Why is Couples Therapy often charged higher than Individual Therapy?

This guest post was written by Rachel Elder, LMHC, and is featured in our Clinician Spotlight series, where we highlight mental health clinicians and the topics most meaningful to their work.

 

I was reviewing referral posts in my local therapist Facebook group and was intrigued to read about a colleague inquiring why couples therapy is priced higher than individual therapy. Being a couples therapist myself, I clicked instantly to read all the intriguing comments, and also thought about how I might respond myself.

I, too, charge higher for my couples therapy work than my individual therapy. Part of that reason was simply that that’s how I saw it done by others. I did not really think through exactly why at the time, and modeled what I saw others doing. Over time, though, I now understand why I charge higher for my couples' work than for individual work.

 

The time invested and involved looks different than individual.

For all my sessions, I have preparation involved. The couples I work with require more time and energy in that preparation. I am not only looking through the lens of one person; I am looking through the lens of two individuals and then their relationship. I am exploring what each partner’s dynamic, family of origin background, insecurities, and ways of adaptation are, to understand how they are then impacting their relationship.

The training to become a qualified couples therapist has also required more investment and time. While we all need continuing education, it is my belief that to truly specialize as a couples therapist and do quality work, you need to invest time and financial resources into developing this skill set. I’ve had some colleagues say it’s not different from having one person to multiple in the room, and I beg to differ. When you do not have a strong background in couples therapy, training, and knowledge, the likelihood of harming the couple and their relationship is much higher.

I am often the third or higher couples therapist my couples have worked with, and have heard the horror stories of their previous work. You could hang a shingle up and say you’re a couples therapist, but to truly do the work well with holding “do no harm” at the forefront, you have to be trained and specialized in it. Because of that, my rate reflects the time, energy, and investment I’ve made to ensure I am providing quality couples therapy work.

 

Sessions are often more emotionally demanding and taxing on the therapist's nervous system.

I love couples work and would rather have a full caseload of couples than any other type of client. The difference in this is that I cannot maintain as high a caseload as I did when I only had individuals. I used to see 8 individual clients in a day and be fine (Let me be clear, I don’t encourage this anymore, but it is how I got started in the field). When I started working with couples, I tried to do the same, and it truly felt impossible. I imagine some people do have a caseload of 8 couples a day and are managing okay, but I don’t think the sustainability is truly there.

Whether it is couples therapy or individual therapy, we are holding many emotions, hurts, insecurities, and pain with our clients. Couples therapy requires holding it two times each session, and that is simply different than holding it with one person only. It does feel more emotionally draining than an individual session and requires a different stamina level.

The other factor with these emotions is that most couples are coming to therapy when the stakes are higher, and the hurts are harder to uproot. I find that the first 4-6 sessions are key to helping a couple shift and work towards true repair and healing. The preparedness, emotional regulation, and attunement required in those first few sessions can often feel like multiple hours of work pushed into 1-2 hours, and that is taxing in a different way than individual therapy can be.

While these two reasons are not an all-inclusive reasoning for why couples therapy is often higher than individual therapy, it is a look into the world of this work, and I hope it can help someone who may be wondering if being a couples therapist is a direction they want to go, and understand the financial difference. What I hope this post does not do, though, is encourage people to start doing couples therapy simply because they can make more money.

One of my biggest critiques is against therapists adding couples therapy into their work because it's a good niche to have. I am truly frustrated by the number of clients who come to work with me and share how poor their previous couples therapy work was and how it damaged the relationship. To be a quality couples therapist, you need to be trained and take accountability to do this work well; you need to be skilled and ready for how the work is different than individual therapy.