Why does therapy cost so much?
You know therapy is helpful and you are in a place where you need or want to try it out. You search and find a therapist who gets it and seems to have the tools you need to solve the problem you have.
You navigate their website and find that their cost of an hour session feels a little more that you thought it would be. Over $100 for an hour of mental health therapy? Are all therapist just rolling in the dough? Not necessarily so. There’s a lot more that goes into you receiving services from a knowledgeable, warm, caring and responsive therapist than you would think.
The first reason is the education and requirements it takes for a therapist to become licensed to practice. Becoming a licensed therapist requires several key steps, which can vary depending on the type of therapy you want to practice and the state or country where you plan to work. Here’s a general roadmap:
1. Earn a Relevant Bachelor's Degree (4 Years)
Common majors: Psychology, Social Work, Counseling, Human Services
Some programs allow direct entry into a master’s program, but a strong foundation in psychology or related fields is helpful.
2. Obtain a Master’s Degree (2–3 Years)
Required for most therapy licenses (LPC, LMFT, LCSW, etc.).
Common degrees: Master’s in Counseling, Clinical Psychology, Social Work (MSW), or Marriage and Family Therapy (MFT).
Programs typically include coursework in therapy techniques, ethics, and clinical assessment.
3. Complete Supervised Clinical Experience (2+ Years)
After your master’s, you must complete postgraduate supervised hours (often 2,000–4,000 hours).
This involves working under a licensed professional to gain real-world experience.
4. Pass a Licensing Exam
Most states require passing a national exam, such as:
National Counselor Examination (NCE) or National Clinical Mental Health Counseling Examination (NCMHCE) for Licensed Professional Counselors (LPCs).
Association of Social Work Boards (ASWB) exam for Licensed Clinical Social Workers (LCSWs).
Marriage and Family Therapy Exam for LMFTs.
Some states have additional exams, including ethics or jurisprudence tests.
5. Apply for State Licensure
Requirements vary by state, but you must submit proof of education, supervised experience, and exam results.
Background checks and additional ethics courses may be required.
6. Continuing Education & Renewal
Most states require continuing education (CEUs) to maintain licensure.
Renewal periods vary (usually every 2–3 years).
In my case, I had to pass TWO licensing exams to become independently licensed in Ohio.
The next reason is that Counselors cannot just see 40 clients a week back to back as that would cause severe burnout. The number of clients a counselor can see per week depends on several factors, including their work setting, specialty, and personal capacity. Here’s a general breakdown:
Typical Client Load
Full-time private practice: 20–30 clients per week (4–6 per day)
Part-time practice: 10–15 clients per week
Community mental health/agency work: 25–40 clients per week (can be higher due to shorter sessions and high demand)
School counselors: Varies greatly, often managing caseloads of 200+ students but not seeing each regularly
Intensive settings (hospitals, rehab centers, crisis centers): 30–50+ clients per week (often in group formats)
Factors That Affect Caseload
Session Length & Type – Standard sessions are 50 minutes, but some therapists offer shorter or longer ones. Group therapy allows for more clients at once.
Work Setting – Private practice allows for more flexibility, while agencies may have high client loads.
Specialization & Complexity – Therapists working with high-acuity clients (trauma, severe anxiety, PTSD) often take fewer clients to prevent burnout.
Self-Care & Burnout Prevention – Many therapists limit their caseloads to maintain their own well-being and effectiveness.
For someone working with clients who experience anxiety (like your clients), a balanced caseload of 15–25 clients per week is often sustainable.
Running a private counseling practice comes with various costs, which can vary depending on location, services offered, and whether you work solo or in a group practice. Below is a breakdown of the typical expenses:
1. Startup Costs ($2,000–$10,000)
Business Registration & Licensing: $100–$1,000 (varies by state)
Liability Insurance: $300–$1,500 per year
Office Setup: $1,000–$5,000 (furniture, décor, therapy supplies)
Technology: $500–$3,000 (laptop, phone, EHR software, telehealth setup)
Marketing & Website: $500–$2,500 (branding, website development, business cards)
2. Recurring Monthly Costs ($2,000–$7,000)
Office Expenses
Rent: $500–$3,000 (varies by location; home office = $0)
Utilities & Internet: $100–$300
Office Supplies: $50–$200
Business & Legal Costs
Liability Insurance: $25–$100/month
Licensing & Memberships: $10–$50 (e.g., APA, ACA, NASW dues)
Billing & EHR Software: $30–$100 (SimplePractice, TherapyNotes, etc.)
Telehealth Platform (if applicable): $20–$50
Marketing & Client Acquisition
Website Maintenance & Hosting: $20–$100
Advertising: $100–$1,000 (Google Ads, Psychology Today, social media)
Professional Networking/Referral Fees: Varies
Taxes & Fees
Self-Employment Taxes: ~15.3% of income
Health Insurance: $300–$600+ (if self-employed)
3. Income Considerations
Session Rate: $75–$250 per session (varies by location and specialization)
Number of Clients Per Week: 15–25 clients is sustainable for most therapists
Annual Revenue: $50,000–$150,000+ (before expenses and taxes)
All in all, there are lots of costs associated with a therapist providing care, including time, education, licensing, case load restrictions, burnout prevention, additional training, business costs and office expenses. It is helpful to consider the full picture when you are seeing a therapists rate!
This is also why I have a benefit calculator right on my website so you can see how much your insurance will reimburse the session fee! I hope you found this article helpful.