Fees, Confidentiality, and Ethics

Fees for therapy can vary a great deal, from free (at community or college-training clinics) to $250 an hour for a top-notch psychiatrist. Many therapists have sliding fee schedules, depending on your income level. Many health insurance policies cover all or a portion of your mental health treatment. Many therapists are contracted with "managed care companies" which pay a set rate for certain therapies for specified conditions. Typically managed care companies will pay for 3-20 sessions of therapy. Sometimes co-payments are required. Medicare and Medicaid pay for therapy with some therapists. The average number of therapy sessions per client across the United States is around 7-10 sessions. Frequently clients will see a therapist for a period of time, get back on track, and then return at a later date for another series of sessions.

What you discuss with your therapist is confidential, unless your therapist has reason to believe that a person's life is in danger, a child is being sexually or physically abused, or the therapist receives a court order for information pertaining to a case for trial. A therapist may lose his license if they do not keep strict confidences.

You may also risk losing a degree of privacy if you elect to use you health insurance to pay for psychotherapy, because your insurance company will now have access to information about you mental health. In some cases, you employer will also have access to this information. Some people are not comfortable with this situation, so they elect to pay for therapy out of pocket rather than using their health insurance. Some therapists offer a discounted rate for cash patients who elect this option.

Your therapist should always behave in a professional manner with you. There is NEVER a therapeutic reason for a therapist to develop a physically intimate relationship with you.
If you feel physically uncomfortable with your therapist for any reason, you should first discuss this with him or her. If your therapist tries to engage in a sexual relationship with you or even hints at the possibility, you should report them to their licensing board.

Therapists are not allowed to have what is known as a "dual relationship" with a client. This means that there must be firm "boundaries" so that you and your therapist are not connected in another way than as a therapist-client. Examples of boundary crossings would be entering into a business agreement, your therapist hiring you to work for them, or bartering therapeutic services in exchange for professional services offered by you.

Some therapists practice out of a home office. Many clients are very comfortable in this type of home setting, but if you feel uncomfortable, discuss your feelings with your therapist, especially if sessions are interrupted by phone calls, children, animals, etc.

Contributed by Dr. Tony Fiore