Questions, Part 1 - Value/Worth
When therapists start out in the field, we are often very heart-connected to the idea of helping, and pursue the many years of dedicated study and practice because of the internal emotional connection we feel to the meaning of this work for each of us.
The larger-scale economic structure and culture around us has also decided that some professions are high-paid, some are low-paid. You educate our children, the stewards of the earth and bearers of the future, all day? Here’s a salary that won’t cover the rent on a one-bedroom apartment. You sell predatory lending scams, and kick people out homeless into the streets? Shall we direct deposit your millions straight into your tax-evasive offshore accounts for you, or would you prefer it in international bills since you’ll be vacationing?
We know that working in this career will not likely bring in the income of, say… a tech startup born from the money of multigenerational wealth, a social media CEO, or an investment banker. Many of us work in very emotionally intense settings during our early careers, are exposed head-on to some of the most difficult systemic problems like wealth inequality and the powerlessness of being among the working poor, the school-to-prison pipeline that starts with the intergenerational traumas of both racism and poverty, and the insulting inhumanity of public services available for those who are disabled.
None of what I have to say is about therapists not deserving to be paid. I’m not here to say we should be martyrs. I’m not advocating for us to work for free. I’m not saying we need to only charge low fees, and that it’s “unethical” to charge a fee as you see fit for your business.
But I am here to say that when we talk about our “value” and “worth” as therapists, and the discussion is restricted to how much we charge and then watered down to “we deserve to be paid well” vs this imaginary argument that “no we don’t!!!!” (that actually no one is saying), we’re only talking about the tiny part of the iceberg we can see above the water line. And I want to talk about the whole rest of that iceberg.
Why do we begin to tie our “value” or “worth” to dollar values? The answer isn’t exactly a secret—we have to live, living costs money, we need money, we live in a social structure where we have to do work to earn money to live. Our lives, families, and needs all matter. There’s no question that therapists should be paid for our work, and that we should be able to sustain our lives with that pay. I’m not sure that anyone is actually arguing that therapists should not be paid for our work, but I do know that there are corporate entities that control health care in the US, and that, like so many holders of power, they are only powerful because we allow them to be.
We can nearly all probably agree that for-profit health care, as a system, is unsustainable and against all human logic. That deaths, and lives ruined, and bankruptcies occurring because of health care costs are unconscionable. But we all participate in the system of for-profit health care in the US, because it’s what we are given as our option. We are powerless as subjects of this system, because the profit is designed to funnel toward corporate insurance companies, not to the health care professional, or the human with a need for health care. But as health care providers, we have the power to act collectively for the good of everyone, too. We just… haven’t.
What we seem to do, instead, is to play into a manufactured argument about “what we deserve” and “knowing our worth” and battling to our death in the completely false game of capitalism without asking if there are any other games we can choose from. You watched Squid Game, right? We’re all out here in green jackets with numbers on the back, and we think the only way to win is to be the very last one left alive… but what if the 400+ contestants had said at the beginning, “no, we’re not playing, and you have no hope of forcing us, because we know that there are far more of us than there are of you.”
When we agree to play this game, we take on certain language. One phrase I often find brought up within this discussion is, “my time and my expertise are valuable!” Another is the rallying cry, “therapists, charge your worth!”
Yes, you are so valuable! And also, do we have full awareness of the consequences of assigning “value” and “worth” to ourselves in dollar amounts? Do we have a picture of the full meaning of this seemingly simple idea, before we do it?
Let’s make the fundamental assumptions that 1) your time and expertise are actually SO valuable that they have a value beyond what dollars can measure, and 2) that as private practice therapists, we each have the choice to set our own fees, and engage in our own business practices, as we see fit for our own lives and needs.
I’ll speak about myself as an example.
Having valued myself and my time in such a way—to assign it the cost of $175 per hour, which is my own “standard” rate for the therapy hour—immediately invites a host of questions, points for consideration, and comparisons.
First, well, how did I come to value “my time and expertise” at this dollar amount? How are those definitions operationalized to make them meaningful to me, and then how are they meaningful in their application from one therapist to another within our community? The truth is that these definitions we come up with to determine our “value” cannot be generalized at all, because of a constellation of factors like:
marginalized identities and lived experience
the geographical area we’re working in, and cost of living
the type of license/degree we hold
our postgraduate training
certifications within postgraduate training that lead to any special designations
years of experience
whether we are paneled with insurance companies
whether we are in a solo private practice or a group
whether we are training and supervising interns/associates
individual states’ business regulations and laws
what type/s of therapy we offer
the needs of an individual single adult vs. the needs of more than a single-person household
what is a “basic need” and what types of privilege afford access to it…
It’s just not possible to invent some kind of new math to represent a system of determining “value” that makes any real-life sense when applied to an incredibly diverse field of choices. I understand the appearance of a logical process when we can only hold the yardstick up to measure ourselves as compared to “the competition,” because this is how value is determined under capitalism. If we are flush with a full caseload and high demand for our services, we seem to encourage each other, “time to raise your rates!” And when no calls are coming in, we feel the pressure to lower our prices just to snag one paying client, to take on clients who we may not even be sure we can really help, just to get paid. This entire conceptual model depends on supply/demand instability and price competition… and it seems to be the Cup Noodles filled with freeze-dried exploitation and burnout that just needs the hot water of inequality/scarcity to come alive.
For me, any questions about finances and fees in therapy create even more questions to consider and to try to measure.
As I assert that my time is “worth” or has a “value” of $175 per 50 minute session, what does that really mean? What allows me to feel allowed, safe, even entitled, to define my worth and value at that level and in that unit of measurement?
Where another therapist could set their own rate at $400, or at $20, does that also mean their time/expertise has the corresponding “value” and “worth”? Does that mean we are, by necessity, competing? Does that mean we are, or are not, forced into becoming comparable against one another? Does that mean I hold more power than the therapist earning $20 per hour? How does that dollar amount lend itself to power dynamics within the therapist-client relationship, and how does it affect power dynamics within my professional community?
Am I creating and/or perpetuating a narrative that “high quality = expensive” and “low cost = low quality”? Who does that narrative serve and how? Who manufactured that idea to be sold in the first place, and why? Who is harmed by it the most?
If I feel I am being devalued by not being paid as much as another practitioner in my field, who is holding that power against me? What holds power over me, and where am I the holder of power?
If I have enough money to just get by, and then I see others having more, what systemic and interpersonal dynamics are affected? How does this change my emotional relationship with my work and my fee? How does it change my emotional relationship with, and reactions to, the human beings I’m seeing in their therapy sessions?
If I set my therapy session fee based on how I personally see my value, what if I am a person who is culturally socialized toward humility or community equity? Am I fundamentally then worth less than a cishet white man who grew up with hearty class privilege and now has no problem declaring himself worth as many dollars as he can get away with? Aren’t we always talking about “impostor syndrome this” and “trauma lives in the body that”???
As I’m starting to hint, the concepts of “value” and “worth” seem to me just flashy buzzwords, and the depth of meaning can really only be found with further critical analysis.
I see it as our responsibility, in holding the social and educational privilege and power of our titles as therapists, to expand our own and others’ awareness into social/systemic/institutional power dynamics, to understand and identify the impacts of internalized ableism and capitalism, and to hold ourselves accountable for pushing against institutions and systems that enact and perpetuate harm. Like ours.