• Does my session fee seem outrageous to you? 
• Were you hoping to get skilled, high quality couples therapy for $80-$150/session?
• Were you hoping to find someone who accepts your insurance, so you can just pay your copay?

The purpose of this post is not to tell you those things are impossible, but to explain why they are unlikely, and to help you get comfortable with the idea of paying for the therapy you need, if it's at all possible. Here are four reasons why you should consider paying my cash fee to help your relationship become all you want it to be.

Reason #1: You May Only Get One Chance

I've been working with couples nearly 25 years, and exclusively with couples for the past five. Half or more of the couples I see have attempted couples therapy at least once (some multiple times) before coming to see me. 

Why aren't they returning to the therapist they worked with before? 

It's usually because their last couples therapist wasn't helpful. Sometimes one or both partners felt their last therapist was actually harmful.

How is this possible? 

Because of the math of the thing. Over 80% of therapists see couples. Anyone with a degree in psychology, counseling, or social work can offer couples therapy, but only about 12% of us have pursued extensive post-graduate couples therapy training. 

Even fewer of us than that see couples exclusively, and keep our caseloads fairly small so we can offer each couple the most attention possible. 

This isn't to say therapists like us are the only good couples therapists, but the vast majority of therapists are just not trained to do this work. Those are the realities in the field and you should know them. 

Most couples who show up for couples therapy are in different places regarding how enthusiastic they are about doing therapy. Typically one partner has been ready and has been asking the other to go with them to therapy for months or years. The less enthusiastic partner may be willing, but they may not feel comfortable with it, and they may not even really believe therapy can be helpful. They may also fear being blamed by either their partner, the therapist, or both, for most of the problems in the relationship.

If your partner is less open to therapy than you are, if it goes badly, or the therapist doesn't seem to know what to do, that might be the only chance you get. 

Your partner, who was already not thrilled about going, can now honestly say, "I tried, it didn't work, I don't want to hear anymore about it." Now you're in a relationship that still isn't working because the therapist didn't help, and possibly made the problem worse. 

What comfort is it going to be that you paid $480 or less for six ineffective or harmful sessions instead of $1800 for six sessions that instilled hope and convinced your skeptical partner to get on board with you to finish this important work?

You may only get one chance to see a therapist with your partner. 

Do you want to waste that opportunity on a therapist who only sees couples occasionally, isn't trained specifically in working with couples, and/or doesn't have a lot of experience in doing this work? That could easily turn out to be the most expensive money you ever saved. 

Reason #2: You Need Someone Who Can Tell You What to Do

In individual therapy, one of the most unethical things a counselor can do is tell a person what they should do (e.g., "You should leave," "You should give that person a piece of your mind," "You should take some time off."). 

The goal of individual counseling is not, after all, for the therapist to simply solve your problems for you, it's to help you explore you own feelings, values, ideas, limitations, and needs so you can come up with a solution that works for you. But things that are important in individual therapy are often harmful in couples therapy. 

Couples must be told what to do. 

Couples are suffering because they care about each other and want to have a good relationship, but don't know how to make that happen. The intuitive way they talk about problems and approach their challenges together chronically brings them further apart, instead of closer together.

Trained couples therapists are able to help partners see this, and provide proven, workable alternatives/treatments that change the undesirable results they have been getting for so long. Untrained or inexperienced therapists are likely to focus on tried and true "communication skills" that may be good ideas, but couples need a therapist who can help them apply these skills.

What dollar value do you put on working with someone who will teach you specifically what you can do to make things better?

Reason #3: Becoming a Skilled Couples Therapist Costs Money and Takes Time

Most therapists are not taught specifically how to address relationship problems in graduate school. We are taught principles of wellness and unwellness, theories about causes of distress and dysfunction, and are exposed to an arsenal of basic techniques we can use to treat some of the most common mental health issues such as depression and anxiety. 

Aspiring therapists in most graduate programs may have one class in relationship therapy, where there is not enough time to cover how to apply specific techniques to specific problems, and no time at all to practice these techniques and develop expertise in using them.

If you find a couples therapist who has received specific and in-depth post-graduate training in couples therapy, they have nearly always financed that training (which is often quite expensive) personally. Many couples therapists learn several different systems of couples therapy to enhance their understanding, grow their toolbox, and deepen their expertise. The amount of time I have spent in post-graduate training in couples therapy is reaching the point of equivalence to another whole graduate program, and I have no plans to ever stop. 

Do you want a couples therapist who got out of grad school and is doing much the same work with couples as they do with individuals, or do you want one who will be spending money and time for the rest of their careers specifically on getting better and better at helping you?

Reason #4: Most couples therapists I've described above do not accept insurance

Most highly trained and experienced couples therapists do not take insurance for a simple reason: no insurance company in the United States accepts insurance for couples counseling.

This means therapists must jump through certain hoops to get reimbursed for couples counseling. These hoops expose us to possible fraud allegations, and legal and financial penalties. 

While that is not likely for therapists who work with a broad variety of issues, it becomes more likely for us who work only with couples. It also poses significant challenges to therapists who want to document transparently what we are doing with couples in sessions, rather than writing what an insurance company might be looking for. 

Do you want a couples therapist who is ultimately working for you and not an insurance company?

I want to end by stating again that I'm not suggesting you absolutely cannot find a trained, qualified, and experienced couples therapist who accepts insurance. Indeed, if you find a couples therapist who 1) has received extensive post-graduate training in couples work; 2) sees fifteen or fewer couples a week; and 3) accepts your insurance, you might consider scheduling a consult with them immediately!

The point of this post is this is unlikely, for all the reasons I have explained here. I'd love to address any further questions you might have, and see if we'd be a good fit to work together.