How much do psychotherapists get paid

Private practice therapist pay is rarely based on a salary. Instead, there is a series of steps for determining psychotherapist pay.

Firstly, every private practice sells a service, usually psychotherapy or psych testing. And then they collect payment for the sale of that service.

Typically both the client and often an insurance company pay part of the fees. Sometimes other income sources contribute, perhaps from a church or family member who is paying for some of the cost of the psychotherapy. From there, things get more complicated.

What happens to the money?

Private practices have two ways of managing the money from there. In some cases, the income from all sources is deposited by the therapist into the therapist’s bank account. Expenses and rent then are paid from that income. This is a typical “independent contractor” scenario. It is the simplest organizational structure and is quite common.

In other cases, the income is collected by the organization where the therapist is employed. The organization then pays the clinician either a “percentage of collections” or a flat hourly fee for the work that was done. The organization can choose whether to pay the clinician as an “independent contractor” or as an “employee.”

When comparing different possible private practice therapist pay structures, it is essential to understand the differences between an independent contractor or a W-2 employee. Taxes are handled differently and that is a big deal. Let look at that now.

Taxes: Independent contractors or employee

Most importantly, the Internal Revenue Service allows for two types of employees: independent contractors and regular W-2 employees. (See Picking the best option: Independent Contracting vs Employing and the IRS website for more on this topic.) This decision determines who pays which taxes.

Specifically, the IRS requires independent contractors to pay 100 percent of their Social Security and Medicare taxes. This adds 7.65 percent to the independent contractor’s tax bill over a regular W-2 employee’s tax liability. But if the employer decides to pay the therapist as a regular W-2 employee, then the company, rather than the individual, pays that 50% of the employee’s Social Security and Medicare taxes.

To summarize then, an independent contractor will pay 15.3 percent of income toward social security taxes. Whereas, a W-2 employee will pay 7.65 percent of income toward social security taxes, and the company will pay 7.65 percent toward the employee’s social security taxes. The IRS always gets their money in one way or another. In other words, independent contractors pay all of the social security tax. Whereas, employees pay half of it with the employer paying the other half.

A simple example

Let’s compare two separate compensation plans. The first is an independent contractor. The second is a W-2 employee. How do we make them equal?

If the Independent contractor’s arrangement is for 57.65 percent of the collections to come to the therapist, this plan equals
A W-2 employee’s agreement for 50 percent of the collections

In others words, taxwise these are equal deals.

Recognizing how taxes are handled allows us to compare independent contractors and employees.

The split: How much goes the practice, and how much to the employee?

The most common way that organizations handle wages is to calculate the private practice therapist’s pay based on a “percentage of collections.” The practice collects the fees and divides them between the therapist and the practice using a formula to determine actual amounts. This approach is sometimes also called productivity-based pay and is perfectly legal. Interestingly, this approach is popular with physicians as well. According to the latest physician salary info, productivity is a basis for pay for the majority. See Pay is productivity-based for nearly 55% of physicians.

However, the actual percentages vary quite a bit. In most areas of the country, employee percentages range from a 40/60 to 60/40 split for W-2 employees. In other words, the therapist gets 40 to 60 percent of the collections. The organization gets the remainder. (For more on what practices actually do, see the results of a survey I did where 40 clinicians shared their data: Survey results: Therapist wages and benefits from 40 practices.)

Usually, independent contractors get about 10% higher to cover the additional taxes we talked about earlier.

The exact split may have to do with regional differences as well as various incentives that employers build into their formulas. In the practice I owned, we had a set of graduating percentages that gave busier and more experienced clinicians a greater portion of collections.

Distinctions in psychotherapist pay by license and ownership

As a side note, most practices make no pay distinctions between psychologists, social workers, mental health counselors, and marriage and family therapists. Occasionally practices pay psychologists a higher percentage. I discourage this. Why? Because social workers, mental health counselors, and MFTs get a lower reimbursement rate from insurance companies anyway. Hence I encourage all practices to pay everyone with the same formula.

When there is only one owner, then that owner may create any number of ways to get paid. Typically though, the owner will also take a distribution from the profits, usually annually. Furthermore, when practice owners are in a partnership, there may also be a partnership profit-sharing distribution toward the end of the year. But of course, distributions can only happen if there was a profit.

Other factors

The last set of factors to consider is harder to quantify. And yet importantly, these factors can make a difference in the employee’s experience and income. For example,

How many referrals will the employer be providing? This has significant ramifications for the pace of growing a caseload and, therefore, the income that you take home. Obviously, the more the practice is helping build the caseload, the more valuable it is to join them. (See, Enough referrals for a stable caseload of 1000 sessions per year.)
What kind of reputation does the organization have in the community? This can have enormous ramifications for how easy it will be for you to build a solid reputation in the community.
How will that reputation enhance your marketing efforts?
How much is the organization providing to you for marketing, supervision, technology, and back-office support?
See:
- Building your practice infrastructure: Tech, legal, and financial structure,
- Selecting a practice management system, and
- Developing a practice website for examples of these parts of an organization.

Furthermore, consider are the other benefits that the organization is offering? Some practices make contributions or payments for retirement benefits, health insurance, continuing education contributions, licensing fees, and malpractice insurance. For example, these exist in some larger and more established private practices. Not in most. Assuredly, these benefits add value to an offer.

I have created a calculator of all the factors that determine a therapist’s final paycheck here: How to calculate a psychotherapist’s private practice pay.

The whole psychotherapist pay package

In the end, following the money leads us from the sale of a therapy session through a few steps. Whether one is paid as an independent contractor or a W-2 employee, the money is divided into different accounts. Some money goes to benefits and a paycheck for the therapist. The rest goes to the practice to cover its bills. Keeping all the parts working together is what a business does.

Also, read this:

Picking the best option: Independent Contracting vs Employing

Estimating your private practice income

Wealth in Mental Health – Where are the good-paying jobs?

Why create another mental health practice

https://growingourpractice.com/ultimate-guide-to-managing-growth/

Verywell / JR Bee

Psychology can be a high-paying job, but it is important to recognize that there is tremendous diversity among psychology professions, and salaries and yearly earnings are just as varied. In a struggling economy, many students have turned their interest toward some of the highest-paying careers in psychology. The highest paying psychologist career salaries average around $167,000.

While many psychology careers have a higher than average yearly salary, it is important to remember that actual income depends upon various factors, including geographic location, employment sector, educational background, and years of experience.

Learn more about some of the highest-paying psychology careers, the typical salaries for such professions, and the educational requirements for entering these fields.

Cost is one of the greatest barriers to mental health treatment. Although the Affordable Care Act and other regulatory reforms sought to improve access to behavioral and mental health services, many people worry about the costs of therapy. While the cost of therapy is a very real concern, it is often possible for people to access free or low-cost therapy, especially if they live in large metropolitan areas or near a teaching university.

Average Cost of Therapy

Therapy generally ranges from $65 per hour to $250 or more. In most areas of the country, a person can expect to pay $100-$200 per session. Some factors that can affect the price of therapy include:

The therapist’s training. Highly trained and very experienced therapists typically charge more.
The location of therapy. Therapists in large metropolitan areas and regions with high costs of living must charge more to pay their bills.
The therapist’s reputation. Well-known therapists who are highly in demand often charge more.
Insurance coverage. People whose therapy is covered by insurance tend to pay less.
Length of the therapy session. The longer the session is, the more a client typically will pay.
Specialization. Therapy tends to be more expensive when the therapist is an expert in a highly specialized field or treats an unusual or challenging condition.

Some therapists also charge more for a longer initial consultation.

How Much Does Therapy Cost With Insurance?

Under the Affordable Care Act, all insurance plans must cover mental health care. Additionally, plans must not impose different rules on mental health clients or fund mental health care at lower rates.

This means people with insurance usually have some coverage for therapy. In most cases, they must choose a therapist within their network. They may also have to meet other criteria, such as having a mental health diagnosis, meeting a deductible, or getting a referral for treatment. Consequently, even people with insurance may opt to pay for their therapy out of pocket.

When people pay for therapy through insurance, they typically must pay a co-pay. Insurance co-pays vary widely, from just a few dollars to $50 or more.

How to Pay for Therapy

For many people, insurance offers the best option for funding therapy. Try calling your insurer to ask about mental health coverage and to get a list of in-network providers.

If you don’t have insurance, you may be eligible for insurance through your state’s Medicaid program or through the Healthcare.gov marketplace.

Some employee assistance and benefit programs also offer help paying for therapy.

Many universities offer free or sliding-scale therapy programs to people pursuing training as therapists. Try calling schools near you to ask about access to low-cost therapy.

Additionally, some therapists offer therapy on a sliding-scale basis. Consider asking about this option when you interview therapists. Some therapists may also offer payment plans that allow you to pay for therapy over time.

Many therapy practices also employ novice therapists who need experience. These interns or apprentices may offer free or low-cost mental health care.

Telehealth services, which offer counseling online or on the phone, may also be more affordable.

Is There a Way to Get Free Therapy?

A number of clinics are working to expand access to health care services, including mental health services, by offering free or discounted treatment. The National Association for Free and Charitable Clinics, for example, offers free and low-cost care.

Some other options for finding free therapy in your area include:

Contacting your state’s department of public or community health. Many offer community mental health clinics or referrals to free or low-cost services.
Enrolling in studies for mental health conditions. If you have a specific diagnosis, your local college or university may be researching your diagnosis. You can often get free care, including medication and therapy, by enrolling in such a study.
Seeking care at a college or university clinic. If you are a student, you may be eligible for free care at your college or university. If you are not a student but are located near a university that has a mental health care program, students in that program may offer free treatment to meet licensure requirements.

What Therapists Say About the Costs of Therapy

Lisa M. Vallejos, MA, LPC, NCC: Therapy costs have an extremely wide range. I know clinics that charge as little at $5 per session and others that charge $300 per session. It really is dependent on the therapist, your location, and the going rate for therapy in your area. There are many things to consider in addition to the cost that I would like to address.

Another factor to consider is whether you plan on using your insurance for therapy. In that case, you will likely be limited to however many sessions your insurance will pay for, which can vary. Also to consider if you are using your insurance, is whether there are only certain types of therapy that are covered, such as cognitive behavioral therapy. If you are paying for therapy with insurance, also consider that to be covered by insurance you must have a “covered” diagnosis. Your therapist will diagnose you and will list that diagnosis on your reimbursement paperwork. You will likely have a co-pay to pay when you seek insurance-reimbursed therapy, so be sure to find out how much that is as well.

Many therapists elect not to take insurance to avoid having to diagnose and the challenges that come with working with insurance companies, so it may be worth your while to ask the potential therapist to work with you on a fee that you can afford to bypass insurance.

Finally, many therapists will work on a sliding fee scale, but they do not always advertise that. A sliding scale is a payment structure that is based on your income. You can ask your potential therapist if they do, and if they do not, would they consider doing it for you.

Marla B. Cohen, PsyD: The price of therapy varies. Many insurance plans cover psychotherapy, and if you choose to work with a provider within your network, you will only need to pay your typical co-payment. Should you choose to see a therapist outside of your insurance network, you will find that therapists charge different rates depending on their office location, level of education, and degree of expertise in their field.

Some therapists may charge as much as $200 or more per session, but most will charge $75-$150 a session. Many therapists work with a sliding scale fee schedule, which means their fee will depend on your income level. If you have out-of-network benefits with your insurance plan, you may be reimbursed for the majority of what you pay the therapist. Your therapist’s office can create a ledger for you to submit to your insurance company for reimbursement. If costs are an issue, many areas have community mental health agencies that provide therapy at a reduced fee.

Stacey Fuller, LMFT: When it comes to the cost of therapy, there is no set industry standard. The cost of therapy can vary widely depending on a number of factors.

Some therapists are part of a panel of providers who accept a particular insurance. In this case, the cost of therapy may only be a co-pay and/or deductible payment determined by the insurance company. Typically, insurance companies will limit the number of sessions they pay for in a calendar year so it is important to check with your insurance provider prior to initiating therapy to determine how much of the cost of treatment will be covered.

Some therapists choose to not accept insurance and instead offer fee-for-service (otherwise known as private pay) only. How private pay therapists set their rates is dependent on a number of factors: area, specialization and specialized training, number of years of experience, how in demand they are in the community, etc. In my area private pay therapists are typically priced anywhere from $65 on up to $250 a session. In other areas of the country, the prices may be quite different. Checking out some GoodTherapy therapist profiles in your area will give you a general sense of the cost of private pay therapy.

Free or low-cost therapy is often available for people with limited financial means through local clinics, hospitals, and community agencies. Frequently these providers are students in training or mental health interns who provide therapy at a low rate or free of charge in exchange for experience hours towards licensure.

Getting Help

Therapy can be expensive, particularly when you look only at the price tag and not the total value. Yet therapy can also confer significant benefits, including an improved financial outlook or better career prospects. People who are less productive because of depression, who suffer from creative blocks, who struggle to identify the right career path, who engage in compulsive shopping or gambling, and who experience problems at work may ultimately have more money as a result of therapy. Even when therapy does not offer a direct economic benefit, it can greatly and permanently improve a person’s life.

People considering therapy should consider the overall value of therapy, not just the cost. To find a therapist who can bring real value to your life, click here.

References:

Gold, J. (2017, November 30). Health insurers are still skimping on mental health coverage. Retrieved from https://www.npr.org/sections/health-shots/2017/11/29/567264925/health-insurers-are-still-skimping-on-mental-health-coverage
Mental health and substance abuse health coverage options. (n.d.). Retrieved from https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage
Rowan, K., Mcalpine, D. D., & Blewett, L. A. (2013). Access and cost barriers to mental health care by insurance status, 1999-2010. Health Affairs, 32(10), 1723-1730. doi: 10.1377/hlthaff.2013.0133

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.