what's a "fair" fee for therapy??

[Phipps]

Okay,

I am starting grad school later this month --yeah!! and I am thinking of starting therapy. I think it would be a good time...so, this is a personal question, purely for my own information and I hope it's okay to ask on this forum:

I found a Ph.D. level psychologist I would like to work with. This person asks for $120 per 50 minutes and I wonder whether that is an okay/fair fee to pay. I have not been in therapy before and don't know about insurance coverage etc. but think I would prefer paying out of pocket even though it is a stretch, financially.

Any thoughts are appreciated.

Thanks, Ms. Phipps

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[2012PhD]

Okay,

I am starting grad school later this month --yeah!! and I am thinking of starting therapy. I think it would be a good time...so, this is a personal question, purely for my own information and I hope it's okay to ask on this forum:

I found a Ph.D. level psychologist I would like to work with. This person asks for $120 per 50 minutes and I wonder whether that is an okay/fair fee to pay. I have not been in therapy before and don't know about insurance coverage etc. but think I would prefer paying out of pocket even though it is a stretch, financially.

Any thoughts are appreciated.

Thanks, Ms. Phipps

The problem with going through insurance is that they have to diagnose you with a DSM code and something biological if you want to get the most services, like MDD. These diagnoses then stay on your record and can affect your ability to land insurance later in life or to qualify for life insurance.

120 sounds very fair to me for psychotherapy services. However, your program may have a list of "low cost psychologists" that they circulate around. Many psychologists have low cost slots for graduate students are are willing to go down to $25 per session. You can ask around for low cost folks. They are usually just as good from my experience.

 

[Phipps]

The problem with going through insurance is that they have to diagnose you with a DSM code and something biological if you want to get the most services, like MDD. These diagnoses then stay on your record and can affect your ability to land insurance later in life or to qualify for life insurance.

120 sounds very fair to me for psychotherapy services. However, your program may have a list of "low cost psychologists" that they circulate around. Many psychologists have low cost slots for graduate students are are willing to go down to $25 per session. You can ask around for low cost folks. They are usually just as good from my experience.

Wow. $25! That is pretty low. Thanks for the lead.

 

[aequitasveritas]

Someone charging $25/session will not be as good as someone who can charge 125. Demand side economics...those of desire can raise their fee higher.

 

[Therapist4Chnge]

Some clinicians will provide a "professional discount" for grad students, so it may be worth contacting the state/county psych association. I knew someone who did this for a reduced fee ($50/session instead of $140/session), though he'd only have a slot or two set aside for it. I think it is a good experience for people to have, though obviously it can get expensive.

 

[2012PhD]

Someone charging $25/session will not be as good as someone who can charge 125. Demand side economics...those of desire can raise their fee higher.

Many psychologists have low fee slots (maybe 2 or 3) even though their regular fee is $150. The low cost psychologist i saw was charging everyone else $150 for evening spots and had a few low cost clients, including me. For those spots, she charged whatever i could pay. The quality was the same in this case. In general, lower cost is not a great thing, but there are plenty of quality psychologists that have a few limited low cost slots.

 

[aequitasveritas]

Some clinicians will provide a "professional discount" for grad students, so it may be worth contacting the state/county psych association. I knew someone who did this for a reduced fee ($50/session instead of $140/session), though he'd only have a slot or two set aside for it. I think it is a good experience for people to have, though obviously it can get expensive.

Haha. Just realized u kept that as ur signature. chuckle

 

[Therapist4Chnge]

Haha. Just realized u kept that as ur signature. chuckle

It made me crack up after a LONG day.

 

[deadmau5]

i think 80$/hour is reasonable minimum. there's quite a bit of work outside the hour during the week.

 

[PerhapsMaybeOk]

i think 80$/hour is reasonable minimum. there's quite a bit of work outside the hour during the week.

80$ Canadian dollars ?

 

[isupsych253]

All this talk about psychologists getting $130-$150 per session...why is everyone complaining about psychologists not getting paid enough? haha

 

[cara susanna]

A lot of it goes towards maintaining the private practice and/or insurance companies.

 

[2012PhD]

All this talk about psychologists getting $130-$150 per session...why is everyone complaining about psychologists not getting paid enough? haha

This is a common misconception. The vast majority of psychologists can't have an out of pocket therapy practice if they are doing this full-time because there are very few people who can afford this fee and will not fill up their practice. This only works in a very wealthy area or if you are a famous psychologist and can charge a lot.

Many psychologists get reimbursed $50-70 per therapy session (1 hour) from insurance companies. That is, if the insurance doesn't deny coverage. Most of us can't see more than 6 people per day because we are spending lots of time on each patient and making phone calls outside the session. Its is not a factory like an MD practice. Plus, deduct office space (can be $3,000 in a big city), continuing education, and health insurance and malpractice insurance and you will see that the average PP psychologist can't survive.

 

[Phipps]

This is a common misconception. The vast majority of psychologists can't have an out of pocket therapy practice if they are doing this full-time because there are very few people who can afford this fee and will not fill up their practice. This only works in a very wealthy area or if you are a famous psychologist and can charge a lot.

Many psychologists get reimbursed $50-70 per therapy session (1 hour) from insurance companies. That is, if the insurance doesn't deny coverage. Most of us can't see more than 6 people per day because we are spending lots of time on each patient and making phone calls outside the session. Its is not a factory like an MD practice. Plus, deduct office space (can be $3,000 in a big city), continuing education, and health insurance and malpractice insurance and you will see that the average PP psychologist can't survive.

The topic about what's a fair fee if one pays out-of-pocket seems to touch on several issues...at least for me --after reading posts here:

I had been asked to pay $120 per 50 minutes and I'd be happy to pay that EVEN THOUGH it is a financial stretch. One reason I would pay $120 is that I'd ask myself how much I would want to get paid by clients later on. If this is what I would want to receive, I should make an afford to pay that...
on the other hand, after the Ph.D. level clinician I met with learned where I am going for grad school and that it is a rather expensive school and a Psy.D. program, the penrson assumed that I THEN can spend $120 since I have the money for grad school...which is a misconception.
On the other hand, I think it may be a humbling experience to pay a significantly lower fee b/c of financial reasons.

Does it really come down to $$$?? What are the therapeutic implications or issues behind negotiating a fee, e.g., power issues, feelings of humiliation, not paying a therapist what s/he may be 'worth' according to ed. and experience.
How about pay raise: am I as client responsible then to give the therapist a raise like every year or so?

Any thoughts?

 

[wigflip]

Does it really come down to $$$?? What are the therapeutic implications or issues behind negotiating a fee, e.g., power issues, feelings of humiliation, not paying a therapist what s/he may be 'worth' according to ed. and experience.
How about pay raise: am I as client responsible then to give the therapist a raise like every year or so?

I think that negotiating a fee is a good opportunity to observe your prospective therapist. If you are feeling anything less than fully comfortable with how s/he is handling things up front, I'd consider interviewing more therapists. You don't want to find out down the road that this person is a nut with boundary issues. This happened to me--LCSW said something so blaming, stupid, and patently offensive that I was put off therapy for years. When I finally did find someone new, I grilled her before jumping in.

Oh, and you're not responsible for giving her/him a raise.

 

[wigflip]

after the Ph.D. level clinician I met with learned where I am going for grad school and that it is a rather expensive school and a Psy.D. program, the penrson assumed that I THEN can spend $120 since I have the money for grad school...which is a misconception.

If this is true, I'd say it's a red flag. It's such a silly assumption to make that it doesn't fill me with confidence.

 

[2012PhD]

If this is true, I'd say it's a red flag. It's such a silly assumption to make that it doesn't fill me with confidence.

Let's not jump to conclusions here. One can easily argue that a graduate student earning a PsyD/Phd should not qualify for low cost therapy given future earnings and prospects (on average). Low cost therapy is really meant for people who are disadvantaged (no college degree, single parents with kids and earning under 30K). In the future, I plan on having low cost slots even though my full fare will be closer to 150 plus. These low costs would likely be for people who have really depressed incomes and lack education, although i'd probably include students who come from disadvantaged backgrounds in there and have to support a family.

After 8 years of training, $120 is a very fair fee, especially considering the amount of time therapists spend on each case compared to MDs and other providers. However, think about it like any other service you are receiving. You can always try to negotiate the fee. To me there is no shame in this. I negotiate fees with other professionals all the time, including my dentist, auto mechanic, landlord, gym since i am a student earning 25K.

 

[wigflip]

I negotiate fees with other professionals all the time, including my dentist, auto mechanic, landlord, gym since i am a student earning 25K.

2012, you are worth your weight in gold. It would have never in a million years occurred to me to negotiate with my dentist.

As for my previous posts, I think I was picking up on (or perhaps reading in) some unease on the part of the OP.

 

[2012PhD]

2012, you are worth your weight in gold. It would have never in a million years occurred to me to negotiate with my dentist.

As for my previous posts, I think I was picking up on (or perhaps reading in) some unease on the part of the OP.

You can also negotiate your outrageous medical bills down a ton if your insurance doesn't cover something. I think people know that times are tough and they would rather get a reduced payment then no payment at all.

 

[Phipps]

You can also negotiate your outrageous medical bills down a ton if your insurance doesn't cover something. I think people know that times are tough and they would rather get a reduced payment then no payment at all.

I agree, i.e., times are rough, financially, for many...however, my issue is more related to 'character': am I willing to pay $120, knowing that it may be a fair fee and still below what the Ph.D. level psychologist would charge normally, and 'sacrifice' other things I would get otherwise, and knowing that I would want clients to pay a fair price to me later on and maybe be willing to do those 'sacrifices'...

 

[Phipps]

Oh, and you're not responsible for giving her/him a raise.

I think, this is really an interesting point you are raising...I DO NOT KNOW who is responsible for giving a therapist a pay raise --considering that the client is the person (if fee for service) who 'employs' the therapist, I guess, it may be correct for the client to give her/him a raise. However, often, the client seems to feel like being in a weaker position even though de facto it should be a partnership, the therapist determines the amount to be paid (at the onset of therapy)...and maybe is considered more powerful than the client. Therefore, why would the therapist expect the client to raise the pay?

 

[stigmata]

It would be completely inappropriate for a psychologist to accept a "raise" from a patient. Rates for services are 100% up to the provider.

 

[wigflip]

It would be completely inappropriate for a psychologist to accept a "raise" from a patient. Rates for services are 100% up to the provider.

I agree. I think if a prospective client conducts her/himself respectfully during the interview/negotiation then the the client needn't be concerned about the psychologist's "stuff" (how psychologist feels about fee, possible future renegotiations of fee down the line). That's the psychologist's job.

I guess I still don't feel comfortable about the OP's suspicion that psychologist feels sure that OP can pay given OP's swanky school choice. As others have pointed out on this forum, this is a risky business; future earnings may never materialize, OP might be in debt for many years to come--(though I hope not--wish you nothing but the best). Clearly psychologist has the right to ask for whatever s/he feels is reasonable (just as prospective client has the right to decline, seek therapy elsewhere). I'm just uncomfortable with that original assumption, which OP her/himself labels a "misconception." Or more precisely, I'm uncomfortable with what to me seems to be OP's discomfort about it.

 

[wigflip]

However, often, the client seems to feel like being in a weaker position...and [the therapist] maybe is considered more powerful than the client.

I would say this is right on the nose. It's not that the client has NO power; one can post nasty things (true or untrue) about one's therapist on the Internet (though this could potentially boomerang back as a defamation law suit), cease treatment, report therapist to her/his professional organization. But the therapist can cross boundaries in very damaging ways. They can also diagnose you with a personality disorder, or 5150 you (at least in CA). Ultimately, there can't be true symmetry in a relationship in which someone can have you hospitalized against your will.

Maybe it's my own past experience with a really bad therapist, or a cohort effect (my generation remains suspicious of authority figures). I'm just suggesting that you pay attention to anything that's making you feel uncomfortable up front because ultimately it is an asymmetrical relationship. Trust yourself, and if you feel comfortable with the therapist, and with the $120 and the way that fee was arrived at then proceed.

 

[2012PhD]

It would be completely inappropriate for a psychologist to accept a "raise" from a patient. Rates for services are 100% up to the provider.

The psychologists i know usually raise their fee every few years to keep up with inflation. I think this makes the most sense.

 

[2012PhD]

I agree, i.e., times are rough, financially, for many...however, my issue is more related to 'character': am I willing to pay $120, knowing that it may be a fair fee and still below what the Ph.D. level psychologist would charge normally, and 'sacrifice' other things I would get otherwise, and knowing that I would want clients to pay a fair price to me later on and maybe be willing to do those 'sacrifices'...

It depends on one's priorities, income, and level of distress. $120 an hour is not much if it can lead to a long-term increase in quality of life, better relationships, or increased productivity at work. Therapy saves lives for others and so the "return" on investment is clearly huge and can't even be quantified in those cases. If you are willing to spend $3,000 on a graduate student course to get your PsyD, then I think therapy is a worthy investment. 6 months of therapy is the equivalent of one graduate student course. My bet is that you would grow and learn more from being in therapy than a typical class.

If money is an issue, one thing you can do is tell your therapist that you are interested in "short-term therapy" and will re-evaluate after. With a competent therapist, 6 months is a good amount of time. Research shows that many of the gains in therapy occur in the earliest sessions. Even dynamic therapists these days can work within a 20-25 session model and lead to significant gains.

 

[SFPsyd]

It depends on one's priorities, income, and level of distress. $120 an hour is not much if it can lead to a long-term increase in quality of life, better relationships, or increased productivity at work. Therapy saves lives for others and so the "return" on investment is clearly huge and can't even be quantified in those cases. If you are willing to spend $3,000 on a graduate student course to get your PsyD, then I think therapy is a worthy investment. 6 months of therapy is the equivalent of one graduate student course. My bet is that you would grow and learn more from being in therapy than a typical class.

Very well said, 2012PhD. We are in a rare field that can actually lead to increased happiness and lasting quality of life improvements. Considering people pour tens of thousands into luxury cars, huge McMansions, and other such expenses ostensibly to increase happiness (even though this is a dead end), quality therapy is well worth the cost.

 

[Phipps]

Very well said, 2012PhD. We are in a rare field that can actually lead to increased happiness and lasting quality of life improvements. Considering people pour tens of thousands into luxury cars, huge McMansions, and other such expenses ostensibly to increase happiness (even though this is a dead end), quality therapy is well worth the cost.

I fully agree with both of you in regard to investment in therapy as a path to (hopefully) embracing a kind of life/satisfaction that does most likely not occur through material things.
For me personally, paying $120 per session means not being able to have a cell phone, I do not own a car, YTD I have earned about $9000 and paying this amount for therapy truly means bringing sacrifices, and I am not saying, I am not willing to. Attending grad school does not always mean one is rich and a therapist assuming one is, misses the point of how hard one may work, juggle school, etc. to pursue such a degree nevertheless.

 

[wigflip]

I fully agree with both of you in regard to investment in therapy as a path to (hopefully) embracing a kind of life/satisfaction that does most likely not occur through material things.
For me personally, paying $120 per session means not being able to have a cell phone, I do not own a car, YTD I have earned about $9000 and paying this amount for therapy truly means bringing sacrifices, and I am not saying, I am not willing to. Attending grad school does not always mean one is rich and a therapist assuming one is, misses the point of how hard one may work, juggle school, etc. to pursue such a degree nevertheless.

Hi Phipps,

Just my opinion here, but if you are a woman with no car (am guessing based on your avatar--my apologies if I got that wrong), a cell phone is a must for safety reasons. If money is that tight, I wonder if you might be able to defer starting therapy for a while, or find a therapist like the ones described above who might be willing to flex their fees a bit more. Or perhaps a masters level clinician would be more affordable? The only grad students I know who could afford $120/hour are those from wealthy backgrounds.

 

[Ollie123]

Not to be the voice of dissent, but I'm honestly not sure I'd pursue therapy in your situation - at least not for that sum of money. Its one thing if someone is genuinely struggling and has a reason to see a therapist, but I don't think that's the case here. I do think anyone can benefit from quality therapy, but I also recognize that it may not be reasonable to prioritize it in a person who is doing fine right now and just looking for the experience of therapy, etc.

I do think its important for psychologists to experience therapy at some point, so if you have never been in therapy before it may make sense to pursue it. If you already have done that at some point and its a financial struggle right now...I'd hold off and see. You may find that between didactics, supervision, and social support you are fine and if not, you can make a decision then.

While obviously I'm a proponent of therapy, I don't operate under the assumption that everyone needs it. There's minimal evidence for "cosmetic" therapy, though I don't doubt some benefits exist and I want to see more research done on it. Given that, I usually terminate with clients fairly quickly if they are doing well because its not a good use of their time and money, or my time either if its a setting with a waiting list.

 

[wigflip]

Not to be the voice of dissent, but I'm honestly not sure I'd pursue therapy in your situation - at least not for that sum of money.

I'm with you, Ollie.

 

[aventurine]

One can easily argue that a graduate student earning a PsyD/Phd should not qualify for low cost therapy given future earnings and prospects (on average). Low cost therapy is really meant for people who are disadvantaged (no college degree, single parents with kids and earning under 30K).

How is that an easy argument? Presuming a person is coming to therapy with genuine issues that cause distress and is subsisting on a low income (as most grad students do, unless supported by family members), why should he or she be discriminated against based on level of education or parental status? I am a licensed Ph.D. who gets by paycheck-to-paycheck due to high cost living in my city, student loans, childcare and family medical expenses. But even if I had a higher paying job or thriving full-time private practice, how would that have helped me afford therapy during all of those years of doctoral study? What is the argument for not deserving affordable mental health care at a time when you are barely squeaking by, just because you might do well in 10 years?

I could only understand this if therapy were simply for personal exploration, but even then...I do think it's important for doctoral students to have their own therapy. If there is not access to sliding scale clinics in the area, hopefully some therapists will continue to provide affordable therapy for grad students.

 

[wigflip]

How is that an easy argument? Presuming a person is coming to therapy with genuine issues that cause distress and is subsisting on a low income (as most grad students do, unless supported by family members), why should he or she be discriminated against based on level of education or parental status? I am a licensed Ph.D. who gets by paycheck-to-paycheck due to high cost living in my city, student loans, childcare and family medical expenses. But even if I had a higher paying job or thriving full-time private practice, how would that have helped me afford therapy during all of those years of doctoral study? What is the argument for not deserving affordable mental health care at a time when you are barely squeaking by, just because you might do well in 10 years?

I could only understand this if therapy were simply for personal exploration, but even then...I do think it's important for doctoral students to have their own therapy. If there is not access to sliding scale clinics in the area, hopefully some therapists will continue to provide affordable therapy for grad students.

Totally agree. The way the OP describes the negotiation process would have made me too uncomfortable to continue with that therapist.

Oh, and by the way, the Scholastic Snake Oil blog has some great posts on student loans...

 

[futurepsydoc]

Someone charging $25/session will not be as good as someone who can charge 125. Demand side economics...those of desire can raise their fee higher.

While I would agree with this point in most cases, I do not believe this to be true for psychology students seeking therapy from practitioners in the community.

To be specific, my program helps people find low cost psychologists in the area who generally leave one to two slots open for students interested in seeking psychotherapy as part of their experience in graduate school. Much like the billing issues other people brought up, this allows students to attend treatment without having to go through insurance for reimbursement and keeps it affordable at the same time.

So far as I can tell, the professionals who do this view it as a way to give back to the profession/field. I am sure that not every psychologist can or would do this given the current economy, but for those who can I don't think it has anything to do with making money. If you think about it, those who do it are probably in better financial situations which allows them to have low cost slots in the first place. This would suggest that they are more likely to be successful practitioners, at least financially speaking. While this might not prove that they are "good," I would think it serves as evidence against their being poor clinicians.

Thoughts?

 

[wigflip]

While I would agree with this point in most cases, I do not believe this to be true for psychology students seeking therapy from practitioners in the community.

To be specific, my program helps people find low cost psychologists in the area who generally leave one to two slots open for students interested in seeking psychotherapy as part of their experience in graduate school. Much like the billing issues other people brought up, this allows students to attend treatment without having to go through insurance for reimbursement and keeps it affordable at the same time.

So far as I can tell, the professionals who do this view it as a way to give back to the profession/field. I am sure that not every psychologist can or would do this given the current economy, but for those who can I don't think it has anything to do with making money. If you think about it, those who do it are probably in better financial situations which allows them to have low cost slots in the first place. This would suggest that they are more likely to be successful practitioners, at least financially speaking. While this might not prove that they are "good," I would think it serves as evidence against their being poor clinicians.

Thoughts?

At the very least, I would think that a few sliding scale fee slots suggests a compassionate practitioner with some orientation towards social justice (awareness of class issues). Like the above poster, I think it's a good sign.

 

[Phipps]

It would be completely inappropriate for a psychologist to accept a "raise" from a patient. Rates for services are 100% up to the provider.

So, are you saying that if your (out-of-pocket/fee for service) client would like to raise your pay f.e. $5-10 per hour, let's say from &35 to $45 --you would find that inappropriate b/c it is your responsibility only? I am trying to understand both sides of the topic, i.e., the money issues and the therapeutic issue; I mean, could this not be the responsibility of both to re-negotiate and talk about raising the fee??

 

[hereandnow]

Especially if this is your first time in therapy I would strongly suggest that you explore the following options:

(1) Try your school clinic, if it has one. Many students at my university program get 4 years of free therapy either through student health or the counseling center. Some of these clinicians are extraordinarily seasoned and could charge well above the going rate in private practice. Of course, some are also less so, so let yourself shop around and see what will be a good fit.

(2) Actually, regardless of if it is in a school setting or not, I would suggest that you let yourself shop around for therapists for a period of time prior to committing to long-term therapy with one therapist. It is difficult to know what works for you, what is going to be a good fit, especially if this is your first time, so take your time and let yourself explore. It will also be helpful to your grad school education, that's for sure.

(3) Avoid the common misconception that better therapists always and necessarily charge more. Although there are trends in this regard, I know clinicians who charge $275/hour who are certainly competent, but less effective, in my experience, than some devoted clinicians who work at agencies where clients receive services for low-cost or even for free. While individuals who are able to maintain a high end private practice charging beaucoup amounts of money generally have at least a base level of competency (and often a high degree of skill in salesmanship), they also, in my experience, sometimes prioritize their personal financial compensation over patient welfare and this is something to be conscious and careful about.

(4) The low-cost referrals for students that your university keeps on file and which others have mentioned is an excellent idea and option. This would be my personal first list to go through. At least have a conversation with these individuals -- if nothing else, for the sake of your own education.

(5) Trust your instincts. Personally, if I met a clinician who demanded that a client to pay $120/hour while knowing that the client could not afford a cell phone or a car, I would run. If the clinician does not offer a sliding scale (which is their absolute perogative and right), in my opinion, it is nevertheless the clinician's responsibility, given your financial circumstance, to refer you to other competent and comparable lower-cost providers.

My best wishes to you as you explore your many options.