‘And How Does That Make You Feel?’ The Cost of Therapy
by Deb Weiss
Opinions and descriptions of therapy vary as much as the individuals who engage it: It’s medical; it’s personal; it’s a luxury; it’s a necessity; it can be tremendously helpful and beneficial; it can be expensive.
Therapy involves trusting someone with your deeply personal thoughts, your secrets and your raw self. Yet therapy is bracketed by commerce — it is a service, and a source of revenue and expenses, with insurance adding another twist in the process. If I quantified the comfort and help I get from therapy, that number would be far higher than what I can afford to spend. Money and value play a tricky game here: I want excellent care and support; I also want to minimize my out-of-pocket costs.
When I decided to see a therapist in New York, I had three options:
• See a therapist who did not accept my insurance
• Pursue a low-cost alternative, like a student training program or referral center
• Find an in-network therapist.
I figured out these options after stumbling into the office of a pricey out-of-network therapist. I met with this therapist based on a recommendation from someone in the field, and I liked her right away. Scratch that, I loved her. She looked like she could be my aunt, she totally got me, and she was going to fix everything! I could feel my problems melting away — right up until she told me she charged $220 per 45-minute session, and did not accept insurance.
It was a rude awakening. I had assumed that insurance would cover my visits, and didn’t think to ask about fees until the end of our first session. I briefly considered if I could make this work, but the thought of spending $900 each month for these sessions practically had me breaking out in hives. For $900, I could buy 100 Chipotle burritos! (Though probably more like 85 burritos with guac — they really get you on the guac.) Still, the ups and downs of eating three burritos a day would be stressful, as would worrying every month about coming up with enough money to pay for therapy. It was hard to walk away from someone I felt could really help me, but practically, I needed a lower cost option.
Other friends had found help through training centers and graduate programs, with costs ranging from $0–60 per session. I researched nearby places, many of them with rave reviews about their services and low costs, and called for intake appointments. However, the variability in their pricing gave me pause. None of them took my insurance in-network, though after intake fees of $30–60, I might be assigned to a therapist who accepted my insurance. There were too many unknowns for me in this scenario. I wasn’t sure if I was eligible for sliding scale fees, and that would not be determined until after the assignment was made. It was impossible to anticipate what this route would cost me.
Additionally, this would be a long process — it could take a month to be seen an intake, then more time for an assignment. Ever the optimist, I inquired about reassignment if I didn’t like my initial therapist. I was assured it was possible, though would make for a longer process. I wanted more certainty about both provider and costs. This might have been the least expensive option, but I couldn’t know until later in the process. I was impatient, and didn’t want to spend any more time wondering about therapy’s affordability.
Looking for someone in-network was appealing, since my in-network deductible was significantly less than my out-of-network one. I spent several hours on Psychology Today’s website looking for providers who would take my insurance and seemed like a good fit (I also used recommendations and my insurance’s doctor directory). I called and emailed a dozen therapists. Many therapists did not take my insurance, were not taking new in-network clients, or did not have suitable time slots available.
Research and follow-ups were a frustrating process that required a hefty time investment. And it was stressful; I often felt hopeless about finding someone I could afford who would be a good fit for me. I worried if the quality of care I would receive from someone in my network would be as good as my $220 therapist-on-a-pedestal. I felt limited by my finances. I wanted to give up. But I didn’t give up.
I started having introductory phone calls and sessions with therapists I hoped would be my match. The parallels to dating here are unavoidable: friends, and even other therapists, trotted out familiar language, like “keep meeting people until one feels right” and “I’m sure you’ll find someone great.” These lines could be in the pages from a book called He’s Just Not That Therapist for You.
But comparison shopping for people is very different from flipping between tabs for Amazon and Target. Shopping around for a therapist feels slimy, like letting a dude at a bar buy you a drink without mentioning your live-in boyfriend. I could tell, sometimes within seconds, that this was not the relationship I wanted. Unlike a bad date, the check I had to write at the end of a bad session was far more than the cost of two gimlets.
This story has a happy ending. Well, sort of. I found someone in my insurance network that I like working with. She charges $80 per session, and after meeting my in-network deductible in the first month, I now pay $10 per session. I feel good about what I’m paying and the quality of care I’m receiving. But the process of seeking therapy has made me realize how cost can be a deterrent to seeking good care. Finding the right therapist required persistence, and I can understand why someone might give up or settle for someone they’re less than satisfied with, particularly in a period of depression or high stress. Fortunately, I didn’t have to deal with psychiatrists and prescriptions, which I imagine add another layer to this sometimes dizzying process.
I have tremendous respect for therapy, and see immense value in doing the work of mental health. It is hard to place this service in a medical context of deductibles and $10 co-pays. Therapy might make me feel much happier, but that feeling does not deposit thousands of dollars in my bank account to cover payment. Maybe there’s psychological heft to paying upwards of $200 per session, but I don’t feel like I’m getting “only” $10 worth of care when I see my therapist. At the same time, I don’t want her to feel that I undervalue the time we spend together because it costs less than a gym membership.
We often associate more money with more worth, though money and value are not the same thing. My least expensive option would have been forgoing therapy altogether — something I never considered. Yes, therapy can be extremely expensive. It can also be very valuable. For me, it’s worth it.
Deb Weiss is not a health, insurance, financial or medical professional. She is also not a therapist.