Why Does Therapy Cost So Much?

I get it. With or without using your insurance, therapy is not cheap. But why is it so expensive for one hour? How much does my therapist really make?

At Conscious Roots Counseling, one of our top values is authenticity. So I am going to break down why therapy sessions cost so much. 

Money In

Let’s start with how much money a therapist typically brings in through sessions. In Cincinnati, Ohio the typical cost for a therapy session ranges from $125 - $175. Our initial session is $150 and follow up sessions are $125. For the sake of this example, I will use $135 as our cost per session. The average full-time therapist sees around 20 clients in a typical week. 

$135 x 20 = $2,700

Most therapists I know work about 46 weeks a year (2 -3 weeks of vacation, 1-2 weeks off for trainings, and 1-2 weeks of sick time or snow days). Please note: therapists do not get paid for time off. In private practice, we only get paid for the time we have sessions with clients. 

$2,700 x 46 = $124,200

WOW!

Look at all that money a therapist is making! They are rich! And they were told they would never make a lot of money in the social services field. 

Hold on. 

Now we have to take money away from the therapist. 

Money Out

I am going to use round numbers to make the math easier, but this budget is typical for one counselor in private practice. This is not accounting for practices with multiple therapists. 

Rent: This is typically the largest expense. Finding a single office that includes a lobby, in a safe/clean building, that has parking can be really hard to find. In the Cincinnati area, there is an abundance of therapists in the Blue Ash area because it is a central location, easy to access from different highways and most office buildings are accommodating to therapists. 

$500/month = $6,000 year

Software: In order to be HIPAA compliant, mental health professionals have to keep our records and communication safe and secure. For this reason, we have to pay for “Electronic Health Record” systems (EHRs), HIPAA compliant email and phone services. An EHR helps us submit insurance claims, schedule sessions, keep record of sessions, create superbills (for out-of-network claims), allow credit card payment, etc. But because they do so much, they can be expensive. 

Also included is software like Quickbooks, Microsoft Office, etc. 

$2,000

Trainings: Like many professionals (teachers, nurses, lawyers, etc.), therapists have to have “continuing education” (CE). In Ohio, counselors must have 30 hours of training every 2 years. Many therapists have a specialization such as EMDR, Somatic therapy, and CBT. Many of these specializations have certifications which generally require additional hours of CEs. For instance, I am a Registered Play Therapist - Supervisor (RPT-S). Every 3 years, I have to submit 18 hours of play therapy specific training. Because I am also a supervisor, I must have an additional 3 hours of “supervisor” specific training. 

On average, a therapist likely needs 15-20 hours of training per year to keep up with licenses and certifications. And trainings are not cheap. It is a steal if a training comes out to $100 per hour or less. So let’s assume $100 per training hour (and this is an underestimate). 

$100/hour x 20 training hours = $2,000

Travel: Add an additional $500 - $2,500 for travel to attend these trainings. For our purposes, I will again underestimate. 

$1,000 

License: In addition to paying for trainings, therapists have to pay to renew their license. It is about $100 every two years, so we will say $50 per year. 

$50

Insurance: Like any other business, therapists need to have liability insurance. 

$500

Professional Services: As amazing as therapists are, they cannot do everything for the business themselves. We need accountants, assistants, billers (if accepting insurance), etc. Depending on how much assistance they need, it can range from $1,000 - $6,000 a year. We’ll use the average. 

$3,500

Dues and Subscriptions: In order to stay informed about our field, particularly any specialities, therapists usually belong to at least one professional organization. Because the cost varies widely, I’m going to use an estimate for how much I pay in a year. 

$500

Marketing/Advertising: In order for clients to find us, we have to pay for marketing. This usually includes therapy directory services such as Psychology Today, Good Therapy.org, and Therapy Den. Each of these listings is about $30 per month ($30 x 3 = $90). I’m going to round up to $100 to also cover the costs of printing business cards, paying for coffee during a networking coffee date, etc. 

$100/month = $1,200 

Website: In order to have a professional looking website, you need to pay for it. Hosting sites like SquareSpace and Weebly are the most common. You also have to pay for a domain name. This comes out to about $150 per year. 

$150

Credit Card Fees: This is a big drain on income. But it’s necessary for convenience. Let’s go to our original income of $124,200 per year. We also need to know how many sessions we have a year because there is a $0.30 cost per transaction: 20/week x 46 = 920. 

920 x 0.30 = $276 

Then credit card companies take an additional 3%. 

$124,200 x 3% = $3,726

$4,140 + $276 = $4,002 But to make it simple, let’s round down to $4,000

$4,000

Office/Other Supplies: Think pens, paper, tissues, hand sanitizer, copier ink, etc. If a therapist has a speciality such as play therapy, art therapy, or sand tray therapy the cost is going to be higher to keep up with supplies and materials needed. 

$500

Savings/Other Costs: Therapists have other costs that are (thankfully) not every year: furniture, laptop, website design, travel and attendance to national conferences, etc. It is smart for therapists to save at least $5,000 a year in order to pay for extra costs in the future. 

$5,000 

Personal Expenses: Unlike a salaried job, therapists in private practice do not have taxes taken out automatically from their paycheck. It is recommended to save 25% of income for taxes. 

124,200 x 25% = $31,050 - let’s make it a nice $31,000

Also, if the therapist needs to have their own health insurance, that’s about $500 per month - $6,000 a year. 

$31,000+ $6,000 = $37,000

Let’s Add It All Up! 

$63,400 is the estimated cost for one year. 

$124,200 (income) - $63,400 (costs) = $60,800

$60,800 is within the average range of income for someone with a Master’s Degree in Ohio. 

Conclusion

Therapy is expensive. I know it is. I pay for my own therapist out of pocket. But mental health professionals are highly educated individuals that are specially trained to help you. While most of us did not choose this career to make a ton of money, we deserve to make a living that is comparable to other professionals with Masters Degrees. So while it may seem that a therapist is making bank charging you over $100 for 45-50 minutes of their time, they are really charging a respectable amount that honors their level of education and expertise.