More than half of private practice therapists worry about economy, plan to raise rates in 2023, survey finds

More than half of therapists are worried about the economy and plan to raise their rates in 2023, a new survey has found.

The survey, conducted by Heard, a bookkeeping and accounting solution for therapists, reached more than 1,200 self-employed therapists to better understand the state of private practice finances today. 

More than half of respondents were “very worried” or “somewhat worried” about the future of the economy and its impact on their practice in 2023, and more than half said they planned to raise their rates this year. This may reflect concerns about inflation, the report suggested.

In 2022, the top five states where therapists were based were California, New York, Florida, Texas and Colorado, with the first four being the most populous. Heard collected the most data for these states, the report noted. 

The most common types of licenses among respondents included social worker, mental health or professional counselor, marriage and family therapist, psychologists and psychiatrists. Respondents were able to select multiple licenses on the survey. 

Distribution across gross income ranges was relatively even. Nearly half of respondents earned $50,000 to $100,000 annually, while more than a quarter earned $100,000 to $150,000. Only 15% earned more than $150,000. When taking into account expenses and taxes, 65% of respondents earned less than six figures in net income. 

Nearly 40% of respondents had more than one source of income—most commonly consulting, teaching and coaching. Other sources of income included speaking, supervision and product sales.

Increased gross income did not closely correspond with an increase in business expenses, the report found. Nearly half of respondents, with a wide range of gross incomes, claimed their total business expenses were less than $25,000, while 14% claimed their expenses to be $25,000 to $50,000. These figures could represent the growing popularity of telehealth, the report noted, with therapists moving from offices to home-based practices.

The majority of private pay sessions (78%) cost clients $100 to $200, and fewer than 7% of therapists charged less than $100 an hour. Most therapists surveyed offered a sliding scale option for payment and accepted some form of insurance. In the states where Heard collected the most data, the most common rates were: 

1. California: $150-$175
2. New York: less than $100
3. Florida: $175-$200
4. Texas: $125-$150

5. Colorado: $150-$175

Rent was the largest expense for more than a quarter of therapists, followed by cost of dues and fees and accounting and marketing fees. 

The most common payers that therapists worked with were Cigna, Blue Cross Blue Shield, Anthem, Oxford and Humana. Most who accepted insurance were reimbursed $100 to $150 a session. Of the five states for which Heard collected the most data, Colorado had the highest most common reimbursement rate range, from $200 to $225.

Oxford had the highest range for common reimbursement rate at $200 to $225, while the most common range for BCBS, Anthem and Cigna were $100 to $125. More than a third of respondents said they were paid less than $100 per session by Anthem.