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Chapter 2: Payment of Therapy

Let’s talk about money.

I placed this chapter near the front of the book because I’m a realist. Money can be a very big deal. Most former clients will tell you that their therapy was worth every penny; but make no mistake, those pennies do add up.

It’s important to have some idea of what things are going to cost and how much you can afford to spend before you make your first appointment. The therapist’s office is no place to experience sticker shock.


If you have insurance through an employer or a government program, a good first step is to figure out what kind of mental health coverage you have. Specifically, look for information about Outpatient Psychotherapy or Outpatient Counseling.

To get this information, look through your insurance paperwork, check out the insurance plan’s website, or call a service representative. Here are some questions to keep in mind:

  • Does my plan cover therapy?
  • For how many sessions will I be covered?
  • What is my co-pay for each session?
  • Does my plan only cover certain providers?
  • Does my plan only cover certain kinds of therapy?
  • Does my coverage change if I go outside the network?
  • What sort of paperwork will my therapist and I be required to submit?

Remember that the goal of an insurance plan is to spread the risk of healthcare costs out over a large group of people. To keep costs down and make a profit, insurance companies seek to restrict payments for any services that are not considered medically necessary. For this reason, it can be difficult to get coverage for family or couples therapy. Individual therapy related to a specific diagnosis, on the other hand, is usually approved.

Managed Care

Managed care organizations such as healthcare maintenance organizations (HMO) and preferred provider organizations (PPO) are like insurance plans except that they also take responsibility for managing and coordinating health care delivery.

If you’re a member of an MCO, find out what kind of coverage you have for Outpatient Psychotherapy or Outpatient
. Check out your plan’s paperwork or website, or call
a service representative. Keep these questions in mind:

  • Does my plan cover therapy?
  • Do I need a referral from my primary care physician?
  • For how many sessions will I be covered?
  • What is my co-pay for each session?
  • Do I have a deductible? How much is it?
  • Does my plan only cover certain providers?
  • Do I have partial coverage if I choose to go outside my network?

As the cost of health care continues to rise, managed care organizations are becoming increasingly popular because of their ability to keep costs down.

Just like insurance companies, managed care organizations control expenses and make money by limiting services, so be prepared to jump through some hoops to get the coverage you need. Dealing with the bureaucracy can be frustrating, but it pays to be persistent.


Depending on what part of the country you live in, the full cost of therapy can be anywhere from $60-$300 per session, with most therapists charging somewhere in the $80-$120 range.

If these numbers scare you, don’t panic. What you actually pay out of pocket may be quite a bit less than the full price.

Almost all hospitals, clinics, and community agencies charge according to a sliding scale. In other words, you may pay less than the full fee depending on your income, number of dependents, and so on.

Don’t make the mistake of thinking that sliding scales are only for the benefit of the very poor. In reality, most working-class and middle-class clients will also qualify for a reduced fee.

You also may not realize that even many private therapists offer a sliding scale or reduced fee program for clients who could not otherwise afford therapy. Remember that it never hurts to ask.

If you have serious financial difficulties, you may be provided services free of charge. If you can’t track down these opportunities, contact your county’s mental health or social services program.

Believe it or not, paying out of pocket offers a few real advantages. Because you’re making a personal investment in therapy, you’re likely to have more motivation and make progress more quickly than someone who can simply coast from session to session with no financial consequences.

Employee Assistance Programs

Many employers—particularly large organizations—offer employee assistance programs. These programs can offer anything from legal advice to substance abuse rehabilitation. Some EAPs also offer counseling services.

Typically, these services are limited to a certain number of sessions, and may deal only with specific issues. If you have an EAP where you work, it’s worth checking out. You may get the services you need at no cost to yourself.

School-Based Counseling Programs

If you’re a college or university student, you probably have access to your school’s counseling center. Since the center is funded by your tuition and fees, services will be provided to you without an additional per-session fee.

Most school-age children have access to tax-funded counseling services through their school district. Contact a guidance counselor to see what options are available.

Health care Savings Programs

Most employees now have the option of putting away a certain amount of their income on a tax-free basis to cover health care costs, including therapy fees or co-pays.

There are several kinds of accounts available, so contact your human resources or benefits manager to learn more about the options available to you.

Activity 2

At the top of an index card or a small piece of paper, write Payment. Below that, write how you plan to pay for services. You may choose more than one option.

  • Insurance
  • Managed Care
  • Self-Pay
  • Employee Assistance Program
  • School-Based Program
  • Health care Savings Program

Below that, write down how much you can realistically afford to pay out of pocket for services on a weekly basis.

I can pay _____ a week for therapy.

Chapter 2: Payment of Therapy

Ben Butina

Ben Butina is a therapist and trainer. He is the executive director of Westmoreland Marriage, Inc. and lives with his wife and two children in Latrobe, Pennsylvania. This book is reproduced here with permission and is copyrighted © Ben Butina. All rights reserved.

APA Reference
Butina, B. (2009). Chapter 2: Payment of Therapy. Psych Central. Retrieved on August 9, 2020, from


Scientifically Reviewed
Last updated: 7 Jul 2009
Last reviewed: By John M. Grohol, Psy.D. on 7 Jul 2009
Published on All rights reserved.