For many years, it was a patient's market, when it came to choosing therapists. Therapists in many areas were as thick as flies, and people had lots of choices to make. Through the Covid crisis, and also the increased understanding of the improvements therapy can make in life quality, there has been a shift. Now many people find themselves looking for therapists, rather than the other way around, and furthermore, some can't locate therapists for very specific reasons. With therapists making the choices more often than not, it's good to consider what markets you as a client.
Many times finding a therapist comes down to how clients can pay. And almost every therapist works hard to make some room for clients who can't afford the market rates-- between about 120-200--depending on where you live. There are also some low fee clinics where therapist trainees and associates can see you for lower prices.
For many people, both therapists and clients, one of the big issues is money. This typically does not mean insurance. There are those who take it but many don't. The reason for this is that few insurances fail to reimburse at a wage a therapist can successfully accept. Average rates of reimbursement from insurers may be anywhere from 30-80 per hour, and the therapist must then deduct 37.5% of that in taxes. Not to mention the fact that many insurers are not fair payers and put up a lot of obstacles when it comes to payment. The amount of paperwork an insurance company may ask a therapist to generate could equal many extra hours of work, so the starting wage may be halved or divided in three and then the taxes still go out. If X insurance pays me 40 dollars, which after taxes is 25, and then turns down my claim a few times or requires a full report of the client's file, I suddenly make $8 dollars an hour, for 3 hours of work. Repeating this again and again means much more work for less money, and this is for a person likely to hold at least $50,000 in student loans to get the Master's Degree with 3000 hours of advanced training that allowed them to become therapists. In the end, this is why many therapists work on a cash only basis. Cash only psychotherapists typically set aside a few spaces for clients who can't afford their rates and still be able to make payments on their loans.
Another place where therapists are challenged by insurers is due to the oversight of companies who do get to decide when and when not to pay someone. If you work at the grocery store, and at the end of the day, the manager decides you really only did half a day instead of a full day's work, you would be pretty frustrated and you'd be paid half as much as you expected. Similarly, denials of claims means therapists are sometimes working for free, and they can appeal, but they don't always win, and that is more free hours of work. When a private therapist has a contract with a client, these two decide on the nature of payment, before therapy even begins.
The basic problem is an inequity between what should be earned and what is reimbursed. Some companies haven't raised their reimbursement rates in over 20 years. And therapists, like everyone else, are facing higher housing costs, grocery bills, gas prices, and the like. A fair reimbursement rate would probably send therapists right back to insurers, but what's happening now simply isn't fair. Nor is it fair to the people who have insurance.
So what can be done? It's not a popular answer for some people, but single payer would likely create a more equitable system for everyone. Right now people pay high prices for insurance, and often aren't getting their money's worth. (High deductible plans, for instance, may mean insurance never pays a cent of therapy). The alternative is for people to go private and therapists to do what they can to offer a few spaces for lower paying care. Funding low pay clinics is also a great idea, as this can give people the opportunity to see someone at a low price and train new therapists simultaneously. Right now, though,
we have an unsolved problem, and we need to put our heads together to fix it.