Devaluation of Mental Health Professionals

If you scroll on therapist Threads, TikTok, or Instagram for a few minutes, chances are you'll come across some posts about therapists. People may complain that therapists don't take insurance or that they charge too much. People characterize the profession as "just listening," and pop psychology takes real mental health concepts and twists them into marketing strategies.

According to the APA (2025), about 1 in 10 adults have sought mental health care, but not received it. About 25% have had trouble finding therapists who are in-network with their insurance (APA, 2025). And about 29% said they were worried about the cost of treatment (APA, 2025). In the present moment, healthcare is difficult to afford and access for many people, due to costs of insurance, costs of healthcare, and costs of living. There's a shortage of mental health professionals in the US as well, as about 40% of the US population lives in a Mental Healthcare Shortage Area (HRSA, 2025). 

With this in consideration, let's discuss how US society devalues therapy - and by extension, therapists.

When I decided to become a therapist and started my journey in 2021, I knew I would have to do everything I could to make it through. The tuition and fees were thousands of dollars every semester. I also had to pay rent, utilities, groceries, internet, and for my dog's things. I didn't come from a family with a ton of money. In the first year of my Master's degree, I worked as a therapist for free in a training clinic - paid not even a dime for my time, and working at a daycare to have an income. My second year, I was paid $15 an hour to provide therapy services for about nine hours a week - not fair compensation at the time for the work I was doing - and I had to dip majorly into my savings that my parents had strategically created for me.

In my doctoral program, I managed to secure myself a teaching or research assistantship every single year. This ensured my tuition and fees were mostly, if not all covered, and I received a monthly stipend of $1599 - $1625 per month for nine months out of the year. At the start of my program, I also worked for a practice that charged $65 an hour for my services - and paid me $35 an hour of that total. I eventually left that practice, and then worked for a practice that paid me $58 an hour for about 5-7 hours of work a week. All of the therapy services I provided in the first year of my doctoral program were also free - I wasn't paid a single dime for that work either.

I was lucky, in that I was raised on how to have a tight wallet, I had a partner who also worked (once I was in my doctoral program), and I had parents who were strategic and set me up really well for success. I managed to get many scholarships and fellowships as well. However, my story is not the only one by far. And many marginalized people who come into the therapy field struggle to make it out the other end.

So let's put the blame where it should lie: the insurance companies.

As stated earlier, a quarter of the adults who were asked stated they had trouble finding therapists who accepted their insurance (APA, 2025). A quick search on any social media site will also give you a host of mental health professionals who state they don't take insurance for a variety of reasons. The ones I've heard include: Insurance reimbursement rates are too low to be sustainable, it takes too long or is too difficult to get reimbursed, or insurance companies take back payments years after they paid them out to the therapists. In addition, many insurance companies don't allow associate-licensed clinicians to panel with them, forcing associate-licensed clinicians into a bind.

Because of these reasons, many therapists choose to go private pay - where you pay the therapist directly, and there's no third party. A New Chapter Therapy does private pay only for the reasons listed above. At time of writing, A New Chapter Therapy is only me (Hi, it's Kaity!) and I simply do not have the time nor energy to devote to bounty hunting insurance company payments.

Why are providers treated as poorly as the clients? There many be many answers to this question - greed, public perception of necessity of mental health care, etc. However, it is fair to assume that at least some of it is based in discrimination.

In the therapy field, there are two main "-isms" that I feel pop up most frequently: Ableism and sexism. These are systems of oppression based on disbaility and assigned sex at borth, respectively.

You may be asking "But Kaity, what about mental health stigma?" Well, that's under ableism, friends - many mental illnesses are permanent or temporary disabilities. In a book on ableism by Nario-Redmond (2019), she discusses some of the root causes for ableism - eugenics, Protestant work ethic, social dominance, meritocracy, and individualism. The ones we will focus on in this article will be individualism, meritocracy, and Protestant work ethic, although all of them contribute to the problem in some way.

When we look at the system of health insurance in the U.S. right now, there's a few different ways to obtain health insurance. There's Medicare and Medicaid, which is provided by the government, with strict qualification requirements. Then there's private insurance companies, which you can get insurance from through the Insurance Marketplace or by getting a job. We already encounter our first barrier: Access to health insurance. You either have to a) have a job that provides health insurance, b) be able to afford private insurance on your own, or c) meet the qualifications for Medicare and/or Medicaid. Let's walk through each of these.

We'll start with Medicare. Medicare is for those 65 and older, those under 65 with a "qualifying disability," or those living with end-stage kidney disease or ALS. According to Medicare Advocacy dot org, a qualifying disability is met when someone has been enrolled and received Social Security benefits for 24 months (2 years). Medicare includes Part A and B, which cover the majority of services someone might need from medical care. Depending on qualifications, certain people may still have to pay premiums. The way this is set up severely limits who can have access to free or reduced cost healthcare - creating this idea that you need to be "disabled enough" to obtain resources. A lot of this relies on individualism, which is the idea that the individual should be able to do things on their own and achieve success as one person. This means that U.S. society, at present, is less willing to give resources for "free" unless the individual can prove without a shadow of a doubt that they need it. 

Here, we also see social dominance rear its ugly head. Social dominance is a concept that describes how certain groups, in this case, abled people, enjoy certain privileges while others do not. This often results in resistance when the oppressed social group, in this case, disabled people, receive privileges that the non-oppressed group already enjoy. If we were to attempt to expand Medicare to cover all, or even just more people than it already does, there would likely be some form of an uproar. People would argue that some people "don't deserve" these benefits, as if healthcare is an optional subscription for life. This "deserving" mindset - the idea that you have to "earn your keep" and your worth comes from your work - comes from meritocracy and Protestant work ethic respectively.

This bleeds into the other forms of obtaining healthcare as well. Perhaps the most obvious one is obtaining insurance through a job - tying health insurance to a job ties your life and survival to work. Work is your worth, which is the message of Protestant work ethic. You also see examples of this messaging when someone argues that people who are "lazy" and "don't work" do not deserve basic rights such as healthcare. This also ties into the requirements for Medicaid. For each state (yes, Medicaid is state-run!) they are required to cover certain eligible groups. This includes low income families, adopted/fostered/guardianship children, "qualified" pregnant women and children, blind and deaf people, disabled adult children, and more. The ACA helped to change some of the financial qualifications to be based on Modified Adjusted Gross Income (MAGI), and helped to simplify the application process. 

However, this still places work and by extension, money, at the center. This is another conversation for a longer essay, but suffice it to say that the U.S. is money-centric. When you look at the insurance marketplace (thanks to the ACA!), many people are still able to access healthcare who weren't able to before. The passage of the ACA was a step towards Healthcare for All. However, the insurance marketplace still has its issues - primarily ease of access.

In marketing courses, there is a priority on decreasing friction for the consumer. When it comes to a purchase, make that purchase as easy to access as possible. The more difficult it is, the more likely your customer is to leave and not make a purchase. This is the exact concept that is not presently addressed in many programs run by the U.S. government. Many programs are difficult to access or figure out how to use. I have insurance through the marketplace and I had to call someone whose whole job it was to help people find and apply for healthcare insurance! And I only knew of that number because of my bank - which is one of the best banks out there, in my opinion.

The cost of health insurance - and dental and vision, which are separate, which again is a whole other discussion - is also often prohibitive. It reduces the amount people have to spend on other things, such as rent, groceries, or even a treat or fun night out!

So let's focus back in on where mental healthcare ties into this picture. As we see, private insurance companies essentially "rule" the market. The goal of insurance companies is to keep as much as they can, and avoid paying as much as they can. With a goal like this, they aren't really invested in the wellbeing of the people who need the insurance. This has been the cause for a lot of unrest around insurance companies, which could include the murder of the CEO of United Healthcare not too long ago. 

When it comes to mental health care, let's look at reimbursement rates to start. For Medicare, the rate for my part of the state is $171.02 for a diagnostic evaluation. Individual psychotherapy is somewhere around $167. Okay, not bad (until we remember the narrow eligibility requirements for Medicare!). What I found for Medicaid for Texas (after a fair amount of searching!) was "Counseling services provided by a licensed professional counselor, a licensed clinical social worker, or a licensed marriage and family therapist in compliance with applicable professional licensing laws and regulations are reimbursed at 70 percent of the existing fee for similar services provided by psychiatrists and psychologists as described in §355.8085 of this title (relating to Reimbursement Methodology for Physicians and Other Practitioners)." According to a mind-numbing table which I struggled to read, psychologists get reimbursed $93.72 for 60 minutes of therapy for those 0 to 20, and $89.25 for those 21+. How much do you need to charge to get even those rates? No clue.

Then we remember - wait, MFTs, LPCs, and LCSWs only get paid 70% of that. That's then $65.60 and $62.48, respectively. Which is not a feasible amount to live on, given that in the mental health field, "full-time" is considered 30 hours per week due to the nature of the work - and that's not all face-to-face time with the client. For context, as a fresh-out-of-university Master's clinician, I was told I could charge $85-$100 per hour for my skill set and experience. So already, we're facing underpayment for our jobs.

When we turn to private insurance companies, it gets worse. Private insurance companies don't share their reimbursement rates because they change their rules extremely frequently - and it varies between providers. This is a very similar feeling to this idea of "don't talk about your salaries." If we're uncertain what we're each getting paid, we can't fight for fairer rates. With the two insurances that I could accept as an Associate licensed clinician in a group practice, the ranges were $78-$98 (Aetna) and $71 t-$92 (Cigna). These two insurance companies are considered some of the more reasonably paying companies compared to others. This is better than Medicaid, but again, not really enough to pay expenses, let alone bills, especially when you still have to take out taxes too! In addition, insurance companies have to accept you as part of their network, so there's no guarantee you'll get in!

With all of this considered, let's look at the additional component - and a partial reason why reimbursement rates may be so low.

For a long time, the therapy industry has been and still is majority women. In general therapist positions, White women dominate at around 70%, while for psychologists, that number drops to around 57% (IPI, 2025). The average salary for a therapist who is a woman, nationwide, is around $55,000 (IPI, 2025). For psychologists who are women, this salary jumps to around $92,500.  For men who are therapists or psychologists, those numbers are around $57,000 and $98, 200 respectively (IPI, 2025). It should be noted here that most therapy fields need only a Masters to be licensed, while becoming a psychologist requires a doctorate. Psychologists are also more likely to be in academia, while therapists are more likely to be in a private corporation or practice.

Given the gender spread, as well as the differences between most therapists (LPCs, LMFTs, LCSWs) and psychologists (PsyD), the general therapy field is valued lower than psychologists are, even though they are likely a larger part of the mental health care workforce. Therapists are also in high demand - there aren't enough therapists for as many people that need therapy. It may be due partly to the fact that women dominate the therapy field that pay is lower than that of other healthcare professions dominated by men. There is a noticeable phenomenon that occurs when women enter a field en masse - the pay drops and the value of the field drops. U.S. society values labor less when it is predominantly done by women. 

So when you take sexism + ableism, you end up with a recipe for a severely underpaid, undervalued, overextended, and overworked workforce of therapists. Insurance values them less than what they are worth, which then leads to a burnt out and exploited workforce, which leads to lower quality care, which can lead to more negative perceptions of the mental health field. Thus the cycle continues.

At A New Chapter Therapy, we aim to counter this by humanizing and centering our clinicians in our business practices. Therapists should be paid what they are worth, and not be expected to overextend themselves to do it. This allows our therapists to not worry about survival and have the ability to thrive and provide high quality services. It's not about how many sessions they can complete here - it's about how good their therapy services are. After all, we would want our therapists to be paid well and taken care of, and we assume that you feel the same way.