How Much Should Therapy Cost?
This is a tricky question to answer. In an ideal world, therapy would be accessible to everyone who needs it. In reality, becoming a therapist requires extensive and costly education, and continuing to hone and develop skills once registered is also incredibly expensive. Not only that, but those of us who live in Vancouver reside in one of the priciest cities in the world. Unfortunately, the current economy restricts us to paying for services with money, and ethical guidelines prohibit counsellors from exchanging goods or swapping skills for therapy. These guidelines aim to prevent an imbalance of power or a sense of one person feeling indebted to another. While I am fully in support of reducing the imbalance of power in therapy, it is hard to know that this comes at the expense of making support unavailable for some folks who have financial limitations.
Many factors come into play when thinking about therapy costs, and ultimately, each of us might land in different places. Here are some things I consider when making ethical decisions and finding comfort in where I have landed.
Recommended Fee Guidelines
Most Colleges or Associations provide recommended fee guidelines. I am part of the BCACC (British Columbia Association of Clinical Counsellors), which offers guidelines that not only outline a range of fees but suggest adjustments based on experience. This fee guide is publicly available on the BCACC website.
As of Fall 2024, the range of fees for less experienced RCCs (Registered Clinical Counsellors) is $140–$155, and for more experienced RCCs (those who have practiced for at least 3–5 years) is $150–$165. The BCACC also highlights that those with specialized skills or training, which provide added expertise, may charge between $165 and $250. All of these fees reflect a standard 50-minute individual therapy session, while relationship therapy typically costs more.
At the Commons Wellness Collective, we are committed to accessible therapy, and part of this commitment is ensuring that our fees align with these recommendations. You have the right to question fees that seem inconsistent with these guidelines. It is always acceptable to ask what training or specialized skills your therapist has to justify a higher fee. Remember, higher fees do not always mean more skill.
Why Is Therapy So Expensive?
Like many para-health expenses (e.g., naturopathy, physiotherapy, osteopathy, dental care, vision care), mental health counselling fees take into consideration a few things. Education and training are significant—therapists require a master's level education, and continuing education is both ongoing and costly. Additionally, preparation for sessions involves research, reading, and note-taking outside of the time spent with clients, which the session fee compensates.
Mental health professionals face one of the highest burnout rates of any field, and working in a sustainable way is important for us to be able to continue this work long term. For this reason, we do not conduct 40 hours of client sessions per week; instead, our work week includes admin, note-taking, studying, training, reading, business tasks, and client sessions.
The bigger problem isn’t that therapy sessions are expensive, but that therapy is not considered an essential part of healthcare. It is not reasonable to put the burden of making therapy accessible solely on therapists; rather, policy makers should work to make therapy more widely funded, and employers should enhance access through health plans.
If you’re a therapist, discussing fees with folks you’re supporting may not have been part of your training, and finances can be uncomfortable for many to discuss. For therapists, working through these conversations can be an important part of creating a safe-enough space for financial discussions. Transitioning from an employee mindset to one of charging per service can be challenging; anticipating this and creating a plan for handling requests for lower-cost services with peers or a supervisor can be an essential part of building confidence in your work.
Where Can Folks Access Low Cost Therapy?
Many therapists in private practice recognize accessibility issues and offer sliding-scale fees. In addition, several clinics provide low-cost or even free services. Willow Tree Counselling publishes an up-to-date list of low-cost options in BC and the Lower Mainland, including affordable group sessions that provide support.
To become an RCC, students must complete several hundred hours of clinical experience for free under the supervision of experienced therapists. Students, due to their enthusiasm and desire to learn, can offer an excellent therapeutic experience and may be available for extended placements lasting up to a year. We are now hosting a student intern ourselves, and are pleased to offer Low Cost Counselling. This can be a great option for someone hoping to do longer term work but at a reduced fee.
Hope for Change
I dream of a world where everyone’s needs are met sustainably. If you’re interested, I encourage you to do your own reading and research to explore how much of our mental healthcare system is embedded in capitalist and systemically oppressive practices. Decolonizing Therapy by Dr. Jennifer Mullin is a great place to start. If you are also curious about this topic, I’d encourage you to research ideas that stem from Solidarity Economics, or the concept of “shared enoughness.”
Until this world becomes a reality, we must work within the current system. At the Commons Wellness Collective, we want to support you, so if finances impact your ability to access therapy, please know that by openly discussing these concerns, we can create a sustainable plan together.