Why is therapy so expensive?

“Therapy is extremely expensive.

Popping bubble wrap is radically cheaper.”

Jimmy Buffet

Behind the Scenes

Why do you charge so much when all you do is sit and listen?!

If you’ve ever wondered why therapy is so expensive and how, as therapists, arrive at the pricing we do, then this article is for you. 

Here is an honest and transparent summary of my 9 main expenses of running a private therapy practice. I’ve included what I pay plus some typical market averages for comparison. This is obviously different if you’re employed by an agency or larger practice, or working in the public or third sectors.

As this is about Intimata, I talk mostly about therapy in the UK and EU, with costs in pounds and euros, as these are the areas and currencies I work, train, and pay taxes in.

Part of the reason I’m writing this now is I’m in the process of relocating from England to France, so I’m acutely aware of the differences. Also, I’ve spent a lot of time and money on all aspects of my business that haven’t worked. So the relative success you see now comes after thousands of pounds of, “hmmm, that didn’t quite work out as planned.”

1. Number of clients vs hours worked

Although a typical working week is 40 hours, this doesn’t translate to 40 client hours. Typically, I see 12-16 clients per week. Many full-time therapists see 15-20. 

Personally, for my own mental health and wellbeing, I only see clients 4 days a week, Monday – Thursday. Having boundaries around my working hours is crucial to long-term sustainability in this field. This gives me 2 days to rest and recuperate not listening to people’s problem, and one day a week for admin.

In relation to actual costs, I charge individuals 90€ per 50-minute session and relationship therapy is 120€ per session. I also have up to 4 low-cost clients per week at 50€ per session.

If I were to see 40 full-cost clients per week I’d be bringing it around 4000€ per week (and having a nervous breakdown…). In reality, it’s more like 1000€ per week, so around 4000€ per month. Sounds terrific, you must be loaded! Well, keep reading…

2. Training

In January, I’m starting a Level 8 Advanced Diploma in Relationship Therapy. This will be my final year of training to be a qualified psychotherapist. The course fees are £3000. 

Typically, you study a level a year, so this comes after 7 years of counselling and therapy training. Although course costs vary, they’re often around £2000 per year. So you’re looking at at least £16,000 in fees, often substantially more.

Personally, I’ve done a number of other trainings such as Holistic Life Coaching and Body Love, as well as a PhD in Life Coaching, which all add up too!

The course fees are only part of the expense, as when you’re in training, you usually also need to be in supervision and personal therapy (see points below), not to mention buying books and traveling to attend the trainings in person. 

3. Venue

Pre-Covid, most therapists worked in person with clients in therapy rooms. Renting a room is often the main business expense and prices depend largely on the facilities offered. It can be anything from £15 – £100 per hour. Some venues will include a nice waiting room, receptionist service or even marketing. Another option is to rent an office space per month, which can be £200-£800 and you furnish it yourself. 

Personally, I’m currently only working online. I aim to have a face-to face practice again by April. That said, I still have to sit somewhere and warm my office and run my website. So just because I’m working online doesn’t mean I don’t have venue costs! I use Google Meet which is part of the Google Business suite and costs 10€ per month. I have previously used Zoom (140€/year). Many colleagues use various tele-health platforms that include booking, payment, client paperwork management, and video call facilities for £15 – £50 per month. 

With Intimata only being online, my current venue costs are around 120€ per year plus general heating costs for my home office.  

4. Self-employed Costs

The three main points to mention here are accounting, taxes, and holidays.

I’m a spreadsheet nerd with a delightful accountant so I don’t pay for accounting software. I pay him around £250 per year to file my personal and business accounts. Many therapists do their own and use platforms like Xero, which are around £14-£20 per month.

Taxes vary depending on your business structure and location. In the UK, the least you’ll pay is 20% as a company director, after you tax free allowance of £12,570 each year. In addition, you can offset reasonable business expenses, such as training, room hire cost, and necessary equipment.

In harsh comparison, in France as a self-employed therapist, I’m taxed on my total net income regardless of business costs and with no tax free allowance. The tax rate is about 29%. At first it felt a bit like altitude sickness, making me nauseated and light headed, but I’m starting to acclimatise! 

Lastly, unlike salaried folks, we don’t have paid holidays. This year, I’ve taken off 3 weeks in August and will take off 2 weeks in December. Those 5 weeks of living expenses need to be factored into the 47 other working weeks of my year. In number this means that if I’m making 1000€ per week for 47 working weeks, that’s about 900€ over the whole year. Then take off the 29% tax and we’re at 640€ per week. 

brown wooden frame sing board close up photography

5. Marketing

What therapists spend on marketing varies hugely and depends on how long you’ve been established and the size and quality of your referral network. 

Currently, I receive around 1/3 of my clients from previous client recommendations, 1/3 from other therapists, and 1/3 from Google Ads. Previously, I paid around £45 per month for my Google Ad. As I’ve recently relocated, I’m trialing different advert options and paying about £100 per month.

If I had an in-person practice locally I might pay to print flyers and posters, although I think that’s probably better suited to other types of therapy than sex and relationship therapy! 

Also, there are various free and paid registers you can join, such as findmysexpert, which costs £25 per month. Currently, I’m not paying for any of these as my practice is full without using them.

6. Hardware & Software

I feel myself getting noticeably self-conscious as I type this, but I promised transparency so here we go. 

In terms of business hardware, I have a gorgeous pink, 24″ Apple iMac and an iPad Pro with an Apple Pencil. (I got my first Apple G4 Powerbook in 2001 and have stuck with Macs since.) The total cost of which was around £2600. 

I have a home office, so all the usual furniture of a chair and desk etc. If I had a therapy room I’d need to purchase or rent all of that furniture too. Depending on your tastes, this can cost hundreds or thousands.

In relation to software, there’s no end to what you can spend money on. If you want the human touch, there are PAs, VAs (virtual assistants), and answering and concierge services. If, like me, you prefer digital services, there are platforms for booking, payment, note-keeping, client management, and everything else you could dream of.

In Intimata, my business expenses include a self-hosted WordPress website (99€ per year), Calendly booking platform (free version), Wise business bank account (free), SquareUp for non-European payments (3% of payment), Mailerlite for newsletters (free version), and Streak for client onboarding and offboarding (free version).

I have tried a lot of different platforms and found the ones that work for me. I’m not saying these are the best or recommending them above others. It’s about what feels comfortable and manageable for each person. For example, I’ve paid for websites in the past but ended up making my current one myself. 

7. Insurance & Legal requirements

Professional insurance can vary a lot depending on where you’re working, your level of cover, and where your clients are. It’s always more expensive to be insured for working with people in the US and Canada compared to anywhere else in the world. 

Currently, my UK-based professional insurance is £60 per year but doesn’t include if I give trainings, only therapy. The quotes I’ve received so far for professional insurance in France are around 400€ per year. 

Whether self-employed or a director of your own company, you need to be government registered. Setting up as a new business is easy to do online but does have costs.

Most therapists are part of at least one professional organisations. The fees vary from student membership around £50 per year to full membership around £200.

The three main organisations in the UK are NCS, BACP, and UKCP. All require you to have certain business structures in place including a Client Contract and Privacy Note explaining how you treat sensitive information such as client details and for the company to be registered with the Information Commissioners Office (ICO). This costs £45 per year.

Altogether, the insurance, memberships, and ICO registration currently cost me around £350 per year.

8. Supervision & CPD

In case you didn’t know already, all counsellors and therapists have to have a supervisor who they see regularly. This is usually a more experienced therapist who is trained as a supervisor. This person supports and guides us in our practice and ensures we’re working appropriately with our clients. 

Supervision can vary from £40 – £150 per hour. Currently, I pay £60 per hour and have roughly 1.5 hours per month.

During training, the requirement is to have 1:6 or 1:8 supervision hours to client hours. Therefore, if your training requires 150 or 200 client hours, you have to also do 35+ hours of supervision. At £60 per hour that’s at least £2000, so a considerable addition to training costs. It’s a worth noting that for most trainees, those 150 or 200 hours with clients are unpaid. This roughly translates to working for free full-time for 3 months. 

Even once you’re qualified, you still need to do Continuing Professional Development (CPD). The number of hours required between governing bodies but tends to include anything relevant including short trainings, conferences, panels, and podcasts. Realistically, many therapists spend £200 – £500 per year on CPD.

9. And finally - Therapy!

Guess what?! After all the stress and strain of listening to clients and running a business, we need therapy too!

While we don’t have to be in therapy all of the time, unsurprisingly, many of us are.  At the moment, I pay my therapist £70 per hour and see them every other week. Over the year, that’s roughly £1500 if you take off the holidays. 

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That's all Folks!

I hope you enjoyed coming behind the scenes and wandering around the workings of Intimata? I’ll leave you to do the maths and calculate the totals if that the sort of thing tickles your fancy. 

If it sounds like a lot of hard work, it is. That said, I absolutely adore being a therapist and genuinely love my clients. I wake up every day delighted to do this work. As each year passes, Intimata runs more smoothly and efficiently, and brings me more and more joy. I like to think I’m also offering better quality therapy, as well as an all-round positive client experience.

I hope this helps answer the question of why therapy is so expensive. Writing it has made me wonder if I should share an updated version next year?!