Why is Therapy So Expensive in Canada? (Professional Therapy)
If you’re struggling with your mental health or wellbeing, the first thing to know is that you’re not alone. Approximately 1 in 5 Canadians struggle with their mental health each year.
Regardless of whether you're struggling or not, mental health is something that affects us all.
Therapy can be an essential resource that offers the tools and strategies to cope and manage through life’s challenges. For many, it’s necessary for managing mental health conditions and illness.
Sadly, of those who are struggling with their mental health, approximately half have reported their needs are unmet. The top reasons are not knowing where to go, and not being able to afford it.
With such a great need for support, why is therapy so expensive?
There are two main reasons therapy can feel pricey: individual private therapy (i.e. services that aren’t medically necessary) are not covered by Canadian health coverage plans so individuals are most often required to pay out-of-pocket or be covered by individual insurance, and licensed counsellors are highly trained and educated professionals with high overhead cost to practice.
Cost should never prevent someone from accessing the help they need, but affordability is a reality. Knowing what goes into the costs of therapy can help with informed decision-making for getting help.
In this article we’ll explore:
- An overview of what therapy is and why it’s beneficial
- Factors influencing cost
- Insurance options
- How different types of therapy vary in price
- The “cost” of not doing therapy
- Ways to make therapy more affordable
What is therapy?
Therapy (counselling, psychotherapy, or counselling therapy) is a collaborative process of working with a trained mental health professional to work through psychological, emotional, neurodevelopmental, or behavioural challenges. These issues often intertwine and, when neglected, can make day-to-day life more challenging than it needs to be.
The goal of therapy is to help people understand their thoughts, feelings and behaviours to overcome distress, or to support personal growth and development.
Therapy provides an opportunity for clients to develop strategies in order to cope with challenges and improve their wellbeing. Such skills can be especially beneficial for those living with diagnosed mental health conditions or illnesses.
Types of therapists
Mental health professionals in Canada are regulated and licensed by province or territory.
When professionals are regulated, there is a legal Act established that sets the terms and standards for practicing, and there are organizations called Colleges that regulate the professionals under that Act.
In provinces where regulations are not in place, self-governed professional organizations exist (Associations) to maintain their own standards of safe and ethical practice.
It’s important to check the credentials for mental health professionals where you live, and to know if they belong to the appropriate College or Association.
Here’s a quick summary of the types of mental health therapists in Canada:
- Psychiatrists: Medical doctors specializing in mental health. They can diagnose mental health conditions and illness, and are the only type of therapist who can prescribe medication. It’s unlikely you would work with a psychiatrist for general therapy sessions. They are regulated anywhere in Canada.
- Psychologists: Trained in psychology at a masters or PhD level, they can diagnose and treat mental health conditions using evidence-based therapeutic approaches. They can work one-on-one with clients. Often they will continue to do research to contribute to theoretical knowledge. They are regulated anywhere in Canada.
- Psychotherapists and counselling therapists: Trained at a masters’ degree level and above, they use various therapeutic approaches to help individuals navigate emotional or behavioural challenges, relationships, and personal growth, or specific challenges such as grief. Regulations vary for these professionals—check for licensing credentials or association membership in your province.
- Social workers: Equipped with social work degrees often at a master’s degree level and above, they can and do offer counselling. They are regulated everywhere in Canada except Nunavut and the Yukon.
Any of these types of therapists could offer individual, family, couples, or group therapy depending on their area of practice.
Benefits of therapy
Therapy provides a confidential and supportive space for people to express themselves, explore their concerns, learn new skills and strategies in order to better manage life's challenges.
Therapists and counsellors may use various proven approaches and techniques to help their clients improve communication skills, learn effective stress management techniques, and adopt healthier coping mechanisms. They can also help people see their lives with a new perspective that can help them take accountability and control over their choices.
The specific approach and methods used in therapy may vary depending on the therapist's training and specialization, and on the client's needs and the nature of the issues being addressed.
This kind of support can help people feel less alone and accept their challenges as real. It can also help with fostering healthy relationships with others, improving confidence, and shifting behaviours that are unhelpful.
These changes can result in lower anxiety and depression, and lead to personal growth and positive change.
Stigma surrounding therapy
There is still a lot of stigma around therapy that can prevent people from accessing it. Even if you support others for therapy, without judgement, it can be easy to see therapy as a failure for ourselves.
This is because of social and cultural belief systems that perpetuate misconceptions, such as that therapy is only for people suffering the worst mental health crises, or that emotional support is somehow a sign of weakness.
These misconceptions cause many people to feel hesitant about reaching out for help when they need it.
Issues with accessibility to mental healthcare, including cost, only reinforce and perpetuate the stigma. When mental healthcare is more normalized and accessible, such as through robust workplace mental healthcare strategies, people are more likely to feel confident in getting help.
It’s a common misconception that therapy is only for helping through pain or distress. However, therapy can be powerful for self discovery and growth.
Exploring thoughts, emotions and behaviours can foster a powerful sense of self-awareness. Therapy can help with conflict resolution, communication and decision-making. This kind of self empowerment can give people confidence to make choices for growth (vs. survival or self protection), and make it easier to bounce back from adversity.
A stronger sense of self can help people move through a fear of the unknown, build confidence in setting new goals, and inspire joy in life.
Personal growth can be powerful and strengthening when going through life changes like career shifts, evolution of family and friendships, relationship changes or loss.
Factors Influencing Therapy Costs
Another challenge with understanding why therapy is so expensive is that costs are inconsistent. Like any other service, there are multiple factors that can influence therapy costs.
Knowing those factors can help you choose options that are within your budget, or to know if they’re covered under your healthcare plan.
Professional experience and expertise
Therapists will charge a rate associated with their credentials, areas of specialization, or years of experience. Two similarly credentialed counselling therapists could charge a different rate depending on how long they’ve been practicing, or if they’ve continued their training to specialize in an area of mental health.
Always check your workplace benefits booklet to match your therapist’s credentials to what’s covered in your plan, and check for maximums of coverage to ensure each session is affordable for your out-of-pocket budget.
Costs for therapy can vary depending on where you live. Market conditions will always dictate the cost for services where you live. For example services tend to be more expensive. In more urban areas, it costs more to operate there and there are more clients and therefore more uptake for specialized services. These factors increase costs across the board for goods and services in urban centres, including with private mental health services.
You can easily browse First Session to search for qualified therapists in Canada based on location, specialization, or their designation to choose an affordable option for you.
Frequency and length of appointments
Therapists often charge a per-session rate. That means, you’ll pay for each individual session you book. The more frequently you see your therapist, the higher the cost over time.
Depending on an individuals’ needs, therapy may be for a set number of sessions (like a defined program) or it may be recommended someone start with several sessions up front in a short period of time.
When you see a per-session cost, it’s typically for 50-minute to 1 hour in length. There may be situations where sessions are longer or shorter and this could impact per-session costs.
Private therapists will likely charge higher fees compared to those working in community mental health centres or through non-profit organizations.
Therapists overhead costs
Therapists can operate as solo practitioners, or they may operate out of a clinic with many professionals. Their office or clinic space, the technology they use for booking or payment, or other overhead costs will impact what they charge their clients.
On the other side, the COVID-19 pandemic accelerated the use and availability of online therapy. Not only can this be more accessible for many people, it can substantially lower the overhead costs for therapists and therefore potentially lower the cost to their clients.
Understanding these factors may not change the reality of the costs of therapy, but it can help you make informed decisions when seeking options that work for you and your budget.
It’s also completely appropriate to discuss cost with a potential therapist before deciding to start working with them.
You can ask about fees, payment plans, or your financial considerations. They may be able to recommend strategies to meet you where you are.
Insurance and Therapy
It’s important to understand if you have coverage available for mental health services under your private insurance plan—for Canadians, additional private health insurance is usually offered through the workplace.
Insurance plans will define and specify the credentials (type of therapist) and maximum dollar amount per-session they will cover.
When it comes to billing, you can most likely expect to pay out-of-pocket first and submit the bill to your plan provider for reimbursement. You can always ask your therapist if they have the relationship or ability to submit your bill automatically to your insurer.
Some insurance plans require you to pay a deductible (a portion of the cost before your coverage kicks in), and plans will vary in how many dollars per year they’ll cover for each service.
It’s important to read your benefits booklet carefully and reach out directly to the insurance provider or HR if you have questions.
Your insurer may have a specific relationship or contract with a roster of professionals. This can lower the cost per-session compared to a therapist you find on your own. This is sometimes referred to as “in network” versus “out-of-network” providers.
Types of Therapy and Their Costs
Therapy costs can vary depending on the expertise and experience of the therapist, whether or not you have mental health insurance coverage, the therapist's overhead costs and location, and more.
Therapists will also likely charge a different fee structure depending on who they are working with. Costs can vary for individual therapy, family therapy or group therapy.
Sometimes, Associations will recommend fee structures to their professional network helping to guide professionals to understand standard pricing for different groups.
Individual vs. family vs. group therapy costs
The cost for private therapy or counselling can range from $50 to $350 or more per session depending on the type of professional you choose.
Psychologists will typically be at the higher end of per-session cost, at roughly $100 to $250 or more per visit. Counselling therapists and social workers may be slightly less per visit, depending on their expertise or specialization. It’s unlikely you would see a psychiatrist for a private therapy visit, but not impossible. Those sessions could be $350 or more per visit.
You can expect to pay those standard session rates for individual, couple or family therapy, depending on the type of professional you choose and other factors already covered in this article.
Group therapy, however, can be most cost effective as therapists will often charge a lower per-person rate for a session. Group therapy can be extremely beneficial particularly for those who are working through similar challenges like grief, substance abuse or other addiction, or who have common circumstances like parenting. Group therapy can fall more within $50-$65 per session per person.
It’s important to remember that these are general estimates. Ask about fee structures and check your insurance plan, if you have one, to help inform your choice of therapist and setting.
The High Cost of Not Getting Therapy
Yes, paying up front and out-of-pocket for private therapy can be a substantial financial choice. Even for those who are fortunate enough to have the means or insurance coverage for therapy, there is still some level of cost (including time spent).
However, there are hidden costs of not seeking help with mental health. Like physical health, neglect or lack of care can create a ripple effect.
Impact on mental health
Without mental health support, people may not be able to resolve underlying emotional or psychological issues, and this can lead to prolonged stress and distress.
Prolonged stress can be a contributing factor for more serious mental health issues like anxiety or depression. These symptoms can disrupt daily life. It can make work, relationships, parenting, home care, etc. more difficult on a daily basis.
Impact on relationships
Unresolved personal challenges can affect our relationships with others. Difficulty managing stress, mood or conflict can strain friendships, romantic relationships, familial connections, and the ability to function in a workplace with customers or coworkers.
Humans rely on their communities and networks for basic support, survival, and happiness.
Mental and physical health are so interconnected. Mental health challenges can impact everything from sleep to cardiovascular health to immune function to digestive issues and more.
There is very good ongoing research around mental health and the health of our nervous systems. Increased stress disrupts the way our nerves send signals through the body and to the brain. This can have a real effect on how we retain information, how our brain and stomach “communicate” (i.e. digestive disturbances), or the severity of bodily pain, and more.
Work and productivity
Mental health challenges can impact our ability to concentrate, focus, maintain energy and motivation, and this can directly affect work performance.
This can have an impact on an individuals’ ability to perform at work and earn money, but it also has an impact more broadly on organizations’ ability to generate revenue, and therefore on overall economic health locally, nationally and globally.
Studies show workplaces that provide mental health programs could realize anywhere from $1.62 to $4 in return on their investment, and that productivity loss costs the global economy $1 trillion (USD) each year!
Long term costs
Unaddressed mental health issues may escalate over time, and this could require more intense or costly interventions later, such as medications or time off work.
Mental illness is considered a disability in Canada, therefore those struggling with severe conditions that impact their ability to work are, in some cases, able to access mental illness disability benefits. However, these are limited and people struggle often with making ends meet with these supports alone.
Prevention can be very powerful for overall mental wellbeing. Therapy can be an essential tool to address issues before they become more severe.
While the immediate cost of therapy may be a consideration, it's important to weigh these potential long-term costs and impacts on wellbeing.
Ways to Make Therapy More Affordable
Outside of workplace coverage, there are ways to make individual out-of-pocket therapy more affordable.
Sliding scale therapy
Many therapists offer something called sliding scale therapy fees based on income. In these cases, a therapist will work collaboratively with a potential client to adjust their per-session fees based on their income.
The process will often involve an assessment where you and the therapist will go through things like income, other life expenses and your budget, and determine a fee structure that is personalized to you. Some therapists offer a set number of sessions per month at a set lower price that are available to those with a financial need.
Sliding scale therapy does not affect the quality of care. You can expect to receive the same level of attention and time with the professional regardless of the sliding scale fee.
It’s important to be open and honest with a therapist; they are there to help remove barriers that might prevent you from accessing their care.
Online therapy has become much more available and commonplace since the onset of the COVID-19 pandemic.
Telehealth isn’t new, but many therapists adopted virtual offerings when in-person sessions were not possible. Since then, studies have shown that online therapy is generally as-effective as in-person therapy.
Depending on the person, online therapy might be much more accessible. It can offer flexibility around busy work schedules, eliminate the need to travel to appointments, and it could increase feelings of comfort and privacy by being at home.
For others, online therapy may not be the most accessible option. They may struggle with virtual/video communication or not have a safe and private space to talk at home. Some people also have limited internet or phone access, so in person visits are more accessible for them.
Community health centres
There are often clinics or support groups available through local community centres on a low- or no-cost basis, or based on income eligibility. Community health centres will have a team of licensed psychologists, social workers or counselling therapists on-staff to provide support to the local community.
Look for non-profit or other resource centres where you live. They can help connect you with information or organizations with a mission to make mental healthcare accessible. They exist to help people understand and find the support they need.
Each province will have professional Associations or Colleges that oversee licensed professionals where you live. Often, they will also have links or helpful resources to access their network of professionals.
Frequently Asked Questions
In summary, knowing why therapy is so expensive in Canada requires understanding of what therapy is, the different types of therapists and kinds of therapy they offer.
There is no shame in looking for cost-effective mental health options. While access is improving, mental healthcare is still vastly underserviced and up to the public to pay. Knowing the nuances of therapy costs can help people make informed decisions around care, and feel empowered to reach out for help.
Let’s recap some frequently asked questions about why therapy is so expensive in Canada:
Does insurance cover the cost of therapy?
Yes and no. Therapy is not covered by the Canadian healthcare system unless it’s through a medically necessary intervention (i.e. hospitalization).
However, many private healthcare plans, usually offered by workplaces, do often cover mental health. Many workplaces are also increasing their programs and offerings for mental health to better support their staff.
What factors contribute to the cost of therapy?
Many factors can impact the cost of therapy. Primarily, the credentials and experience of the therapist, their location, whether or not they offer online or in-person therapy, the overhead costs associated with their practice, any specializations or niche offerings in their care, and whether or not you are doing individual or group therapy.
Are there affordable options for therapy?
Costs can vary depending on the professional you choose to work with. You can use First Session to browse through hundreds of licensed therapists across Canada, and search by-location, designation and specialization. Each therapist clearly lists their per-session rate on their profile page.
You can ask therapists if they offer any options for financial aid, such as sliding scale appointments.
You may also find cost-effective options locally through community centres or non-profit agencies, or through workplace benefits like Employee Assistance Programs (EAPs)
Is therapy worth the investment?
It can be difficult to commit to the up front cost of therapy, but the long term benefits can far outweigh the near-term cost.
Therapy can help you navigate through life’s daily challenges, and build the tools and skills to be resilient for the future. This can decrease the long-term impact of stress which can improve your mental and physical wellbeing overall.
Why do some therapists charge more than others?
Therapists will charge different rates based on their education, credentials, specializations, and the location in which they operate. It’s important to search and compare professionals before making a decision to ensure they fit within your budget.
How can I find a therapist within my budget?
You may need first to look at your current expenses and any coverage available to know the true cost of a session, and how much you can afford.
If you have a defined dollar amount, you can look for therapists that would be a great fit for you, and who fall within your budget range.
If you’re struggling to find financial room, reach out to your local mental health services or community centres to help direct you to options that will be free or low-cost.
The benefit of connecting with and talking to someone about your challenges and issues can be an incredibly powerful experience. This experience does not need to be “high-end” to be effective.
Therapists and counsellors are there to listen, to offer their perspective, challenge you in healthy ways and help you be accountable to your choices to empower you to take control of your life.
If you’re ready to reach out to a mental health professional, start with First Session and find a therapist who can guide and support you every step of the way.
Nicole Laoutaris is a freelance writer and adult learning professional based in the Greater Toronto Area. She specializes in educational content for brands and companies in industries such as mental health, pet health, lifestyle and wellness, cannabis, and personal finance. Nicole holds a double undergraduate degree in Communications and Film studies from Wilfrid Laurier University, and post-graduate certificate in Corporate Communications from Seneca College. She currently lives in Hamilton Ontario with her spouse and her cat.