How Much Does Therapy Cost in California?

Takeaway: Therapy is an important investment in your mental health. However, it’s important to understand the financial responsibility of counseling before starting the process. In this post, I’ll answer questions you have about how much therapy costs in California so you can make an informed decision about your treatment:

• How much is therapy in California?

• How can I pay for therapy?

• Does my insurance cover therapy?

• When is - and isn't - a good time to start therapy?

I've broken down the above and much more in this post, so read on for everything you need to know about therapy costs and how to navigate your decision-making process!

Everything you need to know about the cost of mental health services in California

I'll give it to you straight - getting therapy can be tricky.

Many want to use their insurance coverage for their therapy costs, but often run into roadblocks when trying to do so.

So how much does therapy cost and what can you expect to pay?

I'll provide detailed information about the cost of therapy per session, what influences the cost of therapy, and how to know whether therapy might be worth it.

What is the average cost of therapy in California?

Therapy cost is a huge factor in accessing mental health care. So, exactly how much does therapy cost?

Here's the thing: many therapists do not accept health insurance, largely because the reimbursement rates paid by insurance networks are pretty low (among other reasons!). In fact, a 2017 survey by the California Association of Marriage & Family Therapists suggests that 42% of California therapists don't accept insurance.

So to shed more light on out-of-pocket therapy costs, I surveyed the average cost of therapy per therapy session for 114 private practice therapists in 13 major California cities*:

City	AVERAGE cost per session	LOW per session therapy cost	HIGH per session therapy cost
San Francisco	$200	$120	$300
Oakland	$195	$125	$250
San Jose	$198	$140	$250
Sacramento	$170	$120	$250
Los Angeles	$214	$160	$250
Long Beach	$177	$150	$231
Anaheim	$173	$150	$225
San Diego	$176	$140	$215
Bakersfield	$156	$100	$200
Fresno	$142	$120	$170
Redding	$153	$100	$250
Stockton	$138	$100	$180
Modesto	$122	$95	$165

This comes out to a statewide average therapy cost of $171 per session.

*Out-of-pocket therapy rates per individual therapy session, as advertised by therapists listed in 4 major therapist directories/online website search. The majority noted that they do not accept health insurance. It is not uncommon for couples/marriage counseling, family counseling and initial assessment sessions to have a higher fee. The statewide therapy average cost is based solely on the data gathered from this survey.

For a comparison of therapy rates, another 2022 survey of over 250 California mental health professionals found that 62% of therapists charge between $150-250 per session.

What determines therapy cost?

So you can get a better understanding of why therapists charge what they do, here are the main factors influencing the cost of therapy:

Training and experience

As mental health professionals, therapists undergo extensive (Masters degree) education, 3,000 hours of supervised internship experience and testing before licensure in order to work with various mental health conditions. Post-licensure, they must undergo ongoing professional development and education in order to provide mental health services.

Many therapists go above and beyond minimum continuing education requirements to deepen their knowledge and develop their skills in the treatment of mental health conditions. The per session fees of these highly trained and experienced therapists can reflect their advanced competency and skill level (not to mention the time and financial investment they make in obtaining specialized training).

Speciality

Some mental health professionals provide specialized mental health treatment for specific mental health conditions (think post traumatic stress disorder, anxiety disorders, bipolar disorder, phobias, etc.). These therapists have advanced-level training - beyond the general training completed in graduate school and pre-licensure - and expertise in helping people find relief and healing for these specific mental health concerns. Specializing requires therapists to invest a significant amount of additional time and money in training, professional consultation and self-study, so the specialist average cost per session is a reflection of this investment. Because they typically have a strong track record in successfully treating the issues they specialize in, you can expect to pay more for their services.

Location

People can usually expect to pay more for mental health care in larger cities and areas with higher costs of living/doing business, as compared to rural areas or smaller towns.

However, if you are seeking treatment via online therapy services, you can see any mental health professional licensed in the state of California who provides virtual therapy. This gives you more options for finding affordable therapy and lowering your out-of-pocket therapy costs (including therapists offering sliding scale or who are in-network with your health insurance) .

With virtual therapy, you can choose from a much larger, statewide pool of mental health professionals -and have more access to therapist specialists with advanced expertise in your kinds of challenges and mental health concerns. Get answers to frequently asked questions about online therapy (and learn more about the specialized virtual therapy I provide) here!

Educational and business expenses

Becoming a therapist is a long and costly endeavor, taking anywhere from 8 to 12 years. The approximate average cost for graduate school alone is $49,000; however over California 90% of therapists pay much more than that, with some graduate programs costing over $100,000 (source*). The vast majority of therapists graduate with significant student loan debt, which includes the high cost of compounded interest over time. Pre-licensure internships are often poorly paid (and some not at all!). Additional, required continuing education means that therapists continually invest in their professional development.

*Figures are for licensed marriage and family therapists or LMFTS, the most common providers of therapy (e.g., individual counseling, couples/marriage counseling, group therapy, sex therapy, family therapy).

How can I pay for therapy?

Here are some options for covering the cost of therapy when you're seeking treatment:

Health insurance

If your insurance provider (including those covered under the Affordable Care Act) offers therapy coverage (including substance abuse and behavioral health services), they must do so in a manner that equals or exceeds medical/physical health coverage.

Contact your insurance company to determine your insurance plan benefits (deductible, co-pay, whether you need a primary care physician referral, etc.). Your insurance provider can also give you a list of mental health professionals that take your health insurance.

CAVEAT: due to the shortage of "in-network-with-health-insurance" therapists, don't be surprised if those in your insurance plan have a waitlist or aren't available.

Employee Assistance Program (EAP)

Like health insurance, employer-sponsored employee assistance programs can offer short-term therapy for mental health concerns. While these mental health services don't cover long-term mental health treatment; they can provide referrals for ongoing mental health services (including for severe mental illness, ongoing psychological and physical symptoms, post-traumatic stress disorder, etc.). Contact your employer or human resources department to find out what therapy resources might be available.

Community mental health clinics

Typically run by nonprofits, universities, or the behavioral health services department of local governments, these can be an affordable option for sliding scale or low cost therapy (and in some cases, even free therapy or other resources). In addition to individual therapy, they sometimes offer support groups/group therapy, substance abuse services, relationship/marriage counseling, and family/child counseling. Therapy is often provided by pre-licensed therapists, meaning there can be a higher rate of therapist turnover.

Online therapy platforms

The mental health industry has seen an explosion in the number of large platforms (BetterHelp, TalkSpace, etc.) offering individual therapy for various mental health conditions via individual therapy and couples/family/marriage counseling). Some accept health insurance, others provide subscription-service affordable therapy that include talk therapy sessions (and sometimes text therapy). These platforms aren't appropriate for serious mental illness, safety concerns or severe psychological and physical symptoms, however.

While big online therapy platforms provide low cost therapy options, there are some things to be aware of:

• Lower therapist pay rates mean that the platforms' mental health professionals (1) are more likely to be newly-licensed/less experienced, and (2) typically maintain a higher client caseload to make ends meet financially, making therapist burnout more likely.

• Less chance of finding a mental health professional with higher-level, specialist expertise for issues like post-traumatic stress disorder, phobias, etc.

• Possibility of having to switch therapists prematurely or mid-treatment due to higher therapist turnover.

• Many mental health professionals have raised concerns about the quality of care.

• As with anything, do your research so you can make an informed choice.

Private pay

I'll give it to you straight: if you cover the cost of therapy yourself, you will (1) have a much larger pool of qualified therapists to choose from, and (2) be more likely to receive high-quality treatment. Not the most popular opinion, but the honest truth (imho!), and here's why:

Really good therapists invest a lot of time, money and energy in learning and honing their craft and expertise. Private pay therapists suffer less burnout since they don't have to see a ton of clients each week (unlike therapists who rely on being paid poorly by an insurance company). They're more present and refreshed when they show up to therapy sessions.

Private pay therapists also have time to invest in above-and-beyond professional development and training to better meet your specific needs - whether it's healing trauma, alleviating depression or simply helping you create the life you want to live. You're more likely to find a therapist who has specialized expertise in your concerns, and while the "specialist" average cost can sometimes be higher, there are therapists who provide sliding scale therapy.

Why do some therapists not accept insurance?

There are a number of reasons why therapists don't work with insurance:

Requirement of mental health diagnosis

Your insurance plan will require your therapist to give you an official diagnosis in order to cover the cost of therapy. This becomes a part of your permanent medical and health insurance record. However, you may simply be seeking support for life issues - be it a divorce, job loss, moving, a medical diagnosis, death of a loved one, a new child - which don't necessarily cause you to have diagnosable mental health disorder. A private pay therapist can provide expertise to support you in navigating your life challenges (and the associated psychological stress!) without worrying about whether or not you qualify for a diagnosis.

Loss of confidentiality

Your treatment confidential, private health information which can potentially be accessed by life, disability and health insurance companies, government agencies, in criminal background checks, security clearances, worker's compensation claims, even court proceedings. etc. Since a diagnosis constitutes a pre-existing condition, this could raise the cost of your insurance premiums.

Compromised control of your treatment

Your health insurance determines the maximum number of therapy sessions they'll cover. Some even dictate the types of therapy modalities that can be used in your treatment. While they naturally cover evidence-based therapy options/modalities, they may not pay for newer, innovative therapeutic approaches that your therapist has found to be effective and are currently being researched.

Private pay therapy means your therapist can make the best, most clinically-appropriate decisions regarding your treatment, without the constraint of an insurance plan administrator who has no training/experience in providing mental health care.

Are mental health services worth the investment?

Therapy cost might make you question whether you should invest in therapy sessions. So let's look at when therapy could be beneficial - and when it might not be the right time for therapy. Whether it's talk therapy, online therapy services, support groups/group therapy, or low-/no-cost therapy via community clinics, weighing the pros and cons of treatment given the potential therapy cost is crucial.

5 signs that therapy is worth the investment

While we can navigate some emotional stresses and psychological challenges on our own, certain signs indicate that therapy could be highly beneficial. So when and why would it be a good idea to start therapy?

1. Persistent Emotional Distress

Ongoing sadness, anxiety, depression or overwhelming stress that endures over time may mean it's time to seek professional support. Therapy can help you get "unstuck" by offering a safe space for exploration, providing tools to manage and heal your emotions, as well as skillfully navigate the challenges that trigger them.

2. Struggling with Interpersonal Relationships

Problems in forming and maintaining healthy relationships, recurring conflicts, or communication challenges are a great focus for therapy. We're biologically wired to form healthy connections with others, and therapy can be instrumental in helping you create fulfilling and meaningful relationships.

3. Lingering Physical and Psychological Symptoms

The intertwining of mental/emotional distress and symptoms such as insomnia, fatigue, or unexplained aches, could indicate underlying issues that can be addressed in therapy. The mind-body connection is real! Psychological distress can impact your physical health - and vice versa - and therapy can be a good place to unravel the complexities of psychological and physical well-being.

4. Coping Mechanisms Losing Effectiveness

If your usual ways of coping—be they hobbies, social activities, or personal routines—no longer feel like they're enough to effectively alleviate your emotional or mental distress, professional individual therapy can help you develop targeted strategies to help you deal with your life stressors and feel better faster!

5. Impact on Daily Functioning

When your emotional struggles start to impede your daily functioning, affect work performance or the way you "show up" in your regular life activities and relationships, working with a therapist can help. Therapy can help you effectively explore and heal the underlying issues within that are negatively impacting your functioning, as well as navigate the external factors that are contributing to your distress.

Be aware that this is NOT an exhaustive list - and starting therapy because you simply want to is reason enough! Experiencing any of the above doesn't mean you're weak, bad or flawed...just human. Life (including the impact of earlier life experiences), sometimes overwhelms our ability to feel better or more fulfilled, and therapy can be a wonderful, life-changing tool for getting to where you want to be!

5 signs to hold off on therapy (for now)

While everyone can benefit from the transformative power of good therapy, the reality is that there are various factors that might call for postponing it. So why might you delay starting therapy?

1. Financial Constraints

The therapy cost of per-session fees can be a barrier to beginning therapy if you have limited financial resources. If feasible, you might opt to research affordable therapy options, such as therapists who offer sliding scale fees, reduced-cost therapy at community counseling centers, or even "big box" low-fee virtual therapy platforms (however, do your research and keep in mind these caveats).

2. Lack of Commitment or Readiness

Therapy requires a commitment to self-reflection and your personal growth. If you're feeling like you lack the motivation or just don't feel ready, it's okay to hold off and re-evaluate down the road. That said, your hesitance might be due to misconceptions you may have about therapy. Consider researching and getting feedback from others who've benefited from therapy so you can make a decision from a more informed place.

3. Limited Time

It might be difficult for you to commit to regular therapy sessions if you have an extremely busy schedule or other life priorities. Consider that a therapy session is typically 50-60 minutes long, once per week. Online therapy can be a time-saving option (no commute!); learn more about virtual therapy.

4. High Level of Instability or Safety Concerns

If you're in an immediate crisis, experiencing severe mental health symptoms or serious mental illness, it may be necessary to explore more immediate interventions, potentially involving a primary care physician or crisis management, in order to get stabilized before or while you participate in therapy sessions. This is particularly important if you are feeling suicidal or having thoughts of harming others, in which case you are strongly encouraged to call 911 or go to your nearest emergency room.

5. Exploring Alternative Resources

If committing to therapy sessions isn't feasible, how about exploring alternative resources like support groups, community programs, or free resources offered by community/governmental agencies? While not a substitute for professional therapy, connecting with other resources and information can help you find support and tools for yourself.

There are a lot of factors - cost of therapy, health insurance coverage, time/energy investment - that affect your ability and readiness to start therapy. If finances are a challenge, take some time to research affordable therapy options, such as low-cost therapy, group therapy, therapists who offer sliding scale fees, and free resources in the community.

Ready to invest in yourself? I’m here for you.

I'm Elisa, and I provide expert, individual therapy for anxious achievers, introspective over-thinkers and self-doubting perfectionists (sound familiar?).

Transforming your "inner critic" into a loving advocate...showing you the way to lasting calm...and helping you connect with a self-assured, inner confidence...THAT'S my jam, and I do it well.

I creatively blend an array of highly-individualized, "you-friendly," evidence-based therapy options to make sure you get the most out of your online therapy sessions. My compassionate, neuroscience- and trauma-informed approach is the result of years of specialized, ongoing training and experience.

As a specialist, I see a limited, select number of clients, giving me the focus and bandwidth to bring my A-game to each therapy session. A refreshed, energized therapist means that your goals and needs will always be front and center!

Curious? Learn more about me and set up your free consultation to find out if we might be a fit!

I wish you well in your healing journey.