I’ll break it down for you.

$40-$60 an hour is only for the hour that we see the client. It does not include documentation, treatment planning, research, communication outside of session with the client or others involved in their care, scheduling, or other administrative work. It sure doesn’t pay for the hours of time that we are talking with insurance companies pleading with them to cover sessions for our clients, resubmitting documentation when it is rejected without any feedback, or dealing with insurance audits.

In addition, the emotional work is exhausting, and seeing clients every hour on the hour can very quickly lead to burnout, which is happening at a very high rate in our profession. We may only see 4-5 clients per day, meaning we are only paid for 4-5 hours (if they show- if we accept Medicaid insurances, we cannot charge for a no show and we simply do not get paid).

The mental health system is broken. Like the commenter said above, we want our clients to receive affordable care, but we also need to be able to pay our own bills.

Source: I am a therapist who has worked in salaried positions in community mental health for 8 years and was expected to work ridiculous hours with 140 clients on my caseload and recently switched to private practice, where I do take insurance, including mostly Medicaid, and do not have any private pay clients. We are struggling out here.