The High Cost of Therapy

I got a fascinating question from someone on my answering machine recently: Can you refer me to a therapist in a "lower income bracket"? The question erroneously assumes I am in a high income bracket! This led to some thoughts that I'd like to share with you about a common misconception that therapists make a lot of money. I know first-hand about this misconception, because I once had it, as a young person in therapy, unaware of all the “behind-the-scenes” work involved.

Many would be shocked to know that for every 45 – 50 minute clinical hour, I need to spend about up to two (sixty minute) unpaid hours (sometimes more) on related tasks. And, expenses run 40 to 50 cents for every dollar received!

Consultation
So what does all this time consist of? Good, effective and ethical therapists rarely work in isolation. When a therapist consults with others, a patient/client’s case benefits from the professional input of a number of perspectives. I have one senior therapist I consult with bi-weekly, and three other peer therapists I meet with on alternative weeks. This consumes 2 - 3 hours per week, and costs about $225 per month.

Education and Training
Here’s an example of on-going training expenses: I just returned from a trip to Washington DC where I attended the American Group Psychotherapy Association’s annual conference. That ran just under $2,000 total, but my group therapy clients benefit from all that I learned. I’ll also be attending the annual 3 day Northern California Group Psychotherapy Conference at Assilomar soon.

Then there’s the semester long PINC (Psychoanalytic Institute of Northern California) Neuroscience class I’m taking. The fee was $600 and requires me to travel back and forth to the UC Berkeley campus, adding another $10 per trip for gas, parking and bridge fare. But, what I’m learning about recent discoveries on how the brain works is an invaluable biological foundation for both the psychodynamic and cognitive-behavioral work I do with patient/clients.

What other activities take up my time?
In addition to consultation and training, I spend hours on case management, writing clinical notes and case formulations, filling out insurance forms, trying to get through to insurance companies on the phone for checks that never come, looking up information for, and talking to clients on the phone, reading, writing and studying, volunteer activities (like mentoring junior therapists and serving on the boards of my professional associations) bookkeeping and marketing, including keeping up a web site (www.sanfranciscotherapist.info) and this blog.

What are the other expenses?
Everyone knows the high cost of living in San Francisco. Office rental, utilities and services are no exception. Therapists also have to pay fees for their license, liability insurance, professional memberships, books, supplies, on-line services, furniture, electronic equipment and more.

Another huge expense is the discount I am obligated to take (up to 50%) whenever I accept a managed care insurance case. And often, I reduce my fee for those who pay directly and can not afford to pay my full fee.

It’s worth it!
Now you know a bit about the background work and how relatively little many therapists in private practice “take home.” In fact, most therapists I know, can’t really make it in San Francisco without a second source of income, such as from a spouse, a second job, a pension, or some other additional source.

But you should also know, not for a moment am I complaining. I am reminded of how lucky I am to be doing rewarding work every time I see a client move through their difficulties and discover how to live without debilitating depression or anxiety. I feel honored to be sharing in a process that helps a young person begin to find their genuine self and feel their aliveness. I feel deep gratitude for my profession, whenever I see people in group therapy learning new and effective ways of relating and learning to appreciate themselves. As far as I’m concerned, all these things are worth the high cost (to me, as well as to you) of therapy!

Barbara Elbl, MFT, CGP (Licensed Marriage and Family Therapist & Certified Group Psychotherapist) provides individual and group psychotherapy in San Francisco for anxiety, panic, depression and relationship problems.