What Counseling and Psychotherapy Costs and How It Is Paid For

Conventionally, psychotherapy is paid for by the "session" -- usually 50-55 minutes. The per-session cost to the client varies widely. It can be zero in an agency setting, where the practitioner is paid a salary by the agency to counsel its clients. At the other extreme, out-of-pocket cost can exceed $100 per session if the client is seeing a famous psychotherapist at his or her own expense.

Fees vary based on several criteria. In general:

• If the practitioner is very well known and/or very busy, his or her fees go up. On the other hand, practitioners who are working to build a practice often keep their fees low to attract more clients.
• The more time and expense the practitioner has invested in obtaining professional credentials, the higher his or her fee.
• Practitioners who are interested in serving a particular population -- or a diverse population -- often work on a sliding fee scale.

Psychotherapy is paid for in several ways:

• As was mentioned earlier, some psychotherapy is provided as a service by a mental health agency. The agency pays the therapist, and the client is not involved in any financial transaction.
• As a variant of the above, Employee Assistance Programs contract with independent practitioners to provide short-term counseling service to the employees or members of their client organizations. The individual client is not normally asked to pay any part of the cost. The client organization pays a fee based on the number of covered employees.
• Many health-insurance programs provide "mental health" coverage that includes psychotherapy and/or counseling. Because this coverage is based on the assumption that the therapy is required in order to "cure" an "illness," the practitioner is usually asked to begin "treatment" on the basis of a formal diagnosis and to justify continued therapy on the basis of progress reports. The client is usually expected to choose a psychotherapist from a panel of practitioners who have agreed to the insurance provider's fee schedule. The client is also usually asked to make a significant co-payment toward the cost of each session.
• Some health-insurance programs allow the use of "out-of-network" providers. In that situation, the client can choose any provider who is licensed to perform the desired service, however the client may have to pay a larger percentage of the provider's fee than if he or she saw one of the insurance company's preferred providers.
• The client can initiate and pay for the cost of psychotherapy without intermediaries. The disadvantage is that he or she bears the entire cost of each session. The advantages are that the client can choose any psychotherapist, negotiate a fee, and be confident that no other parties are involved in the therapeutic process. In some cases, the fee paid by the client may be comparable to the co-payment required by his or her insurance company.