The Hidden Costs of Therapy :Why Raising My Fees Never Gets Easier

Even after ten years of running a private therapy practice, raising my session fees never feels easy. Every time I need to review my rates, I experience the same wave of worry about how my clients will feel and also, if I’m honest, how my peers will interpret the decision.

Each time I go through this I am forced to look at my own complicated relationship with money.  Both money and therapy are deeply connected to our personal values and I want to offer some transparency.

Can Private Practice and Social Justice Co-exist?

A really important question that often comes up is "Shouldn't mental health support be a basic human right? " Absolutely, I agree. Everyone deserves access to good mental health care. That is why I spent 15 years working in charitable and community agencies before opening my private practice.  

I cannot fix our broken healthcare system, but I can be open about how a private practice actually works, what it can offer and what it can’t. The truth is, a private practice is a small business rather than a charity or a funded community organisation. To keep my doors open, my fees have to cover the cost of running that business, alongside funding years of advanced training and ongoing consultation needs.

It is helpful to view private therapy a bit like private dental care or specialised wellness treatments. Because I do not offer emergency crisis support or short-term counselling, it sits outside the standard care you might get from a funded healthcare provider.

What Exactly Are You Paying For?

A common myth is that a therapy fee is simply a therapist's hourly wage. In reality, the time we spend talking face-to-face is highly significant but only a part of the actual job. On average, I spend more than equivalent the amount of time working behind the scenes as I do face-to-face with clients. For every 12 sessions of therapy I deliver, I put in 25+ hours of work.

Behind the scenes:

• Confidential record-keeping: Writing clinical notes, photographing and storing creative work.

• Staying Connected: Emails, free initial calls, managing bookings.

• Safety & Quality: Preparing for and participating in specialist supervision to ensure I am giving you the best possible care; keeping up to date and maintaining compliance with legal responsibilities such as data protection changes.

• Running the Business: Accounting, maintaining the website, advertising.

• CPD: Attending professional training, reading, relevant networking.

• Holding you in mind: This is crucial – I do not forget about you when we are not in session.  I reflect on my work deeply on a regular basis alone as well as in supervision.

The Bills Behind the Business:

Just like any other self-employed person, I have overheads that keep the practice running safely:

• Supervision / Consultation

• Insurance & Data Protection

• Professional Memberships

• GDPR-compliant software for record keeping, video calling and accounting

• Website and advertising

• Office amenities, upkeep, equipment and resources 

This graphic is based on actual current figures.  It fluctuates but provides a snapshot in time. 

There have been times when it would have looked very different – eg. I had several years where my training and office costs alone were over 50% of my income.

I also used to have no safety net for late cancellations, waived fees, holidays, sick leave, training leave or pension, however I have finally begun to budget for this as a more accurate and self-respectful way to manage the business.  

Within reason I waive fees for late cancellations due to illness or emergency

and accounting for this alongside my own needs for recovery and respite feels reciprocal and humane.

The Honest Truth About Discounts and Sliding Scales

People often ask me: Do you offer a sliding scale or lower fees? It is a tough topic. When you work for yourself, lowering your rate means directly cutting into the baseline income after expenses.  The expenses remain the same.  If you ask me to work for “half rate”, which people do, you are effectively asking me to work for free.

I intentionally limit how many people I see each week in order to remain just as present and focused no matter if you are my first client on a Monday morning or my last one on a Friday afternoon.  Because of this commitment I wouldn’t take on someone at a lower rate as “extra” because that would compromise my capacity and ultimately risk my sustainability in the longer term.   

How My Thinking Has Changed

In my early days, I tried a completely open "pay-what-you-can" system. I wanted to reject rigid corporate structures. But over time I came to the recognition that by trying not to impose financial boundaries on others, I was trapping myself. I was over-giving, burning out, and effectively running my business at a financial loss.

In the future I hope to create a system where clients who can afford to pay a bit more can choose a higher tier, directly helping to fund therapy slots for those going through financial hardship. 

Final Thoughts

Talking about money in the caring sector can feel uncomfortable, but it is unavoidable.

Charging a sustainable price isn't about greed; it is about making sure I can keep doing this job for years to come. I am very fortunate to have enjoyed good health throughout 25 years of earning significantly less than I would have done were I to have been employed within  statutory services.  I have, however, burned out more times than I can count.  I’m also a single parent with a fairly modest lifestyle who has needed to rely on benefits at times to make ends meet. And I am not getting any younger! 

The situation is sobering on a wider level because I recognise many of my colleagues charge less than I currently do, like me for so many years, because of a chronic lack of self worth and undervaluing within the field.  This is reiterated when working in the care industry within a capitalist and patriarchal society where service is often seen as meant to be done “out of the kindness of your heart” or, even more deplorably, as “women’s work”.  It’s highly significant for me to have got to the point where I believe I’m worthy of being paid a rate reflective of what I actually do and to be able to plan for the future and for unforeseen needs.