on well-being and money.
This study’s now famous $75,000 mark suggests that a person’s emotional well being (how they feel day-to-day) AND their evaluation of life (their overall perspective of how they are doing) improves up to the point of earning $75k per HOUSEHOLD in the United States.  Beyond this mark, emotional well-being doesn't significantly improve, though a person will evaluate their life as better if they earn beyond this mark.  To quote their findings, “We conclude that high income buys life satisfaction but not happiness, and that low income is associated both with low life evaluation and low emotional well-being” (Kahneman, et al. 2010).

So what do "happy money" spenders do?  Research by Elizabeth Dunn and Michael Norton in Happy Money: The Science of Happier Spending (2014) reveals how money is spent makes the crucial difference in happiness.

1. Buy Experiences.
   • Connect with people; target experiences over stuff.
2. Make It A Treat.
   • Making something special and novel increases its enjoyment.
3. Buy Time.
   • Make time to slow down and pursue what's valuable to you.
4. Pay Now, Consume Later.
   • First, don't consume with money you don't have.  Second, enjoy at a later point- anticipate.
5. Invest In Others.
   • An incredible thing happens when we give: happiness.  "It is more blessed to give than to receive" (Acts 20:35, The Bible, ESV).

Are you making the most of what you have?  Are you caught up in materialism and consumerism?  Today is always a great day to do something different.  

Yours Truly,
Justin K. Hughes, MA, LPC

In Latin, Quid Pro Quo means, “something for something.”  You scratch my back; I scratch yours.  Tit for tat.  It’s how the world runs.

Or is it?

In the business world, this often works.  Social psychology calls it “reciprocity.”  In relationships, well, this is where it gets fuzzy.  Relationships require sacrifice regularly; they require that you stick around, presuming it’s reasonable to do so.  In business, if someone doesn’t offer you a good deal, you can move on.  If you keep doing this with relationships, you will bankrupt your heart and anyone close to you quicker than ever thought possible. 

Relationships involve the molding and holding of hearts.  Business involves the flow of money.

I want to call to the table that many principles that work for business DON’T in relationships, which is partly why someone can be extraordinarily successful in the business world but trade in relationships as often as changing underwear.  The concept of reciprocity is fascinating, and I regularly utilize it in respectful ways when I consider how to engage in business, such as when I “add value” to interactions with businessmen and women by offering helpful counseling materials.  This, in turn, increases my odds of getting a favorable response.  Nothing wrong with it.  I attempt to not do it ONLY for this reason.  However, when I expect a certain response- demand it, even- I am not respecting a person’s freedom, uniqueness, or spontaneity.  And this is precisely the problem when quid pro quo is present as a foundation in relationships.

Everyone from Hendrix to Gottman to Eggerichs (see references below) point out the necessity of proactive initiative in love- an active, intentional doing what’s best for another, choosing love over “balancing the budget.”  In fact, the eminent researcher Dr. John Gottman states the myth of quid pro quo in The Seven Principles for Making Marriage Work (2002): “But it’s really the unhappy marriage where this quid pro quo operates, where each feels the need to keep a running tally of who has done what for whom” (p. 15).  

Isn’t this the definition of selfishness?  And it tears relationships apart.  I don’t know of anyone who says, “Yes, being completely selfish is good; I want to live by the principles of selfishness and teach my kids to do the same.”  No one really debates this.  How quickly it takes over, though!  My role as counselor isn’t to point a finger; it’s to help uncover what’s holding people back.  Consider how you might be “losing while winning,” holding grudges, keeping a record of wrongs.  These things are the opposite of contentment- and love.  "Love keeps no record of wrongs," (1 Corinthians 13:5d) as is often quoted at weddings.

Don’t wait for a person to do good to you.  That’s the whole importance of the Golden Rule and the Greatest Commandment.  If you wait around for the other person to “play by the rules” in loving you, prepare to be unsatisfied.  There will come a time (in EVERY relationship) when loving another becomes hard: when the "high" of newness wears off, when the attractiveness of another becomes the norm, when that little quirk that you thought was wonderful turns out to annoy the heck out of you.  If it’s left up to reciprocity, we’re screwed.  In friendships, romantic relationships- ANY relationship.

If a relationship fundamentally relies on quid pro quo, it will prove an unhappy ending.  Find out how to love others despite what they bring to the table, and reap the overflowing results.  If one person brings a feast to the table, just because the other doesn't bring one won't mean you can’t enjoy yours- and just maybe win them over in love.

Sincerely yours,
Justin


For more information:
Business Networking That Works...It's Called Quid Pro Quo (Forbes)
Getting the Love You Want (Drs. Harville Hendrix and Helen LaKelly Hunt)
Influence and Persuasion (Robert Cialdini)
Love and Respect (Dr. Emerson Eggerichs)
The Seven Principles for Making Marriage Work (Psych Central summary)