Happy, Healthy, & Wealthy Therapists | Ep 23: The “Good Therapist” Lie That’s Keeping You Underpaid

Released: 04/10/2026

Show Notes:

In this episode, Amanda unpacks the real reasons therapists struggle with pricing and charging premium fees, and why it is often about much more than just picking a number. She explores the fear of “hurting people” by charging more, the conditioning that tells therapists they should not care about money, and how systemic and cultural factors like the patriarchy shape these beliefs. Amanda also breaks down why higher fees can actually lead to better client commitment and outcomes, the hidden burnout that comes from undercharging, and the difference between a pricing problem and a volume problem. She shares a powerful reframe around sustainability, ethics, and value, helping therapists rethink what it actually means to do good work while building a financially supportive practice.

3 Key Takeaways:

1. Charging premium fees isn’t unethical… underpricing often leads to burnout, which ultimately compromises the quality of care you provide.
2. Pricing challenges are rooted in deeper conditioning around money, value, and “good therapist” identity, not just choosing the right number.
3. Higher fees require stronger positioning, boundaries, and mindset shifts, but can lead to more committed clients, better outcomes, and a more sustainable practice.

Connect with Amanda:

• Follow on Instagram: @amandakbcoaching
• Check out the Amanda KB Coaching website

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Just a quick heads up, everything I share in this podcast is for informational and educational purposes only. It’s not legal advice, financial advice, or tax advice. Every practice and every state has its own rules. So if you’re wondering how something applies to your situation, make sure to check in with an attorney, accountant, or another qualified professional who can give you guidance based on your specific circumstances.

Transcript:

Amanda (00:00)
Hello, my fellow therapists. It is good to be with you today. I’m gonna talk about a topic that I hope isn’t like a hot take. I hope it isn’t really like spicy or something that is brand new or that you’ve never heard of. But I hope to bring a couple different lenses to this topic, which is pricing, right? We all go through so many back and forth thoughts and feelings when it comes to

How do I price my therapy sessions? And specifically, how do I charge premium fees? How do I raise my rates? Because whether you are brand new to private practice, whether you have been doing this for a while, you’ve probably started to see, especially with the cost of living these days rising, that maybe your fees don’t exactly set you up for the life you have or the life you want to live. So obviously we…

can do a little bit of that math of like, okay, well, if I raise rates, maybe like five or $10, like that might help with X, Y, Z, but also maybe you’re looking at other therapists such as myself, other therapists, whether they’re in your state or just kind of across the country and saying like, wow, that person charges X amount. I wish I could charge X amount. I know that that was me when I was early in practice in 2022, I had joined a bunch of Facebook groups to

kind of get some community, try to get some senses of like, what’s going on? How do I make this work? And at that time, I chose to set a lower fee than most people in my area because while I wanted to book clients and I wanted to book them now, my sole goal in getting out of my college counseling center I was working at was can I just replace my income and not be so burnt out? And so I set my fee below everyone else, but I saw people in…

different Facebook groups. So I started my private practice in Oregon and average cost of therapy, I would say in my area was people were charging like 150, 175, about two hours away from me was a bigger city where I started seeing people charge 200, 225. And I did the thing that probably most of us did, right? We looked at other people’s psychology todays, we looked at other people’s websites. I found some like government website that

literally could show you what is the average cost in your area for specific CPT codes. And that little formula told me a 90837 on average in my area was 185. And so that’s the rate I wanted to charge. I was like, well, that’s average. And I like to think I’m above average, but I needed to fill my caseload because I wanted the financial part to not be so scary. And so I set my fee to 125. I got a handful of clients at that rate.

I raised my fee to 150 and like that still felt pretty good. But I saw other therapists on Facebook charging 200, 250, even 300 and above. And even as I’m talking about pricing generally and these numbers, a lot of us listening might have this immediate gut reaction of like, okay, but if I raise my rates or if I charge premium fees, what if I hurt people by doing this? Or who am I?

to charge that much, or even, I don’t want to burn someone out by being another expense in their life. And so if any of that resonates, I want you to know you’re not alone, and also, there might be more going on here than you think. And that’s all what this episode is going to talk through today. So again, thank you for joining here. I don’t think it’s going to be super spicy, but I want you to think through some things that maybe you haven’t thought about before.

So let’s start with this fear of I’m hurting people. The idea that charging more equals harming the lay client out there, because a lot of us think charging more automatically means inaccessibility. And in that way, that could potentially harm people. But what I really hear a lot of therapists saying, and I know my experience as I was going through raising my rates, because I would raise rates,

every year or even two times in a year if it felt like my expenses were shockingly more than I budgeted for. I had raised them by 25, 50, or even $100 at a time. And so I know what it’s like to have thoughts like, I don’t want to be another stressor. I don’t want to feel like I’m taking advantage of someone. I don’t want to burden people financially. And on the surface,

us thinking about that, that all sounds really compassionate, right? We are here, we are therapists, we do this work because we care about other people. So it makes sense that we worry about those things, but I want to gently challenge all of us to think something different. Because why is it that when you charge for your work, it feels like harm? But when someone else invests in a gym membership or a nutrition coach, a business program, a vacation,

Why don’t we immediately assume they’re being harmed? I think there was this, if you all are Ted Lasso fans, I really loved this conversation between him and the therapist where essentially he’s attacking her for why do you charge if you say you care? And having this conversation of just because you care about your work, just because you would do it for free doesn’t mean that you actually do. Because again, we all have

lives to pay for. We all live in this capitalistic society. again, cost of gas is going up, groceries are going up. Like we all have bills to pay. And if you’re like me, you have student loan debt, you have credit card debt, you may or may not have a mortgage. I’m currently renting. ⁓ So right, like we don’t assume other people when they spend money on other things, even that promote healthy behaviors, we don’t assume they’re being harmed.

But there’s something very specific that happens in therapy spaces around money. And it is not just about ethics. I hear a lot of people throw around the ethic word when it comes to rates generally. A lot of people will say it’s unethical to charge premium fees, but like, who’s to say that? Like, yes, I do think that we have ethics around helping others. We have ethics around providing services.

but I’ve never seen, I’m a psychologist, I’ve never seen anything in the APA, I’ve never seen anything in, I’m licensed in Washington, Oregon, I’ve never seen anything in like the state board laws and regulations that a specific number automatically makes therapy unethical and you should consider what you’re doing. So this comes into a topic of, know, a lot of us are trained explicitly or implicitly.

that good therapists don’t care about money, or good therapists make therapy accessible no matter what, or even if you’re really in this for the right reasons, money shouldn’t matter. And my God, I hated reading all of those things. I have a script in front of me and I hated reading all of those things because I want you to notice how deeply that gets internalized, right? We are told we should care above all else.

And I know there’s been times I felt this way as a therapist and I work with so many other therapists in my coaching business around what exactly is it that we sacrifice in order to really live in this like good therapist conditioning, right? I know so many people who are behind on their bills. I know people who worry about making their rent or their mortgage. I know people who haven’t taken a vacation in years or are working, seeing 35 clients a week.

and they’ve never contributed to retirement and they’re in their 40s and 50s. Like, wow, this is all because we’re in this position where we care deeply about our clients, we wanna do good work, but also we need to make a living. And if we’re not doing all of those three things, I don’t know that honestly, we can’t do any one of them justice. Because if you’re like me, when you are stressed about money,

when you are burnt out, you are not bringing your best self to your therapy sessions. Your clients don’t get the best version of you. I think there’s something to be said for depending on how much of a interpersonal process and how much self-disclosure you do. It might be very validating for your clients to hear, I’m exhausted. Yeah, I haven’t taken a vacation in a while either.

that might be like, okay, like I’m not alone in that, but your clients do want you to take care of yourself, like a million percent, because they know when you are well taken care of, you take better care of them. So when it starts to feel like caring deeply about your clients and doing good work and making a living, when those all start to feel in conflict, like that’s not good, right? There is a space, there is a way to find

harmony in all of that. But here’s the things that not enough people talking about this topic name clearly enough. This is not just about you, right? We internalize all of this. It feels like it’s all about us. Like this is just an us problem. But this is systemic. This is gendered. This is cultural. This is very tied to the patriarchy and how helping professions, especially female dominated ones,

are valued and compensated. So part of this work around setting your fees and being successful in business and being financially successful in life, part of this work is actually about recognizing that this isn’t a personal failure, that it is conditioning, that we have all been through and some of us are steeper in it than others. But we have to recognize that and then we have to ask, now that I can see it,

What do I wanna do differently? I know so many people who are charging premium fees, whatever that means for them. Some people are thrilled by the idea of not being paid $35 an hour of getting off insurance and charging 150 a session. Whatever premium means to you, all of that is relative depending on your financial needs, cost of living in your area and stuff like that. But a lot of people see the changes we make now.

is literally going to inform the next generation of therapists. How much can we create cultural change and fight the patriarchy in this way of just because this is historically? Well, that’s kind of the funny thing about therapy, right? Like it was started quote unquote by men if we think about like Freud and all the behavioral therapies and psychologies. But otherwise, generally most people assume a therapist is a woman. And so…

I think we should fight back on that. think that we should say we deserve to be women who are successful and especially financially, and that does not make us bad people and it does not make us care less. This then leads into one of the biggest lies I hear in the therapy field, which is, well, it’s harder to sell higher ticket therapy, right? It’s harder to book more clients at premium fees.

I totally understand why people believe that there was a time where I thought it too, because it feels intuitive, right? Like higher price equals fewer clients. And, you know, in some ways that makes sense in the sense of like, maybe you don’t need that many clients if you do have higher fees. Maybe if charging 200 allows you to see 12 people instead of, you know, seeing double that amount of people for half the cost. Yeah, that makes sense.

But it’s not necessarily that the high fee itself means that less people are going to reach out. Because in fact, in many cases, higher fee services actually convert better. And this is why, because I know you might have thought right now, well, I’ve tried that before and it’s been hard. Or I’ve seen other people struggle to do it. Or how many people start?

private pay and then go to insurance for whatever reason. And again, we can never know unless we know someone’s full story. But generally, those therapists who are charging higher fees, again, whatever that means to them, generally their messaging is clearer in terms of how they are marketing themselves on their websites, Ecology Today, maybe social media, maybe they’re doing outreaches or news outlets or whatever that might be. Their positioning tends to be stronger. Their clients

may or may not be more committed. I will say there is a difference between someone who really values therapy but simply cannot afford it. It doesn’t mean that they’re not committed, even if they’re paying $0 or $20 a session. But I sure as heck noticed a difference between my therapy clients who were paying $125 to $150 and how frequently they would reschedule or let’s take a break or kind of just talk about

problem with the week stuff, but not actually want to do work. Like I would ask them, do you want to do EMDR today? Should we do something today? And they’d be like, no, I think I just kind of needed today to vent. And that’s fine. Like there’s a time and space for that in therapy too. But the ones, the clients I work with now who pay 350 to 500 an hour and the 500 an hour is my therapy intensive weekend rate, especially when I’m traveling for those.

They’re more committed in that sense of like, they want to dive in, right? By and large, I do not see them rescheduling or canceling their appointments or kind of puttering around. for me, that’s much more, it’s much more calming for me because I know what to expect. I don’t have to worry about a bunch of no shows. I don’t have to worry about pulling teeth in sessions. That’s one of my least favorite things as someone who hates small talk and I know.

me in my therapy sessions, I’m like, let’s go for it. Let’s go into the deep end. So it’s really hard for me to feel like someone isn’t committed. There’s a difference between are they and do you feel it? But generally I’ve noticed clients who are paying higher fees tend to be more committed and more active and they attend more sessions more consistently. And a lot of that is because the perceived value is higher.

If they’re like, I’m paying $350 an hour, I better get something out of this. And if that means I got to show up and do the work, then I guess I got to show up and do the work. And they’re trusting me to put in my end of that effort too. Now, does that mean it’s easy? Higher fee services, I’m saying they convert better. Does it mean it’s easy? No, there is absolutely a learning curve to this. Compared to setting a lower fee for your services,

you do have to communicate differently. There’s a difference between you being the therapist who works with everyone and can help anything at any time and being the therapist who is hyper niche and feels super confident in what you’re offering and can ethically stand behind your premium fee. Because again, there’s a difference between I’m charging this just because I want to, I’m charging this because I need to, and I’m charging it because I feel like I can.

Right? And that sense of, because I feel like I can ethically back it up because I know what trainings I have. I know how I show up. I know I’m not burnt out. I know what else I’m doing with this time, energy and money outside of the therapy hour. So we do learn have to, we do have to learn how to communicate differently on our marketing platforms. Again, wherever that is that you market. You writing copy as a

insurance-based therapist versus someone who’s trying to charge $200, $250 an hour, there is very much a big difference in terms of how your website should be laid out, how in-depth you have to be, what questions you have to answer for someone. You also have to hold your value differently. And I think it’s very easy. And again, because a lot of insurance companies don’t allow you, if any do, they don’t allow you to charge.

no show or late cancellation fees. Like it’s so easy for someone to feel like that hour now is wasted and now they’re stressed and it is easy. Quite honestly, even when I was charging 125, it’s a little easy to phone it in, right? Like how often have you been like, well, that was okay. Like it was kind of a crappy session. I didn’t feel like I did my best because I was tired or I was hungry or I was thinking about this other client that I’m worried about. Like we don’t always show up.

as our best selves and that does make us value ourselves differently. Whereas when you charge a premium fee, whatever that means for you, you do need to learn how to hold more boundaries around that. You do need to learn how to convey yourself confidently, not just in your copy and your marketing, but also in the therapeutic relationship too. And again, that does not have to mean you show off and you say, I’m the expert and everything. It just means.

More like confidence, if anything else, of confidently knowing, even if you don’t have all the certifications in the world, why do you still have value in the work that you’re doing? We also have to learn how to tolerate discomfort differently, because it is uncomfortable to talk about money so frequently, right? Because you do have to say your fee over and over again. You do have to justify and kind of explain your reasoning around

why you don’t take insurance. Not everyone will ask those questions. Some people get it, but some people will be like, really, you don’t do that? Well, how does this work? And my ad and network benefits only cover up to this much, but your fee is higher than that. So there’s a lot more discomfort we have to be able to hold, but it’s not impossible. Here’s the thing is that the issue isn’t no one’s gonna pay for this. No one’s going to pay this fee. No one’s gonna sign up for this therapy intensive.

The issue is more so I haven’t learned how to sell and hold this yet. And those are skills that can be learned. It’s not impossible. We were all uncomfortable. I used to be, when I was working at the College Counseling Center before I went into private practice, we used to have to charge clients $25 if they no-showed. And oh my God, I hated having those conversations with them. And now I have conversations with people about why they’re being charged $350 for a no-show, but they know it.

They consent to it and they don’t love it. But again, that’s what helps them be either consistent with their appointments or, you know, sure as heck they are giving me that 24 hour notice to avoid getting that fee. The other pattern I really see showing up when it comes to setting premium fees is this over delivering trap. So when therapists start to raise their fees, they feel like they have to over deliver like.

I have to be extra prepared. I need to give more time. I need to make sure this is worth it. I remember the first time I went from 125 to 150 and someone brought up a topic in therapy that I wasn’t like super versed in. So I was like, you know what? I’m gonna buy a book and I’m gonna read that book and I’m gonna make sure I incorporate skills from that book into these sessions. So like, I get it. I get that thought of because I’m charging higher fees, I have to…

do something different, have to prove myself, but this is where things can start to backfire because now you’re charging more, but you’re also working harder and you’re holding more pressure and putting yourself in a position where it still doesn’t feel sustainable. So the issue isn’t just pricing, it’s the relationship you have to your value. And if that is something that stirs up a bunch of stuff for you, it’s a lot of what…

I’ve had to gone through and I’ve addressed it in my own therapy. I’ve addressed it in business coaching programs I’ve been in. It’s something that I help therapists address inside the Therapy Intensive’s Academy. Like it makes sense that this needs work, right? Because when we come back to this whole martyr syndrome, this good therapist conditioning we have, we do have to work on not just setting a price that feels fun and sexy to say, like I charge this thing, but we have to do the personal work that aligns with that shift too.

So let’s zoom out for a second because I think this question also gets missed in this conversation. How many clients do you actually need? If you’re charging $150 a session, that’s a very different math problem than $350 a session. The number of clients that you need to meet your needs for the month versus your wants and your goals for the month. The number of

prospective clients you need, like how many people do you actually need reaching out each week or each month in order to hit your ideal client caseload? So the number of consultation calls that we’re booking, the number of how are those consultation calls converting? All of that changes significantly depending on what our fee is, even the difference between 150 and $200 an hour. And yet most therapists are trying to solve a volume problem.

instead of a pricing problem. So this leads to more burnout, more sessions, less space, and honestly, less presence in the work. Right? If we’re just thinking about how do I get as many clients as possible, depending on what your fee is, you’re going to do different strategies, right? To solve a volume problem. If you’re like, I need as many people coming to my website as possible. I need all my reels to go as viral as possible.

that’s very, very different because those are different strategies, different things you’re working on, putting time and maybe money behind, as opposed to what can be solved with a small fee raise. Or maybe I don’t raise my rates for everyone, but maybe it’s for all new clients coming in, or that’s where a lot of therapists explore therapy intensives because maybe you feel like no one on your current caseload can afford the fee that you would want to charge full price, but if you can…

have these one-off intensive packages, then at least that’s something you can book once or twice a month that just increases revenue without you taking on more clients in a consistent and committed way. There’s also this narrative that good therapists basically give therapy away for free. And I know I mentioned this earlier, but I want to come back to it because I want to be really clear about it. That is not inherently more ethical.

You’re not inherently more ethical because you have tons of pro bono or low bono spots. You’re not inherently more ethical because you do charge the lowest in your area. Because like I said, when therapists are burnt out and overextended and financially stressed, which I know I’ve been there, that impacts the quality of care. I remember not feeling like a very good therapist when I was burnt out at my agency before private practice.

I remember not feeling like a very confident therapist when I first moved into private practice because I was learning what it was like to be a business owner. And that’s, I think all of us have this adjustment period of now I have to learn my own billing and do my own scheduling. And I’m trying to do continuing education on top of that. Like when we are just spread way too thin, regardless of why it is too many clients, the stress of not enough clients that is impacting the quality of care. I’ve heard therapists pretty bravely admit.

Like I know I’m giving my C game in this and I hate that. And that’s why I want to learn to do something different with my marketing or my pricing or what types of services am I offering? Because sustainability is what’s ethical. Capacity is what’s ethical. Being able to stay in this work long-term is what’s ethical. It’s not seeing as many people as possible and making as little money as possible because those are the therapists.

who are burning out in a year or two of private practice and just going back to where they came from anyway, right? Of like, I hate agency work, but clearly I can’t make private practice work, so I guess I’m gonna go work for an agency. But was the problem private practice or was the problem the pricing problem, right? So if you are listening to all of this and feeling like, okay, this feels a lot bigger than just picking a number, right? Because you can do all of the…

pricing calculators in the world. I know basically every business coach has one. I do not have one because I’m like, look, I don’t need to make another one. There’s too many out there. But you might have done that and landed on a number and still have feelings about, you know, I don’t like that number. That number still doesn’t feel like an offer. That number feels way too big. And like, I’ll never get to that. It’ll never be sustainable to market myself as a premium fee therapist. So clearly you’re getting like this is bigger.

than just picking something or just listening to the formula that you filled out. And you’re right. This is not just about a number. This is about mindset. This is about conditioning. It’s about systems, strategy, identity. And it’s not something you fix by just, well, I’ll just pick a higher fee and hope that it works. And that’s exactly why I am hosting a live webinar all about this, where I’m going to break down

what actually goes into premium fee setting, why higher fees can actually increase sustainability and client conversions, how to think about your numbers in a way that support your life, and what needs to shift internally and strategically for this to actually work for you. So if this episode brought anything up for you,

That is the place, the webinar is the place to go deeper. You’re gonna get live 60 minutes with me. I usually stay on for an additional 20 or 30 at the end to do some Q and A. So 60 to 90 minutes with me to pick my brain, let me know where you’re at and learn from me. There are lots of people who pay me a good amount of money to work with me and this is a free webinar. So definitely take advantage of it. You can sign up through the link in the show notes.

And there is a free bonus for those of you who are able to attend live. So you’ll definitely want to attend live. And I just want to leave you with this. You are not bad with money. You are not doing this wrong. You were just taught a version of what it means to be a quote unquote good therapist that might not actually support you anymore. And it’s okay to question that. And it’s okay to take some action on that. And that action starts with coming to my webinar and learning about how to challenge that and how to fight the patriarchy.

undo this good therapist conditioning, which inherently will actually make you an even better therapist. So I hope to see you at the webinar. Thanks for listening today.