THE NITTY-GRITTY OF COST EXPLAINED:

Many clients don't realize the time & resources that go into providing a traditional 60 minute session.  We've all heard it:  "Therapy is expensive!"  And I'm here to say absolutely, yes it can be.  I'm here to help you understand the why, communicate the value of therapy as a worthwhile investment, and discuss your options going forward so you can make an informed decision for you.  As a therapist, here are some of my costs associated with doing business that remain hidden in the background:

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A note before we continue:

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AT MY CORE, I BELIEVE YOU DESERVE THE BEST POSSIBLE CARE.

 

YOU DESERVE TO "CLICK" WITH YOUR THERAPIST.

YOU DESERVE TO FEEL COMFORTABLE AND LOOK FORWARD TO GOING TO THERAPY, EVEN IF WHAT WE TALK ABOUT IS HARD.

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YOU DESERVE CONSISTENCY, EASE OF ACCESS, AND CONVENIENT SCHEDULING.

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YOU GET A PRACTITIONER WHO IS INVESTED, ENERGIZED, EXCITED & FOCUSED ON

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YOU

 

AND 100% INVESTED IN YOUR SUCCESS AND WELLNESS.

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 No shows and late cancellation:   I get that unexpected things happen.  Sickness, scheduling fiascos-life happens sometimes.  However, every time you no-show or cancel late I lose valuable time working with you and am unable to recoup that lost income.  Since I am the sole provider seeing pre-scheduled clients one at a time, it's nearly impossible for me to find someone else to fill in your slot if you no show or late cancel.  I can and do charge no-show and late cancellation fees, but this can also place unnecessary strain on the client-counselor relationship.

So please, respect my time and yours.

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Notes and paperwork:  Paperwork and documentation is unpaid, yet necessary, labor.  I document each session and submit it to insurance in order to get paid.  This becomes your clinical record.  I am required to document certain calls and emails.   Any time I spend  researching information and resources, sending and communicating  information to clients, scheduling, emailing, etc is unpaid.  Coordinating with other healthcare professionals, advocating for your care if there is a signed ROI, etc is all unpaid!  The only time I get paid for is the time you are physically (ahem, virtually) live in front of me.  All of this adds up to a large amount of unbillable time-work I do behind the scenes in order to provide the best possible care. 

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Education costs:  As a Master's level therapist I have 4 years of undergraduate work plus a graduate degree.  During graduate studies therapists gain experience through providing hours of free labor in their practicum and internships.  After graduating, state laws require counselors to work for a period of at least two years in a "candidate" position under a supervisor before we are fully licensed providing anywhere from 2000-3000 hours of poorly paid work.  Some supervisors require you to pay out of pocket for supervision during this period.  This equates to 6 years of education, plus 2 extra years of less-than-optimal pay *before* professional independent licensure!  Student loans are also an oftentimes necessary part of higher education; graduate degrees are relatively expensive.

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Continuing education & licensure costs:  Did you know that by law, therapists are required to accrue a set amount of continuing education hours yearly in order to remain up-to-date on best practices and comply with laws and ethical standards?  These certifications allow us to stay up to date with new information, apply new-findings, and continue to grow in knowledge relevant to our field.  Continuing education courses can be expensive, time consuming, and take clinicians away from face-to-face clinical earning.  Travel and accommodation costs with attending trainings yearly quickly adds up!  We must renew our license every two years, and are required to pay applicable fees to stay in good standing.

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Specialization:  Many therapists choose to specialize in specific areas to better serve the populations they work with, and so they can utilize effective interventions and modalities that require additional training.  These specializations are not part of graduate school curriculum and can be pricey:  on the low end hundreds,  on the high end several thousand of dollars -plus- adequate supervision and time in training depending on the specialty.  Not to mention the cost of taking registered exams, and separate continuing education requirements we are required to maintain yearly!

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HIPAA compliance:  I utilize a secure EHR platform, as well as encrypted email.  These are out of pocket costs and are monthly fees I pay up front in order to keep your information safe and secure!

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Technology fees:  High speed internet, anyone?  Costs of maintaining a website, domain name, secure emails and forms, etc.  All out of pocket costs!

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Malpractice Insurance:  I carry a high level of malpractice insurance to protect myself, my business, my family, and our assets.  Being a therapist is a profession that carries a large amount of liability and responsibility.

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Setting:  Private practice vs. Outpatient clinic.  Many costs are absorbed in outpatient settings, such as technology fees and HIPAA compliance, and EHR platforms.  Administrative personnel answer phones and inquiries and book schedules, IT techs trouble shoot issues and update websites, and clinicians see clients in individual or group settings.  Outpatient practices typically are salaried positions, and provide health and employment benefits such as paid time off and health insurance.  However, there can be multiple downsides to outpatient clinic care.  Many outpatient clinic counselors have extremely large caseloads; they oftentimes have long wait lists and limited availability.  You may be directly assigned a counselor who is not a good fit for you, and you may not be able to choose who you see-much less screen a counselor to see if you're comfortable moving forward.  There may be regulations and policies you don't agree with or understand.  Pay for a master's degree position is typically low.  Counselors can be rushed going from client to client and oftentimes have appointments back to back with no break in-between.  There may be less than ideal appointment times available forcing you to have to take time off of work or have difficulty scheduling appointments.

 

Many private practice practitioners end up going into private practice for the freedom and flexibility it provides.  I switched to private practice so I could provide the best possible care and ensure that I am a good fit for every client that I see.  I did not have that option in an outpatient setting; at its height I had 85 clients on my caseload, no time in-between clients to take care of myself or decompress, much-less to do required paperwork, and was quickly approaching burnout rushing from patient to patient.  I was tired, overworked, underpaid, and frustrated that a system that was supposed to help people had so many cracks, and the same system I worked for was hurting me in the process, too.

 

A large outpatient clinic headed by an upper-level office CEO whose company has won the designated insurance contract and has a steady-stream high volume of clients looks vastly different than an independently owned and operated one-woman private practice.  Instead of a salaried position with a steady paycheck or being able to utilize PTO when needed, I rely heavily on the value I provide to my clients and therefore I am incredibly invested in ensuring my clients receive high quality, ethical, personalized, energized, focused, present, and effective care.  In turn, I ask my clients to respect my investment and my time.

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A broken system:  The reality is, the healthcare system is broken as we know it.  Instead of being a part of that broken system, I have chosen to work independently in a way where I can assess what clients are the best fit for me, and show up as a practitioner with a good work-life balance to provide the best-quality care.  (did you know in private practice, a "full" caseload is considered 20-25 clients a week max?   This is the upper limit of most clinicians ability to be able to provide focused quality care, and still have adequate time for required paperwork, admin, etc.  Many clinicians carry a smaller caseload, as high-quality and focused work can be physically, mentally, and emotionally draining.

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