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Therapy is a commitment. When you start therapy, you dedicate your time, your emotional energy, and your financial resources. Many people experience sticker shock when they see how much a therapy session costs. But when you pay for a therapy session, you’re not just investing in the time spent talking with your therapist. The fees you pay cover a range of essential services that happen behind the scenes.

Some of therapists’ most vital work happens between sessions. Here are some “extra” things you pay for when you purchase a therapy session.

Onboarding: Your Therapist’s Initial Investment

Your journey with a therapist begins before you even set foot in their office. Therapists dedicate time to get you set up as a client. This includes creating a patient portal, inputting your information, verifying insurance, and carefully reviewing your initial intake forms. This initial effort takes some extra time to fully prepare to meet your needs.

Session Notes: Your Health Record

After each session, your therapist creates a session note. These notes contain valuable information about your treatment goals, your progress in therapy, and the topics you discussed. These session notes are considered part of your official health record. They also help your therapist track your progress and plan for future sessions, based on your individual needs. The first session note is usually the most comprehensive, as it details your history and establishes a baseline for your treatment goals.

Treatment Planning: Tailoring Your Therapy

Between sessions, your therapist crafts an individualized treatment plan based on your specific needs and strengths. They periodically evaluate this plan, ensuring it adapts to your progress and changing circumstances. Some therapists plan sessions in-between, or take classes to learn new skills to help you. They may explore new interventions or activities to introduce to you. This ongoing refinement is crucial for providing effective therapy.

Treatment Coordination: Collaborating for Your Well-Being

If your treatment necessitates it, and only with your written consent, your therapist may coordinate with other members of your medical team or support system. This can include communication with dietitians, physicians, teachers, school personnel, parents, nurses, psychiatrists, and more. This coordination ensures everyone involved in your care is on the same page, delivering the best possible support.

Treatment coordination can be an intricate process, involving multiple stakeholders. Your therapist may engage in discussions and planning to guarantee your overall well-being. Even if you’ve provided written consent, your therapist is judicious about what information to share: only sharing what is necessary for your well-being and treatment.

Other Documentation: Accommodations and More

Some therapists include additional documentation in their session fee, such as writing letters for accommodations or excused absences. Others may charge extra for these services. It’s crucial to clarify with your therapist what is included in their fee structure.

Scheduling Changes: The Behind-the-Scenes Work

Managing appointment schedules might seem simple, but it can be a complex task. Therapists often correspond with clients who need to change their appointment times, or clients who have a crisis and need to be seen right away. If a client is seen every other week, they may share a weekly “time slot” with someone on alternating weeks. Adolescents may need certain after-school hours. Some therapists even offer between-session or after-hours “skills coaching.”

Ultimately, managing a schedule that fits the clients and therapists needs takes meticulous planning and coordination of various elements.


While therapy can be expensive, it’s a worthwhile investment in your mental health and overall well-being. Your therapy fees cover not only the valuable time spent in session with your therapist, but also the extensive work that happens behind-the-scenes. From onboarding and session notes to treatment planning, continuing education, coordination with other professionals, and scheduling changes, therapists are dedicated to providing you with the best possible care.

Understanding the comprehensive nature of therapy fees can help you appreciate the value of the services you receive. Therapy is a partnership between you and your therapist, with their commitment extending far beyond the hour you spend together in session. Ultimately, this collaborative effort paves the way for your personal growth and healing.

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