Designer Therapy // Is Good Therapy Only for the Rich?

By Elisheva Liss, MA, LMFT

An acquaintance recently asked me to recommend a suitable marriage counselor for her. I gave her the names of some trusted colleagues but warned her that they work in private practice, so it was going to cost. I also offered to look at the list of those who accept her insurance, to let her know if any names looked familiar. She opted to call the private names first. This friend and her husband are hard-working professionals, but they have significant expenses and not unlimited funds. When she heard their hourly rates, she echoed the frustrated sentiments of so many clients and would-be clients: Why does therapy have to be so expensive?

The short answer is: It doesn’t.

But of course, there’s a lot more to it.

It can be terribly frustrating to do the legwork of finding names and making nerve-wracking calls, only to find out that the help one seeks is unattainably beyond the budget. I’ve even heard some go as far as to bitterly suggest that it is “unethical” or “greedy” for professionals to charge such high fees for their time.

So, I thought it might be helpful to publicly shed some light on this common grievance.
The single most important piece of information for the therapy-consumer to know is that therapy need not cost a fortune. Licensed psychotherapy by a trained therapist for a diagnosable problem is available on most health insurance plans, and in many clinics and agencies for a fraction of the cost of private therapy. Any potential client should know this or be apprised of this when exploring one’s options.

If this is true, why would someone opt to see a pricier professional? It really boils down to the basic economics of any goods or services industry, but here are some of the mechanics of how it works in this field:

Some people are willing, or even prefer to spend more if the therapist was recommended by someone they trust—such as a referral service, a friend who had a good experience with that therapist, or a mentor who knows both parties well. Therapy is a deeply personal experience and requires a significant investment of time and trust, so some people feel more comfortable working with a recommended and endorsed clinician.

Sometimes clients have seen particular therapists lecture at an event, or on video, or have read their written material, and felt that the content, wavelength, and style resonated with their personalities, and the therapeutic work they are seeking.

Other times, they want to see someone with expertise or advanced training in a specific subfield, so they would invest in a specialized practitioner, rather than a more general clinician.

Another motivation, for some clients, is the perception that more expensive means better—more experienced, more talented, or at least more exclusive. Sort of like “designer therapy.” (Whether this is actually true or not is debatable, and probably varies extensively by situation and each professional.)

But many clients and prospective clients feel resentful or aggravated by the fact that therapists “have the nerve to charge so much.”

In truth, most rates are set by the interactive natural laws of a free market and human nature. For example, you can buy a dress for $10, $100, $1,000 or more. Some consumers may believe they are getting more durable, beautiful, or finer merchandise for the higher price tag. Others may believe that high-end couture is a rip-off and see no correlation between price and quality. Either way, we generally have a range of fees and prices we can choose to pay for any particular product. This is true of almost all goods or services. Sometimes you get what you pay for, and other times it’s entirely unnecessary to splurge on a name brand to get good quality.

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