Didn't get enough from my first post? If you feel so inclined, here's a continuation on some of the reasons therapists charge what they do and some of the benefits of going to a private-pay therapist.
5. While a graduate degree in psychology provides clinicians with the important education necessary to practice psychology, even a doctorate education of 5 years is just the foundation. Mental disorders and even the general psyche are so complex and varying that it is impossible to learn everything necessary in school to treat clients across all settings. This is why many clinicians not only take continuing education credits (required), but also enroll in much longer and comprehensive training programs. These training programs can be even more in depth than some of the training in graduate programs as they are sharply focused on one topic, like for instance, a specific type of therapy that was not covered during graduate school. These trainings can cost thousands of dollars and require weeks of commitment, which also means taking time off from client hours. These same principles apply to attending conferences.
6. Just because you’ve hung your shackle as a therapist does not mean clients will flock to you in droves. In fact, it may be easier to take insurance because you’ll be on a list for clients with that insurance to choose from. But with private practice, there are hundreds of therapists within a certain geographic territory and if you want to be successful, as is true in any line of business, you’ll need to stand out and get the word out. To do so requires various online advertising subscriptions, website upgrades, monthly fees to websites that present therapists to clients in one place, networking with other therapists and businesses that may offers referrals. To keep a successful business running, the CEO hat never comes off.
7. I wouldn’t be alone in thinking about how cancelations can change your financial outcome. Just like airlines overbook, many therapists find themselves booking more clients than they might prefer to see in a week because of dreaded cancelations – kids, illness, scheduling conflicts, no matter the reason, contractors only are paid when they work. I’ll never forget two years ago when my hair salon asked for my credit card to keep on file. Before recognizing how my cancelation could affect a stylist’s income, I was a bit miffed, but now I very clearly understand the challenge of being an unsalaried employee. Therapists may charge a flat cancelation fee if not notified within a certain number of hours so they can offer up the appointment slot to someone else.
8. Like contractors and those in the gig economy, healthcare is not a given. While you may think your therapist is taking home the fee they’ve charged you, think again as healthcare and retirement benefits enter the breakdown. Being in business for yourself also means that pay raises and bonuses are not a part of the picture. Therapists may raise their fees minimally every few years, but there are no promotions or next, big milestones.
While I may have outlined aspects of a therapist’s job that may seem like a drag or like an essay essentially on what it is to be a 1099 contractor, it goes without question there are many joys and advantages to being a therapist (article on this one in the works!). It is deeply satisfying to see others grow, to feel connected with people daily, gain deeper insight into the human condition and have a flexible schedule with good pay. There are a number of therapists who struggle with putting a price tag on helping others, yet it is a job we do and must be paid like anyone else.
What would change the landscape of affordability and access to therapy (through using insurance) are better reimbursement rates and processes for mental health professionals. Organizations representing practitioners in the mental health field do this important advocacy work and in my time of practicing, I have already seen rates increase for certain services under a couple of insurance companies.
The final point is that seeing a private pay therapist can afford some benefits – your therapist is likely not seeing too many patients and becoming burned out. They may also use their extra training that makes them better able to help you. Your privacy is also ensured as with private pay therapy, none of your struggles are listed on a treatment plan and reported back to your insurance. I see this often with professionals who know there is still an unfortunate amount of stigma if they were open about their struggles. Private pay offers the therpist freedom in recommending care that they truly see neceessary, meaning they won't tell you "time is up" after 10 sessions because your insurance says so. With private pay, the world is your oyster. Dr. XYZ doesn't take Aetna? No problem, you can see them.
While knowing some of the excesses that are involved in accepting insurance may not make it any easier to fight your insurance company, hopefully this knowledge can shine a light on what goes on behind the scenes at your therapist’s office.
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