Managing the cost of therapy - You have more options than you think

By: Tom Cloyd - 7 min. read (Published: 2025-05-24:0846; reviewed: 2025-05-24:1825 Pacific Time (USA))

Cost-related barriers can needlessly keep people from getting needed therapy.

Fear of the anticipated cost keeps some from even seeking help. Insurance-related costs can lead to premature termination of therapy, for others. Then, therapist refusals to deal with insurance companies at all can limit options available to someone seeking help.

BUT…be assured that there are solutions many people don’t know about.

 

Page contents…

• Psychotherapy costs vary significantly ^
• Knowledge is power - talk with your therapist ^
• Dealing with insurance company barriers ^
• A tip for my therapist colleagues ^
• References ^
• Notes ^

Psychotherapy costs vary significantly ^{^}

What this should tell you immediately is that just as with any product or service which has a variable cost, you will likely be rewarded for browsing widely and being a wise shopper. You would have little difficulty doing this if you were shopping for a living room couch or a new circular saw - why should therapy be any different? It need not be at all.

A good estimate of the cost of therapy is that a single session can range from somewhat below $100 to $200 and up.¹ But this statement requires much qualification. For one thing, the majority of psychotherapists hold Master’s degrees, and they charge less than PhD psychologists, and much less than psychiatrists. Studies of treatment outcome have consistently indicated that the most significant factor affecting outcome is not therapist degree level but the nature of the relationship between therapist and client.²

There are distinct regional variations in costs. Like with many other things, your regional economy matters. In my state, on the wealthy west side of Washington, the cost of everything is higher, often by quite a sum. Here in the state’s less populated east side, therapy is more affordable.

Costs can also vary widely depending on a client’s financial situation. This is discussed in the next section.

Knowledge is power - talk with your therapist ^{^}

Don’t let fear of costs stop you from getting the help you need! Take time to get “the lay of the land” - to understand the variety of ways in which therapy is paid for, and the variety of payment levels that may impact your situation. Persist in your study of this and in your search for a service provider you can work with. Smart shoppers get the best deals!

THERAPISTS OFTEN DON’T “TAKE” INSURANCE! The compensation these companies offer is often insufficient,³ and the paperwork involved burdensome. Some insurance companies don’t even have a mental health benefit.

INSURANCE, if you have it, will surely only pay part of the cost. The rest is your “copay”, and that amount can vary considerably. If you don’t have insurance, you pay the full cost, but some therapists have a different charge for non-insured clients.

==> Don’t be shy! Ask about lower fees for uninsured clients.

Insurance companies are not required to have mental health benefits in their policies.¹ If they do, then the coverage must be essentially equal to the coverage they offer for physical health issues.³

It’s smart to take the time to study your insurance policy, so that you can know what your company has agreed to do for you, AND what appeal options you might have if they refuse to pay. Also, you need to have some familiarity with several laws that directly relate to insurance coverage for mental health services. (Read this note.⁴)

TELETHERAPY is now quite a thing. Clients generally like it, as do many therapists. If you live in a costly region but are financially challenged, locate a therapist in a less costly region who does teletherapy (and make sure your insurance, if any, will pay for this).

==> Don’t be shy! Explain your situation. Ask about teletherapy.

SLIDING SCALE FEE SCHEDULES are common, although not all therapists have them. For those unfamiliar with this arrangement, what this means is that the therapist will adjust your fee down, relative to your income. You should have materials available (and with you, if you visit their office) to verify your income. An income tax filing from last year, or a pay stub or bank statement showing your pay should be adequate.

==> Don’t be shy! Explain your need for a sliding fee scale, then ask if they have one. If they do, give them your gross income figure and ask what their fee would be for you. This is a perfectly normal, pre-contact conversation to have.

ASK FOR A REFERRAL if a therapist you’re talking with cannot help you. Often they will know of other providers in the area who may be able to work with you.

COUNTY MENTAL HEALTH AGENCIES AND CHURCH-RELATED AGENCIES⁵ should definitely be considered. While they do have staff to pay, they are more likely to directly address the needs of financially-challenged clients. They also usually have case managers who can help you find services beyond psychotherapy. In rural areas, country mental health agencies may be the only options easily available.

Dealing with insurance company barriers ^{^}

Your insurance company typically has a “network” of service providers they work with. If you use a provider not in this network you will pay more. Your insurance may not even reimburse at all for out-of-network providers. Read your policy or call your insurer for details.

NO IN-NETWORK PROVIDERS IN YOUR AREA? You can still consider telehealth services - accessing a provider not in your area by using a video call service. Make sure your insurance company covers this. Historically, they have been slow to agree to do this, but research on the question of the effectiveness of telehealth service compared to in-person service has consistently shown that there is no difference,² and reimbursement for such services is now more widely offered.

INSURANCE POLICY COPAYS MAY STILL BE UNAFFORDABLE, in which case you should definitely review the previous section and discuss your situation with your therapist.

A tip for my therapist colleagues ^{^}

If you don’t already know this, I want you to know that generosity pays. I would hope you’d be generous simply out of compassion, but in any case, here is what I discovered about generosity, quite inadvertently:

I began my private practice career when I transitioned from managing and doing clinical work in a county mental health branch office, where no one was turned away. Suddenly, I had to deal with the problem of the income-challenged client. They had insufficient funds - or NO funds - for psychotherapy that they quite clearly needed.

Denying them services was impossible for me. It felt wrong. I didn’t get into this career to fail people. So, I quickly developed the concept of giving people “scholarships”. I always did this with a big smile, and I usually said something like “since we’re putting you on scholarship, we’re going to expect truly great therapy from you!” (It never hurts to set positive expectations from the very start.) Typically, I would get a smile back, and this seemed to reduce or eliminate any feelings of distress my client appeared to be having about not having sufficient money.

But then something unexpected happened, again and again. We would get great results from the therapy, and then they’d terminate with me. Some time later, I’d start getting referrals from them. It turned out that pro bono therapy was a great way to get referrals, and they more than paid for the pro bono work I did. I’m still a bit amazed by this, but…it makes sense when you think about it. I encourage you to give it a try.

References ^{^}

Carrns, A. (2014-01-10). Understanding New Rules That Widen Mental Health Coverage. The New York Times. https://www.nytimes.com/2014/01/10/your-money/understanding-new-rules-that-widen-mental-health-coverage.html

Lauretta, A. (2021-10-19). How Much Does Therapy Cost In 2025? Forbes Health. https://www.forbes.com/health/mind/how-much-does-therapy-cost/

Singer, J. (2024-09-15). Therapy Can Be a Financial Burden. Try Telling Your Therapist That. The New York Times. https://www.nytimes.com/2024/09/15/business/affordable-therapy-costs.html (no paywall to access this article)

Notes ^{^}

 

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