What's A Therapist Worth?
by Garry Cooper, LCSW
John, by pointing out the very small amount of how much a human being’s chemical composition is worth, you have made a singular contribution to the trend in our society that increasingly devalues the worth of human beings. If you keep this up, there will surely be a place for you in the Bush administration or on the corporate board of Wal-Mart. I do think that your cost analysis leaves out one important factor--the high value of individual organs. Thanks to transplants, our livers, for example, are worth even more than goose livers in pate de foie gras. And of course the cost of the human heart, as every therapist knows, is inestimable.
You’ve outdone yourself with your provocative comparison of therapists with meds, though you may have inadvertently given credence to the old pharmaceutical company lie that Big Pharma needs their outrageous profits to bankroll their research and development (R&D). In fact, the lion’s share of their profits goes not into R&D, but marketing. I’d advise anyone who falls for that old R&D lie to check out the Consumer Project on Technology web page at http://www.cptech.org/ip/health/econ/allocation.html .
But even these statistics don’t fully expose the R&D lie. That’s because a lot of R&D is driven more by marketing than by benefiting humankind. How often do we hear about a new wonder drug that, a few years later, turns out to be no more effective than an earlier drug? We’ve certainly seen it in antipsychotics and antidepressants. That’s because the driving force behind much of the R&D isn’t to find a better drug, but to find a drug to replace one that’s going off patent. When Prozac finally went off patent and everyone could finally buy fluoxetine—generic Prozac, manufactured by other companies--Eli Lilly lost literally millions of dollars. But as the Prozac patent expiration loomed on the horizon, Lilly spent a lot of R&D money researching whether Prozac could be effective for Premenstrual Dysphoric Disorder—a diagnosis whose validity many question in the first place. Their studies found it could be effective, and so they changed the color of the pill to a female-friendly pink, renamed it Sarafem (thus preserving the patent), spent megabucks on stacked clinical trials, even more megabucks on marketing, and earned millions of dollars on what was the same old Prozac under a new name. There’s R&D money well spent, huh?
And I haven’t even gone into the R&D money devoted to inventing drugs for highly lucrative markets for minor conditions like male pattern baldness or meds for household pets, while they shortchange R&D on serious medical conditions that affect a small minority of the population. That R&D argument is like the oil companies ripping us off at the pump on the phony justification that, gosh, they have to look for new oil sources, while meanwhile they ring up unprecedented profits each year and spend millions trying to get us to buy one brand of gasoline over another.
Sure, many therapists today, even though their bodies may be worth the price of a candy bar, charge well over $100 an hour. In their defense, therapy really is difficult work. My former father-in-law, a tool and die maker all his life, could never understand why I was exhausted at the end of a workday when all I do is sit and listen and occasionally talk. But therapy’s an enormous responsibility, requiring enormous concentration and the use of every neuron of cognition and emotion. A good therapist gives his entire being to every minute of the therapeutic hour. Your R&D argument also makes sense here, John: a lot of expensive training, education and continuing education requirements are required of licensed therapists. And most therapists in private practice hire their own supervision or consultants—and if you think therapists charge a lot of money, see what supervision and consulting costs. The only therapists, in my book, who should break the $100 an hour barrier are those who have the east chance of getting it, the ones who are on managed care panels. They deserve it because of all the damned paperwork and administrative haggling.
I frankly don’t know of any professional whose time is worth over a hundred bucks an hour, unless their operation requires considerable logistical backup and equipment, and other overhead and heavy malpractice insurance. The real reason many therapists charge so much is because they can. I hope most consumers know that those who pay a high price are usually paying for an expensive office, a reputation, or for the illusion that there’s a. correlation between the price and quality of therapy.
Garry Cooper, LCSW is a therapist and writing coach in private practice. His “Clinician’s Digest” column for the national magazine Psychotherapy Networker, covers the latest news and research in mental health and psychotherapy. He can be contacted at garry@psychjourney.com Visit his blog.
Read a counter-point by Dr. John Riolo.
