The word “Psychologist” is a protected title, under California law, to refer only to those who obtained a doctorate degree in psychology (Psy.D, PhD, or EdD). Psychological therapists, or psychotherapists, are usually people who obtained a Master’s degree in psychology related fields (MFT, CSW). The minimum education and training for psychotherapists are shorter than for Psychologists. Psychologists have in depth knowledge about the science and research literature that forms the basis of their treatment. While Psychologists can provide psychotherapy and be called a “therapist”, therapists are prohibited by law to call themselves “Psychologist” if they don’t hold a doctorate degree. Psychologists are the only ones allowed to perform psychological assessments/evaluations like intelligence, personality, immigration, and learning disabilities. Psychologists vary in what they do. Some provide psychotherapy exclusively in private practice, some do a hybrid of psychotherapy and psychological assessments, and some exclusively do research and teach at colleges.

With respect to mental health, there is no difference. “Therapy” is the shorthand version of “psychotherapy”. Both words refer to meeting with a mental health professional to do talk therapy to get relief from emotional and psychological symptoms. Of course, other disciplines use the word “therapy” also. Think physical therapy and occupational therapy. But in the vernacular of our present-day society, most people refer to psychotherapy (talk therapy) when they use the word “therapy”.

For psychotherapy, fully licensed Psychologists could charge between $225 - $300 per 45 minute session. Licensed psychotherapists (LMFT, LCSW, LPCC) could charge between $175 -$225 per 45 minute session. These fees are reduced for clinicians who are in training and could range between $100 - $150 per 45 minute session.

For Psychologists who does psychological assessments/evaluations, the fee is usually a flat rate starting approximately around $2000+. The flat rate includes: the clinical interview session(s), scoring tests, interpreting test results, and report writing.

Therapy is definitely not cheap. The actual fee depends on the geographic area (urban vs rural), the therapist’s licensure status (fully licensed or in training), degree type (Doctorate vs. Master’s), expertise, and years of experience.

It requires years of education and training to become licensed to effectively and ethically treat people. Once licensed, our learning doesn’t stop. We regularly have to pay for additional training to stay abreast on the latest evidence-based treatment interventions and/or get certifications to specialized areas.

Unlike other medical professions, therapists don’t ever double-book their appointments. The therapy hour is reserved solely for you to be with the doctor. Think back to your last visit to the dentist or physical therapist. You probably spent more time with the assistant or paraprofessional than the actual doctor.

Another reason why therapy is costly is because of the nature of the work. Being a therapist is a mentally and emotionally demanding profession. This takes a toll on the therapist. This is why a therapist who prioritizes their mental well-being will limit how many patients they see in a week. Psychologists prioritize self-care to limit burnout. Read more about the importance of a therapist going to therapy here. Building in time for self-care behaviors ensures that each person we treat gets 100% of us. The session fee allows us to be the most effective therapists while enabling us to pay our bills and make a living in our chosen profession.

The decision to not take insurance takes into account complex factors that influence how a Psychologist provides treatment and what’s in the patient’s best interest. Here are the primary reasons why:

1. Confidentiality

Protecting your identity and usage of mental health services is the bedrock of the mental health profession. By law, we are legally required to protect your identity at all cost. The exceptions are if you pose a danger to yourself, other people, or use insurance. Insurance companies and their employees have access to your diagnosis, treatment plan, and session notes. You might not feel the impact of this in the immediate future, but the repercussions of this will be felt when you buy life insurance or apply for a job that requires medical records as part of your background check.

2. Insurance companies dictate how therapy is done.

Providers in network with insurance are required to practice based on the parameters set forth by insurance companies. They determine the number of sessions you need, what gets talked about during your session, and what treatment method should be used. They want you to get treatment with the least amount of cost to them. Often times, what you need to get better does not align with what insurance companies are willing to pay. Your treatment plan should be determined between you and your doctor, not insurance companies.

3. Low rates, inconsistent payments, & delayed payments

Insurance companies pay about 50% of a Psychologist’s private pay fee. For some insurance companies, their pay to the Psychologist changes every year without notice, and payment doesn’t arrive until 4-6 weeks after claims are submitted. Imagine going to work, not knowing how much you’d get paid and when your paycheck will come in.

4. Time consuming

Often time, if there is an issue with claims being denied or payment/session being uncharacteristically low, it is almost impossible to talk to anybody about the problem. It is quite the norm to be on hold for hours, only to get disconnected.

5. Burnout

With insurance paying so low, it forces providers to see more patients in their day to make up for the low fee. The increase in volume of patients to offset the low fee + all the factors mentioned above contribute to provider burnout. Patients ultimately suffer because it is hard to get the best care from providers who are overworked and underpaid.

It depends on what your needs are. Do you need psychiatric medication to help manage your symptoms or do you primary need psychotherapy?

Psychiatrists (MD or DO) are medical doctors who specialize in mental health. They diagnose and treat complex mental illnesses through the use of medication to alter brain chemistry. In present-day, few Psychiatrists do talk therapy. Their primary role is medication management of complex and severe mental illnesses. Psychiatrists are the only mental health professionals who can prescribe medication. If medication is needed, it is typical for people to have a Psychiatrist (for medication management) + a Psychologist for talk therapy to change behaviors.

Many Psychologists do not accept insurance. In that case, you do not need a referral from your general physician (GP) to see a Psychologist. Once you find a Psychologist, you could contact them directly and inquire about their services. The best way to find a Psychologist is word of mouth. Ask family, friends, or other professionals in your life if they know of a Psychologist they could recommend. Look at members in professional directories such as the American Psychological Association (APA) or your local psychological association chapter like Orange County Psychological Associations (OCPA).

In general, people wait too long to see a Psychologist. It is time when you noticed you’ve been especially “moody” and irritable. You feel down and unmotivated. You’re not engaged or interested in things that used to bring you joy. A tell-tale sign is when the thoughts or feelings you’re experiencing are affecting your sleep. Whether it be having a hard time falling asleep or staying asleep. Quality sleep is vital for your mind and body to function properly. Every aspect of your life suffers when sleep is poor. So when your negative thoughts and feelings are interfering with your ability to sleep, function, and enjoy life, then it’s time see a Psychologist.