Oftentimes, I get odd looks or questions about why a therapeutic hour is 45 – 50 minutes. Sometimes this confusion comes from an inconsistency within the therapeutic community, as there are some therapists who will give you the full 60 minutes. This is an exception, or part of their particular practice. Traditionally, any time you are billed for therapy, there is about 15 minutes taken away (60 minutes – 15 minutes = 45-minute session, 90 minutes – 15 minute 75-minute session, 122 minutes – 15 minutes = 105-minute session). So why do we do this? Why do we call it a therapeutic hour? The most straightforward answer is that the therapist takes those 15 minutes to write up their notes on the session.
Let us start with the beginning of the therapeutic process. In order to fully understand what you are paying for, is understanding what it takes for a therapist to get to the point where they can sit in front of you and give potential life changing, even life-saving guidance. We will focus on Registered Psychotherapist (RP), a designation that came into existence in 2007 and became a regulated designation in 2015. A relatively new field.
The process to become a registered psychotherapist involves a 4-year degree in psychology, followed by masters of Counselling Psychology, a program that takes about 4 years to complete, which effectively means you have a lot of debt, and 8 years of additional post-secondary schooling. Afterwards, in Ontario, you need to become a part of the regulatory body, the College of Registered Psychotherapists of Ontario (CRPO).
At least the person in front of you has done this. Which is just the beginning. After that, there is a continuous process of additional qualifications to guide clients. Some you may have heard before: CBT, DBT, narrative therapy, EMDR, and so forth. Each qualification requires time, energy, effort, and more money. Therefore, every time you read up about a Psychotherapist having training in a therapeutic framework, they put a lot of work into gaining the knowledge and skills to help you, which in turn means that it is a big part of what you are paying for.
Many times, I have come across stories of people not being happy with how expensive something is. For example, I recently read a story of someone trying to build a deck. The contractor quoted a high number. The guy was obviously taken aback by the expense. Until they started breaking everything down: the tools, materials, and experience in building the deck. Adds up. He quickly realized that it was a good deal, and paid the person the quoted price, and got a good deck out of it.
Now, many may realize I left out something: time. Tools, materials, and experience are effectively the education and ongoing training the therapist has gone through; materials can be compared to the documentation, offices, and sometimes therapeutic tools (mini trampoline, Lego, video games) needed to do the job.
Time is one of the trickiest things to describe. So it starts when you reach out to the registered psychotherapist. Time spent on free consultations, talking to you about whether they would be a good fit, sending emails, or calling back and forth to get documentation in order, organizing and reading intake forms and other documentation. What many never realize is that the therapist is only paid for the time spent in session; all other work comes without a paycheck.
Now, the first appointment, they have to spend time reviewing the intake form and other documentation. Something they will do before every single appointment moving forward that can take an hour or a few minutes, depending on the client. Then the time of the actual appointment, they have to take steps to make sure everything is ready, in working order, and they are not late for the appointment. The appointment itself. Writing up notes afterwards to remember what was discussed, billing, and booking next appointments. This is what the 15 minutes from your appointment is for. Although more often the time it takes is longer, depending on the therapeutic session.
Then there is the time that the Psychotherapist has been practicing. Psychotherapists are human, and they make mistakes. It takes making errors in judgment, in presenting themselves to clients, and in how they approach a client and help them. They make mistakes. The longer a psychotherapist has been practicing, the more experience they have and the better they are at giving you your money's worth. Which is why a more experienced psychotherapist will cost much more than someone just starting.
That is what makes up the therapeutic hour you are paying for. So I will bring up last-minute cancellations and no shows, and often clients get frustrated when they have to pay for not showing up. The thing to keep in mind is that you may not have shown up, but the therapist has. They are there waiting, their time has been used, the changing their plans to ensure they are available; all the prep work has been done, whether you have shown up or not. So you get billed for no shows. A lot of the work, prep-wise, starts 48 hours before the session, which is why most places have a 48-hour cancellation policy. Within those 48 hours, they could have made other plans, given that time to someone else who needed it, or could have taken an extra-long weekend. Sufficient to say, your fee for your one therapeutic hour covers an awful lot.
By Andre Stam, RP, CCC, OCT, is a psychotherapist who specializes in sleep, teacher support, burnout, anxiety, and depression. He has training in CBT. CBT-I, DBT, SE, and Narrative therapy.
SERVICES
