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Why is therapy so expensive......and can I do anything about it?

I see this question come up a lot in on-line forums and, while there may not be a single answer, I think there are good explanations - and also some realistic alternatives.


At least part of why therapy seems expensive is that, other than Clinical Psychologists who are paid during their professional training, pretty well all other counsellors and psychologists in the UK have paid for their own training and qualifications.  Psychologists have paid their way through their undergraduate degree and then paid again for their specialist Practitioner Psychologist degree.  If done full-time, this will have taken six to seven years with no, or very little, income.  Some people can begin their career as a fully qualified psychologist with tens of thousands of pounds of debt.  So part of what seems like high prices are a necessity to earn a living and pay the bills.  Counsellors and psychotherapists are likely to be in a similar situation although their training period to qualification may not have taken so long.

 


Therapist and client in session

It is also worth noting that, although you pay for your 50 – 60 minutes of therapy, your therapist could spend at least that amount of time again with reading, note writing, reflecting, and planning your therapy outside that hour.  This will vary depending on the particular form of therapy you are having and the style of your therapist.  However,  you could say that for each hour of therapy you pay for, you could be getting two hours……or, another way of putting it is that your therapy actually costs half what you think it does – half your payment goes to face-to-face time and half goes to therapist preparation etc.  Your therapist also has to pay for their own supervision to ensure that the intervention you receive is safe and of a high quality.

 

Therapists have a number of financial overheads that may not be obvious at first glance.  I’ve already mentioned supervision which will cost therapists a similar fee to therapy.  This is an ongoing, regular cost.  They will be paying for room rental or, if they see you in their own home, they will have additional insurance costs.  If you meet virtually, they will be paying for use of the video platform.  Your qualified and registered therapist will also be required to keep their own learning and knowledge up to date with regular training and other Continuous Professional Development (CPD) and just remaining registered with qualifying bodies has an ongoing cost.  They are probably also paying for a website to be hosted; their business to be listed in on-line directories and for professional indemnity insurance.

 

So I’m hoping that you are starting to feel that your therapy is actually quite good value.  Therapists need to earn a living like everyone else and, most that I know, genuinely do this work out of a passion to help people.  No-one goes into this kind of work expecting to make their fortune.


But you might still be feeling that this is ‘all well and good’ but I just don’t have the money for sessions.  So here are some suggestions:


  • I know that NHS waiting lists in the UK are ridiculously long for most psychological and counselling services, but do go to see your GP and ask for your name to be put on the list anyway.  There may be cancellations or your area might offer on-line material or ‘live’ groups that could be helpful.  If you don’t need your counselling appointment by the time it is offered, just cancel it.  It won’t be a problem as there are many people who will be glad of your appointment place.

  • Look up your Health Board or NHS Trust on the internet and search for Mental Health Support.  Most areas offer advice, suggestions, details of third sector providers,  on-line courses and self-help material that can really help you to make a start on working with whatever is challenging you.  This may be enough and you could find that you do not need to work with a therapist.  But even if you still want one-to-one work, any steps you take on your own first will help to make your therapy more effective and perhaps shorter (and therefore cheaper).


  • Most therapists are well aware of the long waiting times for NHS services so some will offer reduced rates for people on low incomes.  Take time to visit therapists’ websites and read them thoroughly.  If you are going to ask for a reduced rate, it is reasonable for the therapist to ask you why you think they would be a particularly good match for you and your difficulty.  You should also be prepared to discuss your financial situation and also to provide evidence if asked.  Some therapists keep a small number of sessions to offer at no, or very low, cost to people in particularly difficult financial situations.  Again, invest in reading the information on your preferred therapist’s website so that you can ‘make the case’ for why you should be considered.  Be aware, there is also likely to be a waiting list for any very low costs sessions.


  • Therapists sometimes ‘bundle’ sessions together for a lower ‘per session’ fee.  This does mean that you probably have to save up to pay the amount up front, but it could be a way of saving money overall.  

  • Do make use of free information and courses on the internet.  There are ways of checking the credentials and validity of people offering advice.  In the UK, you can check if psychologists are registered with Health and Care Professions Council (HCPC) or with the British Psychological Society (BPS).  Counsellors can be verified by checking directories of the UK Council for Psychotherapy (UKCP) or the British   Association for Counselling and Psychotherapy (BACP).  These are the main accrediting bodies in the UK.  This does not mean that other information you find is not valid, but if you feel unsure then checking these directories is a good place to start.


  • Go to your local library and check out the ‘Health and Wellbeing’ section.  You will often find excellent books and workbooks so that you can both gain understanding and also practice skills and techniques to help you.  GPs and other health professionals will sometimes ‘prescribe’ specific books that you can then collect from your library  -  so do ask for advice.


  • Lastly, if you know what you want from therapy and it is different from the usual weekly or fortnightly sessions, go ahead and have that conversation with a therapist.  For example, you might find that you are working your way through a book or programme and just feel stuck, or want someone who you can ‘touch base’ with occasionally to make sure you are on the right track.  So, find a therapist who seems to match your needs and see if they would be willing to work with you in this way.  Not all therapists will work like that, but some might, and it could save you a considerable amount of money to, for example, have monthly or 'ad-hoc' sessions instead of weekly. I realise that all the advice above requires effort and motivation and that you just may not be in a place where this is possible for you right now.  But, if you can, any of these suggestions could mean you are taking the first steps for yourself in making the changes you want in your life.  If you still decide to work with a therapist, you might have already gained some insight into your difficulties and maybe also have learned about which approaches do, and do not, work for you.  So your therapy could begin ‘a few steps ahead.’


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