Why Therapy Costs What It Does (and Why It’s Worth It)

If you’ve ever looked into therapy, you might have been shocked by the price tag.
A single session can range anywhere from $100 to over $250 depending on your location, therapist experience, and specialty.

So what’s behind the cost?
Let’s break down what goes into the price of therapy — and why it’s often one of the most valuable investments you can make.

The Hidden Realities of a Therapist’s Work

1. Therapists Only Get Paid When Clients Show Up

Private practice therapists can only bill for sessions that happen.
If a client cancels or doesn’t show, that time — and income — is lost.

Unlike salaried jobs, therapists don’t get paid for the hours they spend preparing, documenting, or following up between sessions.

2. Therapy Work Extends Beyond the Hour

That 50-minute session is only the visible part of a therapist’s workload.
Behind the scenes, they spend additional time:

• Writing notes and documentation

• Researching resources

• Planning treatment

• Coordinating care

• Fulfilling ongoing education and licensure requirements

In reality, each client hour can equal 1.5 to 2 hours of total work.
That means 20 clients per week often translates to 40+ hours of labor.

3. Therapists Have to Protect Their Own Well-Being, Too

To maintain ethical and effective care, most therapists limit their caseload to around 15–20 clients per week.
Pushing beyond that can quickly lead to burnout — and diminished quality of care.

Many also invest in their own therapy, supervision, and consultation, ensuring they stay emotionally grounded and clinically sharp.

The Real Costs of Running a Therapy Practice

Even without a physical office, therapists have significant monthly expenses.

Required Costs

These are the essentials every therapist must maintain to legally and ethically practice:

• License fees: $12.50/month

• Liability insurance: $10/month

• Continuing education (CEUs): $6–$400/month

• Student loans: $695–$1,100/month

• Office supplies, utilities, internet, phone: roughly $400/month

• Supervision and consultation: $80–$300/month

➡️ Minimum: $1,200–$1,700/month or $14,000–$20,000/year — before rent, taxes, or insurance.

Additional Professional Expenses

These vary by therapist, but many include:

• Electronic Health Records (EHR): $99/month

• Advertising and website: $70/month or more

• Professional insurance and accounting: $200–$250/month

• Office space rental: starting at $1,200/month

Total yearly costs often reach $30,000–$40,000 — and that’s before taxes or personal living expenses.

What That Means for Income

If a therapist charges $150 per session, sees 20 clients per week, and never has cancellations or time off (which is unrealistic), their gross income might be $156,000.
After overhead, taxes, and missed sessions, the realistic take-home can range between $20,000 and $80,000 per year — depending on location and caseload.

Some therapists, especially early in their careers or in rural areas, live close to or below the poverty line.

Why Some Therapists Don’t Accept Insurance

1. Low Reimbursement Rates

Most insurance companies reimburse $40–$120 per session, far below private rates. To earn a living, therapists would need to double or triple their caseload — a direct path to burnout.

2. Confidentiality Concerns

When you use insurance, your therapist must share your diagnosis and treatment notes with the insurance company to get paid.
That information becomes part of your permanent health record, which can sometimes impact future job or life insurance applications.

3. Limited Treatment Flexibility

Insurance companies can dictate which services or lengths of treatment they’ll cover — even denying sessions or issuing “clawbacks” (demanding repayment after already approving services).

Because of these restrictions, many therapists choose to stay out-of-network to protect both their clinical integrity and your privacy.

How to Find Affordable Therapy

If private pay rates are out of reach, there are still options:

• Sliding scale rates: Many therapists adjust their fees for clients with financial hardship.

• Community mental health centers: Offer therapy at reduced rates.

• Training clinics: Sessions with graduate interns under supervision can be $30–$60.

• Online directories: Sites like TherapyDen

• Read more in this blog post: How to Find Low Cost Therapy