Extremely Expensive Therapy (and You’re a Fool if you Pay for It)

There’s an article in The New York Times which discusses therapy with very wealthy clients. The thrust of the piece is on the difficulties these clients face, as well as specific challenges for the therapists who are treating them. What struck me as fascinating, however, was the fact that one of the treatment providers in the article charges $600 per session. Yes you read that correctly: two $300 bills. Or you could give him $10,000 and get $9400 in change. I have never heard of such a rate for therapy and my take on this is that his clients are simply foolish for paying it.

In New York City and many parts of the United States there is a discrepancy in cost for therapy in a private practice based on the discipline of the provider. From what I’ve seen Social Workers tend to charge less than Psychologists, who usually get somewhere between $125 and $225 per session. A Psychiatrist friend of mine charges about $275 and stated that’s mainly because she can prescribe and manage any necessary medications. There’s probably some elitism involved in that as well but that’s not important right now. I’ve heard of some Psychiatrists charging upwards of $400 per session and recently as much as $500 but this new benchmark of $600 blows me away, especially given that there’s no mention of medication management involved.


Here’s the rub: I’ve discussed the perils of choosing a therapist based on degree or years of experience. People constantly make that mistake: he went to so and so school or has been in practice 30 years, so even though he’s pricey he must be the best. Unless I’ve missed some new research on this topic there isn’t substantial evidence to support the “you get what you pay for” philosophy. My postdoctoral training was at an Ivy League hospital. While outstanding in its own way, it wasn’t really any better than the tiny community mental health center in Smalltown, Ohio where I trained as a graduate student. The human condition is so complex and constantly evolving and no one person or institution has all the answers. Therapy will never be an exact science and therefore there will never be the perfect textbook or teacher or school that will create the Ultimate Therapist who puts his hand on your head and cures you of any and every ill.

What is this shrink saying for 45 minutes that could possibly be worth $600? “Your mother is the sole cause of your neurosis. You have both my ethical and legal permission to kill her.” I suppose that might be worth a lot. Is he reciting words of wisdom off of some diamond-studded scroll from the mountain tops with bolts of lightning crashing down to punctuate how profound his statements are? Does he hold the secrets to world peace and immortality? Does he offer a Happy Ending to the clients who are into that stuff?

I suspect that he’s charging this rate simply because he can. His wealthy clients will believe that he’s worth it because he’s so expensive. They’ll tell their other rich friends that’s he’s “the best.” And if they can afford it good for them. But the reality is that Altoids don’t taste any better if you pay $59 per tin.

If anyone has $600 laying around, let me know and I’ll contact this guy about doing a 45-minute interview for the site. I’ve been cranky for the past few days so maybe he can fix that as well while he’s here.

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24 Responses to “Extremely Expensive Therapy (and You’re a Fool if you Pay for It)”

  1. J says:

    I heard the scroll was bedazzled. The lightning? CGI.

  2. I read that article and one of the first things that jumped out at me was a line that said that these therapists had trouble relating to their clients, due to their wealth.
    I suspect the price is a result of their low supply and the high demand from their rich clients, rather than a luxury pricing that is supposed to make them appear more qualified.
    Basically, they deal exclusively with rich clients, who don’t blink at the thought of dropping $15,000 a year on therapy (they probably spend just as much on their golf equipment), and they charge it because their clients are willing to pay it.

  3. Autodidact says:

    Disclaimer: I really don’t know what I’m talking about.
    Is it possible there’s a psychological element in play here? If you’re bidding $8 million for a painting, maybe it’s just easier to take the most expensive therapists seriously?

  4. Mike says:

    You beat me to the happy ending comment. Hey like PT Barnum said there’s a sucker born every minute. I know someone that signed a contract with a chiropractor to pay $16K for 6 months of treatment. What the hell the doctor was going to do was beyond me.

  5. Jack says:

    I don’t think that saying that rich people are simply “more willing” to pay a lot for therapy really makes sense. The wealthy people mentioned in the article have high-level executive jobs, not trust funds–positions that require intelligence, creativity, business savvy. Based on that, you would think they would be -more- likely to negotiate a good deal on therapy, not less. Their goal, like anyone’s, would be to get the best possible therapy at the lowest possible price. Let’s say you want to open a practice aimed at very rich clients, so you call a prospective patient in to discuss terms. You say, naturally, that you would like a million dollars per session; the executive opens up the Yellow Pages to the “Counseling – Cognitive Therapy” section, filled with many, many competing psychologists, and offers five bucks for two hours, plus you wax his car. However, you counter by pointing out all the reasons he’s even in your office in the first place–your shiny credentials, the convenient location, the word-of-mouth from the other rich clients you’ve had. That alone is enough to ensure the basic going rate for your services. But here’s your trump card–because the client has such a well-paying job, his/her time is dramatically higher-priced than the average person. You are offering them the opportunity to rid themselves of a psychological condition that is almost certainly making them less productive–in overspending due to depression, lost productive time due to stress, lower quality of life–and thus, your services are worth the value of whatever money-making capacity you restore to them. The only reasons these therapists aren’t making far, far more (I was surprised that they were getting -as little as- $600/session) is because of how hard it is to quantify how much time you gain when you are mentally healthy, much less put a price on a higher quality of life, not to mention that therapy is by no means a sure way to “cure” anything. If anything, it’s a testament to the negotiating savvy of those clients.

  6. Prometheus says:

    I tend to agree with autodidact, a few posts above me. There’s probably a sense of “you get what you pay for” inherent in these clients’ thought processes, even if that’s not true in reality-they probably would respect someone more, and assume the work was better and more serious, if they paid more.
    As a corollary to this, I wouldn’t be surprised if there was something of a placebo effect built into that as well. They might actually get more out of the session if they think it “should” help them more. Maybe they’ll open up more, to feel they’re getting their money’s worth. Maybe they’ll follow the advice better because it “must” be valuable advice. Or maybe it’ll just subconsciously have a greater effect on them because of the added importance they’ll psychologically put on it, compared to if they were paying less. I have no idea and no knowledge in this area-I’m just speculating here. But it seems plausible.
    Call it the “Bose Sound System” effect. Dress something up in a pretty box, label it with all sorts of buzzwords, and charge triple, and people will *assume* it must be better, and will proselytize to that effect.

  7. Tracie says:

    I have no clue what Jack is getting at.
    As Ilan pointed out above, there is definitely a supply/demand issue going on. If you only need a few clients to keep yourself independently wealthy, you can afford to give them far more flexibility than you would were you juggling 6 or 7 clients a day. The doctors who by the nature of their practice’s evolution become devoted to the specialized needs of the extremely wealthy, and in doing so their work is better tailored to their client. Hence, word gets around, Rich Crazy Dude #1 passes on to Rich Crazy Dude #2 that Doctor for Rich Crazy Dudes is great, and thus such a high-priced practice is sustained. It only takes a little jettison off the concept of higher cost = better to set the wheel in motion.

  8. Jenna says:

    I think Jack has too much faith in the ability of business executives. Rich people get out of touch with how much ‘normal’ things cost and that’s why they end up paying $1000 for jeans and $600 per session for therapy. The psychologists know this and capatalize on it.

  9. Luba says:

    Thank you Tracie.

  10. Tina says:

    Offering a happy ending with a $600 therapy session? That shit is $20 at the massage parlor. For $600 the therapist better follow my ass around for the week and rub one out whenever I feel the urge, AND light my cigarette after.

  11. Dr. Rob says:

    Fee negotiations are fairly common practice in therapy but Tina has taken it to another level. Good stuff!

  12. Blank says:

    Or maybe they use one of the hundreds they get and wipe their client’s ass for them. I dunno, just a thought.

  13. Borderline Betty says:

    Hmmmmmm. Well, maybe those therapists charge $600 just because *they can*. As far as what level of therapist does better therapy, I think it depends on the skill of the person, Not the kind of degree they have. For instance, I have a social worker for a therapist, and I am very satisifed with therapy. When I had a psychologist therapist, I wasn’t satisfied. I felt much more judged by that person. My current therapist trusts me to let me pay at the end of each month, and also waits for the insurance to kick in for the full payment (this has worked out fine for some time, now). I’m really lucky for this arrangement, otherwise I’d probably not be able to afford therapy, even with insurance. And, I need therapy to function normally (more or less…hahaha). Is therapy expensive? Yes. But $600 expensive? Um, *no*. Not yet. I hope it never gets to be that high. It’s a concern, for sure, that therapy, just with normal pricing, is so expensive. I don’t blame my shrink, though. There is rent, insurance and other, relevant issues to consider. I think my therapist charges a fair fee. I have a good “bargain”, mainly because the therapy is so helpful and because I feel extremely accepted by my therapist, yet also appropriately challenged. But the rich, well, they really Are different, I guess.

  14. Anonymous says:

    This was about 10 years ago I think, but this is what 600 bucks might get you…
    http://youtube.com/watch?v=gpVsGgiNWto&feature=related

  15. Yasmin says:

    Don’t be cranky Rob! Yes, some random shrinks may be getting way too much money, but do they have your debonair good looks or athletic prowess? Methinks not! 🙂

  16. Charlie Murphey says:

    From an economics perspective, there’s a couple of reasons why they can charge that much
    When your wealth reaches a certain point, certain things become more important to you. You don’t have to work as hard, because your personal time is simply more valuable to you. This is why you see a lot of built or at least fit CEOs and such. Same thing goes for mental health; the clients probably realize that $600 is an absurd figure, but since money is immaterial anyways, you might as well go for the best.
    Excellent therapy is a status good; you get to tell all your friends you’re seeing a really exclusive therapist. Sort of like having a pink convertible.
    If you could attract that sort of moneyed client base, you too could charge $600, probably more even.

  17. Dr. Rob says:

    I understand that perspective, but that’s precisely my point: there is no “the best.” That is a myth. While psychology is, contrary to popular belief, a science, its practice is an art, which is subjective. The best therapist for one patient will be the worst for another.

  18. Just like in business, to some…’perceived value’ can be more important than ‘actual value.’ For some it is years of experience, for others it is exclusivity, for others it is cost, etc. If they choose to charge $600/session….good for them. The only time this could be problematic is if they were the only game in town, but that rarely is the case in places where this type of pricing is common.

  19. Celina says:

    I thought you may enjoying hearing that when the subject of wage came up in one of my psychology courses, one of the other students brought up your site and this specific article, expressing her appall at 600$/hr. Why is this impressive? Well the course has a grand total of eleven people and is taught in a small francophone university in central Canada. I was rather surprised! You’re getting quite popular! 😉

  20. .’; I am very thankful to this topic because it really gives up to date information ;,;

  21. Dr. Tim says:

    I think that folks whom are able to charge anything more than $80 for psychotherapy, have very few clients, but very wealthy clients. Of course self pay clients always pass around your name to each other, just as non-self pay clients do. It just depends on what business model you are looking to serve and if you are willing to develop that kind of business. I can tell you that I routinely accept $60 for 45 minutes therapy session and I consider myself pretty good. But I also get 97.50 for that same session from one of my insurance contracts. The difficulty in maintaining a practice is really in having a consistent caseload. Sure, I would like to get the higher rate all the time, but there is no way of having a strong caseload with just that insurance contract or self pay patients.

  22. Urbanlegend says:

    I had seen a therapist a few years back (who markets herself as a life coach). She did not have any fancy training and charged about $300/hour. She worked right in NYC. My family had to pay for me because I was not working at the time. She really saved my life and I feel she deserved the $300/hour, probably even more given the extra time and care that she gave me. My point is that the money does not really matter if people are getting better.

    You have to remember that psychiatrists are physicians who go through very similar training with the likes of cardiologists, pediatricians, brain surgeons, etc.. Medical school is the same, the first year of residency is often similar. The total amount of time in residency is about the same. A child psychiatrist spends as much in residency as does a surgeon.
    A well paid surgeon makes about $10000/week and a child psychiatrist is about $5000/week but both have same medical responsibility if a patient were to get ill or need hospitalization.

    I wonder how do feel that a surgeon is being paid more than a psychiatrist? Is that elitism?

    You should charge $600/hour and just enjoy it.

  23. 2p says:

    One thought, which is probably unrealistic, but hasn’t been mentioned, is that very rich people may have (on average) very complex and horrible mental health problems — a theme that was dealt with, for example, in the film “Cosmopolis”. Absolute power corrupts absolutely. If this is so, what sounds like a high fee may be charged, not so much because it’s good value for (disposable) money on the client’s side, but because the service provider is taking extreme risks in dealing with these people.

  24. Seviah says:

    I chose you. You deserve the $600.00. I’d pay it if you asked as long as I could.

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