Why Therapy Can Be Expensive

Who would pay for an in-person therapist when BetterHelp gives 24-hour access to someone for less than a gym membership?

Pretty compelling. Accessible, affordable support, any time you want it. Just reach in your pocket, text your therapist any time of day, 24/7.  At a fraction of the cost it would be to pay each time I see my therapist in her office.

How do you imagine BetterHelp is able to do that?

Here are some of the ways…

•BetterHelp sells your data (customers are categorized as a “depressed person” or an “anxious person” and then connects to your searches. Marketers can then purchase this data on what “depressed people shop for,” for example) Not incredibly intrusive to you personally, but you are making them money by being used as market research, based on the problems that bring you to their platform.

•BetterHelp pays its counselors 1/3- 1/4 of the standard market value pay for therapy or counseling. The only way to make slightly more by working for them is to see a number of clients each week that is not sustainable. There is time spent on your case, by a good therapist, in service of your care when you are not sitting in their office. Therapists do additional research on aspects of your case to stay up-to-date on standards of care and latest treatment protocols. Therapists consult with other professionals in order to make sure you are getting the most ethical and appropriate care possible. And that self-care they coach you to do- they also need to stay on top of balance for their own lives in order to be healthy and clear-headed enough to work with you and others on the most challenging aspects of your lives. This isn’t possible with 30-40 direct client hours/week. Beyond this, BetterHelp expects counselors to accept clients messages anytime of day or night and provide continual coaching in between therapy sessions.

•BetterHelp doesn’t require notes. An important component of case conceptualization and treatment planning is the note-taking process that occurs when ethically-minded therapists and counselors document the work that is being done and the progress that is being made. Progress notes are used in the court of law to determine the quality of care for clients. Progress notes allow therapists to make sure clients are on track and making improvements with the interventions they are providing, and if not, notes are what help a therapist change course so that clients have individualized care, based on their progress. Notes are what assist therapists in consulting about client cases, which ensures best practices are maintained and allows multiple professionals to input on improving client care. Counselors who are burned out, seeing an unreasonable number or clients each week (see previous item), may only have the time to fit so many direct client contact hours in if they do not maintain quality (or any) notes on each client. Higher quantity of clients to each of their counselors means lower quality of care that they are able to provide.

Many people seeking mental health support expect therapists to interact with insurance panels in order to be paid to work with them.

•Insurance is a business, so its priority is to to make money. Insurance companies are not interested in helping you or in paying the providers who give you care. This is why insurance companies deny claims, require hoop-jumping for you and/or the therapist in order to prove you “need” therapy, and often go months without paying therapists even when all of their required criteria is met. This is why therapists often prefer to keep payment for therapy between only themselves and the client.

•In-office care also requires, beyond your therapist’s time and expertise, office rent and the cost of utilities. Exclusively online therapists also need to charge more because they have likely invested in high-quality wi-fi and other safety protocol for the smoothest and safest online connection possible. Therapists have significant overhead for their offices, beyond the licensing fees, professional insurance and continuing education fees that all licensed psychologists, therapists, social workers, and counselors are required to pay in order to maintain a license with their state’s board.

If you were worried about being ripped off for a mere 50-minutes of time with your therapist each week, consider the points above.

Just because it makes sense that therapy is expensive doesn’t mean everyone can afford it, though. Fortunately for those in Central Texas, Austin is filled with therapists-in-training that need practice while they are under supervision, in order to earn their license. You can ask agencies for “sliding-scale” or reduced-fee therapy. If you are in or near a city with a university, they often offer counseling services to the community at a reduced rate. And if you’ve found a private practitioner online who looks like they are just the person that can help you, ask if they have any reduced-fee spots available. Many therapists are able to see a small number of clients at a reduced rate, in order to accommodate varied income levels. It never hurts to ask!