Why Does Therapy Cost So Much?

One of the most common—and completely understandable—questions I hear is: “Why does therapy cost so much?”

It’s a question I welcome, because the answer helps humanize therapists and sheds light on what it really takes to do this work sustainably.

Like many others in private practice, I came into this field because I care deeply about people. I wanted to create a safe, attuned, and healing space where clients can show up fully as themselves. But I’ve learned that offering this kind of care doesn’t just come from the heart—it also comes with significant costs.

Therapists in private practice are also small business owners. That means we pay for everything out of pocket, from the years of education and unpaid or low-paying internships that brought us here (often accompanied by massive student loans!) to ongoing training and continuing education. We’re responsible for our own health insurance and professional liability coverage, and we pay rent for our offices, along with utilities and the everyday expenses that help create a comfortable and welcoming space. Even the things that seem small—like water, tea, snacks, or tissues—are intentionally provided to help clients feel at ease, and they all come from our own budgets. Add to that the costs of technology, like computers, HIPAA-compliant video platforms, electronic health records systems, and reliable internet, and the expenses begin to add up quickly.

Imagine told that in order to do your job, you’d have to pay for your own desk, chair, laptop, office space, and coffee for your customers—every single month. This is the reality of private practice. We aren’t backed by a company. There’s no payroll department or overhead coverage. We do this work because we love it, but love alone doesn’t keep the lights on.

The cost of therapy isn’t just about the money we spend—it’s also about the invisible labor, the time and energy we give behind the scenes. Outside of session hours, therapists spend a significant amount of unpaid time writing case notes, responding to emails, returning calls, and navigating scheduling logistics. We manage our own bookkeeping and accounting, handle billing and insurance matters, and spend hours consulting with colleagues and experts when a case needs extra thought and care. We also pay to attend trainings to ensure our knowledge remains current, ethical, and aligned with best practices. All of this happens outside of the therapy hour, but it’s essential to the quality of care clients receive.

And then there’s the emotional and mental process involved in facilitating therapy sessions. Each hour we spend with a client is a deep investment of presence. We listen beyond the face value of words. We tune in to tone, body language, silence, and emotion. We remember your story, hold your struggles with care, and attune to the parts that feel too heavy to carry alone. This kind of presence takes intention and energy, and it’s not something we can offer on autopilot. In order to maintain that level of care, most therapists limit how many clients they see each day. It’s not about working less—it’s about ensuring that the time we do spend with each person is meaningful, ethical, and grounded.

Now imagine arriving to your job one day and being told that you aren’t going to be paid because your coworker didn’t show up, even though you were fully prepared and ready to work. When a client cancels at the last minute or doesn’t show up, that hour—set aside with purpose and preparation—is often lost. Therapists understand that emergencies arise, and no-show and late cancellation fees aren’t about punishment; they help protect the emotional sustainability of our work. These boundaries ensure we can continue showing up fully, without resentment or burnout, and support the trust and respect that make therapy a meaningful, healing space.

It’s important to say this clearly: While it is not the job of clients to take care of or protect their therapists, it is the right of every person to be humanized and treated with respect—including therapists. We are not machines. We are not endless wells of empathy. We are human beings—just like you—with rent to pay, student loans to manage, medical needs, and families we must support. We’ve chosen this profession not because it’s easy, but because we believe in the power of connection, in the possibility of healing, and in the quiet, courageous work of growth. This work matters to us, and so do the people we do it with.

So yes, therapy can absolutely feel expensive. It is an investment, not just for clients, but for therapists, too. When you choose to invest in therapy, you’re not just paying for one hour. You’re supporting the full, behind-the-scenes reality that makes your hour of transformative healing possible.