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Extremely Expensive Therapy

Posted Oct 23 2008 11:17am

There's an article in The New York Times which discusses therapy with very wealthy clients. The thrust of the piece is on the difficulties these clients face, as well as specific challenges for the therapists who are treating them. What struck me as fascinating, however, was the fact that one of the treatment providers in the article charges $600 per session. Yes you read that correctly: two $300 bills. Or you could give him $10,000 and get $9400 in change. I have never heard of such a rate for therapy and my take on this is that his clients are simply foolish for paying it.

In New York City and many parts of the United States there is a discrepancy in cost for therapy in a private practice based on the discipline of the provider. From what I've seen Social Workers tend to charge less than Psychologists, who usually get somewhere between $125 and $225 per session. A Psychiatrist friend of mine charges about $275 and stated that's mainly because she can prescribe and manage any necessary medications. There's probably some elitism involved in that as well but that's not important right now. I've heard of some Psychiatrists charging upwards of $400 per session and recently as much as $500 but this new benchmark of $600 blows me away, especially given that there's no mention of medication management involved.

Here's the rub: I've discussed the perils of choosing a therapist based on degree or years of experience. People constantly make that mistake: he went to so and so school or has been in practice 30 years, so even though he's pricey he must be the best. Unless I've missed some new research on this topic there isn't substantial evidence to support the "you get what you pay for" philosophy. My postdoctoral training was at an Ivy League hospital. While outstanding in its own way, it wasn't really any better than the tiny community mental health center in Smalltown, Ohio where I trained as a graduate student. The human condition is so complex and constantly evolving and no one person or institution has all the answers. Therapy will never be an exact science and therefore there will never be the perfect textbook or teacher or school that will create the Ultimate Therapist who puts his hand on your head and cures you of any and every ill.

What is this shrink saying for 45 minutes that could possibly be worth $600? "Your mother is the sole cause of your neurosis. You have both my ethical and legal permission to kill her." I suppose that might be worth a lot. Is he reciting words of wisdom off of some diamond-studded scroll from the mountain tops with bolts of lightning crashing down to punctuate how profound his statements are? Does he hold the secrets to world peace and immortality? Does he offer a Happy Ending to the clients who are into that stuff?

I suspect that he's charging this rate simply because he can. His wealthy clients will believe that he's worth it because he's so expensive. They'll tell their other rich friends that's he's "the best." And if they can afford it good for them. But the reality is that Altoids don't taste any better if you pay $59 per tin.

If anyone has $600 laying around, let me know and I'll contact this guy about doing a 45-minute interview for the site. I've been cranky for the past few days so maybe he can fix that as well while he's here.

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