Why is Therapy So Expensive?
I thought it would be fitting to kick off a blog full of therapy thoughts and musings with a question that has been with me since the beginning, when I first considered becoming a psychologist. So welcome, and thanks for reading! I first wondered what makes therapy so expensive years ago when I began my undergraduate education to become a therapist. My university programs strongly recommended attending personal therapy while attending school. Many institutions encourage this, and I do believe that it is really helpful. But wait! What the…who can afford therapy!? (Asked the therapist in training…) I pictured only the fanciest people with very expensive problems having the means for serious work. Your therapist is with you (in human or virtual form) for an hour-ish. Sometimes once a week or more if needed, sometimes less. Yay. For an hour worth of “listening” what is so special about the therapist that comes with a big price tag? The entirety of what goes into that hour is so much more than I ever could have imagined. I hope what I have learned and experienced can help unpack what you truly are paying for when you hire a psychologist. Because money is expensive! Let’s start from the beginning.
To begin the process to become a psychologist, it’s back to school to get an undergraduate degree. Some folks may need additional coursework or upgrading to be eligible for post secondary enrolment so there may be classes before undergrad classes ever begin. Then, the undergrad adventure. Books, exams, supplies, tuition, late nights, paper writing, extra large coffees, plenty of time and energy. There are unpaid counselling internship hours required (hundreds, mine totalled over 800 in undergrad alone), and depending on the program there are countless face to face hours of learning, growing and training, for years. During my studies, I had counselling theory and training courses where I would record myself in a therapy session, and then very uncomfortably and painfully examine and transcribe everything I said and did. What theory was that intervention? What did I miss there in the client’s subtext and tone? Was that even a question I asked?! Feedback and supervision became an integral component of my practice. At last, an undergrad degree is complete! At this point we are less than half way there?! A masters degree is required in Alberta to become a psychologist, so next up is 2-3 more years of similar training, although dial up the intensity, difficulty and add in a thesis if you like. Phew.
School, check, now…registration. To become registered with the College of Alberta Psychologists, there is a very lengthy process to complete to be able to use the title Registered Psychologist. If you are curious about the details of the process, feel free to read more here. But this is the short version: have the right type and levels of coursework, the right credit count, and then complete background checks, supervision (107 hours) and practice hours (1600 hours) after your post secondary education. Also there are 2 (soon to be 3) very important and very challenging ethics and knowledge exams to pass. All of this education, training, supervision and oversight is to ensure your psychologist is ethical, professional and competent. Your therapist needs to be able to get into the tough stuff with you while knowing when to slow down and check in. They have serious power in the relationship and work with individuals at vulnerable times in their lives. They need to be present, attuned and boundaried.
But sure, lots of professionals have post secondary education, why is does a therapist hand you a big bill after seeing you? If you are not a Kardashian, a royal family or crypto tycoon it is understandable to be intentional when spending $200. Or you may want to spend it on good stuff. I mean, for $200 or less you can have some of these fun items! Headphones, art, technology and fitness fun. There is some seriously good stuff in here, and many of these items will bring value/fun/pleasure into your life. This is a key point here, what do you get in return when you exchange money for something? Going one level deeper, often obtaining money requires exchanging a more valuable resource…your time exchanged for earning money. What are you getting in return for your time? When I make financial decisions, I like have a sense of what I am getting in return for my spending, or what my return on investment is. Hopefully something of value. Does spending money on a fancy dinner give you something in return for your investment? Hopefully, if the food is delish, feeds your brain and your body with nourishment and experience is great! But, is spending money on that new handbag a good investment if you use it once? Maybe less so. Another example is buying a new mattress for your bed. Up front a new Casper or similar queen mattress in a box can set you back $850. But, improved sleep for 6-8-ish hours a night (1/3 of your life basically) on an item that your entire face and body literally uses all of every night, your cost per use is minimal and return on investment is huge. Ultimately, can you even put a price tag on being a consistently well rested human? Side note/Sleep Hack: upgrade your mattress if you can, it’s a gamechanger.
What have you spent $200, $1000, $5000 on recently? What value did it add to your life?
Let’s try and add up the cost of mental health, using depression as an example. Because of its high prevalence, lengthy duration, and associated morbidity, depression is found to have the greatest “cost” of all mental illnesses: It is a leading cause of disability and excess mortality in Canada. Depressive symptoms are also associated with chronic co-morbidities including diabetes, heart disease, arthritis, asthma, back pain, chronic bronchitis, hypertension, and migraines. What can depression cost an Albertan? A 2012 study of Alberta patients who had at least one health-care visit for depression had direct costs associated with depression averaging $550 per patient but reaching as high as $25,826 in the top 1% of the cohort. Basically the cost of depression can vary, from $550 on the low end, to almost $26,000 on the high end! The cost can include medications, missed work, health services utilized, relationships, disability claims, and impaired functioning in other areas of life. Thinking financially, what can a therapy term of 10 sessions totalling $2000 actually save you in the long term? Better relationships, better coping skills, improved sleep and overall health? Not a bad deal.
One more point. Your therapist is with you for a minute it feels like, but a solid and skilled therapist will prep for each of your sessions by reading, reviewing notes and researching relevant information. Hours can be spent researching and learning and consulting with other psychologists to give a 5 minute intervention in the therapy room. Recently I listened to a podcast (No Stupid Questions) where the hosts were discussing the term Post Traumatic Growth or PTG. This fit for a client of mine, and all my clients really! This snowballed into hours of reading and digging more into PTG, presenting and discussing with colleagues. Hours of a process outside of the therapy office condensed into sharing with a client about this for a few minutes. I hope it helped.
So, is therapy worth the price tag? I think so. I may be biased as a therapist, but overall health and well being are the biggest ticket items in our lives. We only have one body, so prioritizing and taking care of our inner world and outer self allows us to enjoy more of the ride.
-WB
*Note that training and backgrounds will be different for social workers, certified counsellors and other helping professionals. This is great, the different training and educational backgrounds allow for a diversity of therapists in this field. We need this!
References: Slomp, M, Jacobs, P, Ohinmaa, A, et al., 2012. The distribution of mental health service costs for depression in the Alberta population. Can J Psychiatry. 57(9):564–569.