This is a good question and I have asked my former therapist this. She said, "well, I have like $250,000 in student loans." Yes she was a clinical psychologist, so that does make sense and after going through the process of getting LCSW, I understand why therapy can be expensive. I understand the pain as "client" and "provider." During the pandemic, I looked for therapists that take my insurance and many of them had waitlists or didn't take insurance. If you have Medicaid, it is even more difficult to find the right therapist because of their low reimbursement and "work conditions" independently licensed therapists do tend to move on after earning the required hours for the licensure from the "community mental health" clinic job.
I started to look for a private pay therapist and realize many of them charge between $100-$250 per session depending on their degree type, experiences, certification, "location"...my friends who are in the field also say they have trouble finding therapists that take their insurance and some of them ended up hiring out of pocket and stated it was worthwhile. Again, this goes back to the question: "Why does therapist charge so much? Can't they just charge $20-$45 per session?"
These are my personal opinions but I speculate these are the reasons many therapists leaving the field.
1. Student loans: In order to practice therapy, you have to have a master's degree (minimum) in social work, mental health, marriage and family therapy etc or a PsyD or PhD in clinical psychology. These programs are so competitive that we can't even work while attending school full-time and most of us end up racking up student loans. The largest student loans I have heard from my colleague was $280,000. This was a clinical psychology program in private university
No-or low paying internship and postgraduate low paying jobs: Most internships offered to the students in my Master's program did not offer compensations. We had to pay for those experiences because it was program specific and we did two years of field work as part of the curriculum. My second year internship (20 hours a week) paid $200 a month and I was very thankful for that because it went toward gas. Most of my classmates did not have income from the field work even though some of them actually worked like regular employees at the clinic/hospital/prison/school..wherever they were placed. Those who were on child welfare program received money for tuitions and living expenses with a premise that they will work for the county's child welfare program for two years after graduating from our master's program. Maybe this is the way to go if you really want to work with foster youth.
Clinical supervision: I had to attend fix hours of clinical supervision during the final year of field practicum. But first thing you need to do after graduating from MSW program is to register for LSW exam (in PA, NJ) and ASW exam (CA). Once I obtained provisional license, I was allowed to see clients under the supervision of independently licensed "supervisor" I was determined to work toward my licensure, but I was surprised to see not all places offer clinical supervision to the Master's level counselors here. So if your company does not provide that, you will end up hiring another supervisor. They can charge anywhere between $75-150 per hour and social workers are required to see a clinical supervisor for one hour every 20 hours worked. Unfortunately my latest work place offered free supervision and I still ended up hiring a trusted supervisor.
Business expenses: therapists are running businesses if they are doing private practice. They have to pay for office, supplies, tax. We need to be able to take vacation, pay for full commercial insurance rates unless we can join our partner's insurance plans. Again, we do need clinical consultation from time to time, and malpractice insurance, association fee, website maintenance, website fees.
Our work does not end with "sessions": Therapists need to do clinical documentations, and stay on top of billing issues (that's why I use grow for now), coordination of care, paperwork. Once you have to report safety concerns to child welfare department, I remember that we were often placed on hold for 2 hours.
Continuing education: Therapists are required to do continuing education and I love this portion but it's very costly.
Cost of living: Therapists need to make ends meet. Cost of living is increasing and insurance payers are not adjusting our reimbursement rates. This is why I believe some therapists are going "out of network", dropping insurance plans.
When I am able to do, I reserve 3 slots for sliding scale fee that they can actually afford because I also understand that mental health is health! and it should not be so expensive and it should be accessible to those regardless of income. I hope you got the general sene of what a private practice looks like and why some experienced psychotherapist says good bye to insurance companies forever.
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