Is Therapy Worth the Investment? Understanding the Cost of Insurance vs. Paying Out of Pocket
Deciding to start therapy is a big step, but once you've made that decision, the next challenge is figuring out how to pay for it. Should you use insurance or pay out of pocket? What are the benefits and drawbacks of each option? And ultimately, is therapy worth the financial investment?
This post breaks down the key factors to consider, including cost, accessibility, privacy, and the overall value of therapy. We’ll explore the pros and cons of using insurance versus private pay, helping you make an informed decision based on your needs, budget, and goals. This is the first in a series where we’ll also cover how to find the right therapist and understand different therapy styles, like exploring somatic or experiential therapy.
But before we deep dive into the cost breakdown, it’s important to first ask yourself…
What Do I Want to Get Out of Therapy?
You might want to start therapy for all sorts of reasons. Maybe you’ve been feeling off for a while, and the current state of affairs in the world is only making the stress, anxiety, depression, or existential dread worse. Maybe you’ve recently gone through a significant change, loss, or trauma (or the threat of one), like a breakup or a big move. Or maybe you feel like you’ve lost yourself a little and are feeling stuck and generally dissatisfied with your life.
Before you can determine if the investment in therapy is worth it, it’s helpful to know why you’re going and what you want to get out of the process. Depending on those answers and how much the issue is impacting your daily life will influence whether the investment is worth it and at what level.
Questions to Ask Yourself Before Starting Therapy:
What’s the main reason I’m seeking out therapy? On a scale of 0-10, how much is this issue negatively impacting my life right now?
If nothing were to change and things continued this way for another 6 months to a year—how would that feel? Could I handle it, or would it make things much worse?
What are some of my main goals that I want to get out of therapy? Either short-term or long-term.
Am I looking for an ongoing partnership that can support me through different issues or changes over longer periods of time, or do I want a short-term, brief therapy experience, say for one year or less?
Do I prefer a structured, goal-oriented approach (e.g., CBT) or a more exploratory, insight-based approach (e.g., psychodynamic, somatic work)?
How have I handled emotional challenges in the past, and what type of support has worked best for me?
Am I open to trying different therapy styles if my first approach doesn’t work?
Now that you’ve gotten some basic questions out of the way, let’s dive into the differences between choosing to use insurance or going out of network and what that really means.
The Financial Investment: Is Therapy Worth It?
One of the biggest considerations when starting therapy is cost. Should you use insurance or pay out of pocket?
Let’s break it down.
Using Insurance for Therapy
Insurance can make therapy more financially accessible, often reducing session costs to a manageable co-pay (ex. $10-50 per session). However, there are trade-offs:
Provider, Therapy Type, & Session Limits – You can only see providers who are listed as approved by the insurance company, which means limited access to specialists or certain therapy modalities. Insurance companies may also set a limit on an approved number of sessions, which could interrupt ongoing treatment.
Diagnosis Requirement – Insurance requires a mental health diagnosis to approve treatment, which becomes part of your medical record. Some diagnoses may not be covered, like relationship concerns or personal growth, while others you may not meet criteria for and could hinder reimbursement.
A diagnosis on your medical file may also impact you in instances of applying for life or disability insurance, court proceedings, or job applications.
Limited Confidentiality – Insurance companies review your records, and in some cases, this information may be added to national medical information data banks regarding treatment.
Finding an In-Network Therapist Can Be Difficult – Many therapists have long waitlists, and some do not accept insurance due to low reimbursement rates.
Quality of Care May Be Affected – Some therapists in-network may have high caseloads, limiting the amount of personalized care they can provide.
If using insurance for therapy services it’s wise to know all the details of what will be covered by your plan and to periodically check that nothing has changed in your eligibility or your coverage each year, if plans change.
Paying Out of Pocket: More Freedom, Higher Cost
Opting for private pay means full control over your care. You can choose any therapist, avoid diagnosis requirements, and maintain greater privacy and confidentiality regarding your care and medical record. However, it comes at a higher financial cost.
Rates Vary by Location & Provider – Therapy can range from $150 to $450+ per session, with metropolitan areas like NYC or Los Angeles typically being more expensive. However, many therapists also offer sliding scale options you can inquire about. Similarly, many group practices offer lower fees for pre-licensed clinicians.
Out-of-Network Reimbursement – If your insurance plan includes out-of-network benefits, you may receive partial reimbursement by submitting a superbill. However, this still requires a diagnosis on record. For a list of questions and information to ask, visit my FAQ page.
Greater Access to Specialized Care – Many highly trained therapists with expertise in trauma, somatic therapy, or couples work are private pay only.
More Flexibility in Treatment Approach – Therapists in private practice can tailor sessions to your needs without being restricted by insurance guidelines. Meaning there are no restrictions around length of session, number of sessions, or the need for a diagnosis to be seen.
Longer-Term Relationship Potential – Without session limits, you can work with a therapist over a longer period if needed, allowing for deeper and more meaningful progress.
Which Option Is Right for You?
Knowing your own parameters in terms of budget, the time you’d like to spend in therapy, how much control or privacy you want regarding your medical file, and any specific criteria for a provider (license or therapy type) will all factor into your decision.
While insurance makes therapy more affordable, private pay offers greater flexibility and confidentiality. The best investment is one that allows you to receive consistent, effective care with the therapist who feels right for you (which we’ll cover next in this series).
When Might Therapy Not Be Worth the Investment?
While therapy can be transformative, there are times when it might not be the right investment—at least for now. Here are a few factors to consider:
Your Schedule Is Overwhelmed – If life is too hectic to commit to regular sessions, adding therapy may feel like an extra burden rather than a benefit.
You’re Unclear on Your Goals – You don’t need a perfect plan, but if you have no sense of what you want from therapy, it may feel unproductive.
You’re Moving Soon – Most therapists are licensed only in specific states. If you're relocating, waiting until you settle may be more practical unless your provider can continue seeing you.
You Have Other Support Options – If therapy isn't feasible right now, support groups, books, workshops, or coaching can be helpful interim options.
Financial Constraints Are Too High – If therapy isn’t accessible, consider low-cost community mental health centers, university clinics, or sliding-scale therapists.
Choosing to start therapy is a big decision. If now isn’t the right moment, that’s okay—revisit the idea when you feel ready to commit and benefit fully.
Final Thoughts: Is Therapy Worth the Investment?
Therapy is an investment in yourself—one that requires time, energy, and financial commitment. Whether you choose to use insurance or pay out of pocket, the right therapist can provide invaluable support, helping you navigate life’s challenges and move toward meaningful change.
When considering the cost, think about other investments you make in your well-being: gym memberships, personal training, wellness retreats, or professional coaching. Therapy is one of the few investments that can improve every aspect of your life, from your mental and emotional health to your relationships and career.
