We Don't Talk Enough About Money and Therapy - Justin Lioi, LCSW - Brooklyn, NY

Therapy is a place where a lot gets talked about, but money and therapy together often gets avoided.

We bravely dive into

We spend the hour talking about all the things that most people work to avoid the rest of their week.

One thing that at first glance doesn’t seem to carry the weight of the above topics, but is nevertheless often avoided in therapy, is Money.

Talking about money and therapy can make many people very uncomfortable.

This will be a two part series about talking about Money and therapy: Money IN therapy, and money OUT of therapy.

Money IN Therapy

Often money comes up once in the therapeutic relationship and that’s when the fee is being discussed. On that first phone call or session you’re talking about a set fee, a sliding scale, reimbursement from insurance—and very often that’s the whole money talk. Unless there is a fee increase, money may not come up again.

How often do we talk about the process of negotiation or what it’s like to increase (or decrease) a fee?

How about the transaction? Is there a different feeling if you hand your therapist cash each week from having a credit card on file that gets debited? Some therapists take the fee at the start of the session. Some at the end. Some give a bill at the end of the month.

Do you talk to your counselor about what it all feels like?

Some clients say it feels good—it is a concrete reminder that this is about them and it releases them from having to “take care” of the therapist, emotionally at least. Some parents feel good about spending money to help their child.

Others, more often, dislike it. This goes along with the stigma of therapy itself, the idea that I have to “buy” a friend. Therapy is a process, and it can be a long process, so it’s a large investment. And many people find it quite hard to invest that much into themselves. Especially when it’s not something that feels good all the time.

Sometimes the therapeutic relationship ends, or pauses, if the client can’t afford their therapist’s fee. Ideally, and ethically, your therapist would make sure you have other, more affordable, options if this happens, but there are feelings that may go along with your therapist not able to treat you because of a lack of money.

Should therapists be ashamed by how much they charge? How about when they decide to not take insurance? Should a therapist be judged as “better” if they charge more than a therapist who charges less? Is the effectiveness of the counseling different by someone in private practice than the counselor who works in a mental health clinic?

Whether the “should’s” are answered or not—are therapists shamed and judged for this? Have you let your therapist know? How did they respond?

All of this can be important avenues to explore for yourself with your counselor, but that can take some bravery.

Justin Lioi, LCSW is a men’s mental health and relationship expert. He practices counseling in Brooklyn, NY (and online throughout New York State and internationally.) He received his degree from New York University and has been working with men and their families for over 10 years. Justin is on the Board of the National Association of Social Workers and writes a weekly column for the Good Men Project called Unmasking Masculinity. He can be found on local and national podcasts talking about assertiveness, anger, self-compassion, all with the goal of becoming the man you want to be.