You get what you pay for, as the old saying goes.
Marriage counseling costs range widely and doing your research ahead of time, and knowing what you'll be paying for and HOW you'll pay for it, is a wise first move.
You can find clinics or university training settings in some places charging you as little as $35-$75 for a 50-minute hour.
Is that a good bargain?
In some cases, paying $200-$300 for a 50-minute session with a Clinical Psychologist can be a bad investment.
How can you tell?
Announcing that "Marriage Counseling Doesn't Work" is old news. The science is in and the results are exciting...
A less-expensive intern or pre-licensed professional under the supervision of a certified Marriage Counselor, for example, can be a wiser financial choice than a clinician with less experience or training in working couples.
And the results will still be excellent.
So what's the difference? Read on...
In the hands of a skilled couples therapist, effectiveness at helping couples is rising to 70%-92%.
Price and degree are only two of many important variables to consider when evaluating marriage counseling costs.
We'll talk more about that below.
How do you know if a marriage counselor is good at any price?
In this article we'll talk about:
...a new breed of therapists are committing their professional careers to the art and science of love. We call them: "Couples Therapists."
Bad marriage counseling is worse than NO marriage counseling.
I irritate my colleagues when I say that, but it is true.
Inexpensive marriage counseling at the hands of an unskilled individual isn't worth the time OR the money you'll spend. And I say "individual" and not "professional" because many people without any training in counseling are offering their services to couples.
Bad marriage counseling can actually make matters worse instead of better. Couples often come to therapy feeling depressed or hopeless that changing is even possible. Many generalists with no specialized training in couples therapy confirm their worst fears - "Your marriage is doomed..." - BASED UPON NO SCIENTIFIC EVIDENCE.
Many couples, even today, who could be helped, end up in a senseless divorce at the hands of untrained generalists.
As in any branch of medicine, seek out a specialist if you are looking for the highest level of expertise.
It's particularly important nowadays in Marriage Counseling, and here's why:
There was a time, in the old days, when barbers did both dentistry and surgery (badly). Barbers were the only ones with the sharp tools needed to sever a limb. And because they cut hair, people naturally assumed they could work on other areas of the head, namely the teeth.
Over time, medicine began to experiment scientifically with surgery. They had educational lecture halls where other doctors would come to watch their colleagues perform surgery and learn new techniques. Many people on the table died during this time, but a new, fledgling profession was formed, and they called themselves: "Surgeons."
Gradually, fewer and fewer people went to barbers for surgery anymore.
In fact, as the surgical profession evolved, doctors with basic training in medicine began to "specialize" in this evolving field. Some trained other generalist doctors on how to practice surgery with better patient survival rates. Some only practiced surgically on patients and honed their skills. Leaders emerged who (1) practiced, (2) innovated procedures, (3) demonstrated these procedures to others, and (4) wrote about them so other professionals could learn.
The history of Couples Therapy is similar.
At first, our counseling profession was only concerned with healing the individual. They objected to the very notion of seeing a husband and wife in the same room.
Some even called it "unethical."
But a few radicals persisted.
There's a sad history of "experts" emerging in the 1950's who had no "expertise" at all. They were very influential, however, because couples longed for help with their relationships.
Those with basic training in conducting therapy, (we now call them: "All Purpose Therapists") like M.D.'s with basic medical training (General Practitioners), traditionally believed that they, too, could practice on couples. Sometimes the results were disastrous.
No better than 1 in 3 couples seeing these generalists improve their marriages.
Many couples, even today, who could be helped, end up in a senseless divorce at the hands of untrained generalists. In other words, many patients (marriages), even today, die on the operating table.
But things are improving.
During the 1960's researchers began to scientifically study real couples. Master Therapists who had a long history of conducting Couples Therapy watched newer clinicians working with couples.
Just as in medicine, as techniques improved, so did the patients. Just as surgery became a speciality and survival rates improved, Couples Therapy has become a specialty and science is providing us new and better ways to help couples.
Science-based approaches are available and carefully followed. Innovations to these established techniques are offered. We're seeing better results, writing about it, and teaching what we learn to others in our specialization.
And as a result, the costs for these more effective services is rising.
We're in a renaissance now in Marriage Counseling. More and more generalists, or what we call "All Purpose Therapists" (our GP's...), are recognizing that they just can't see couples as an add-on to their individual private practices.
They need to specialize in couples work or get out of it.
A new breed of therapists are committing their professional careers to the art and science of love.
And more marriages are surviving and thriving after seeing this new breed of "marriage counselors."
They are called: "Couples Therapists."
In the hands of a skilled couples therapist, effectiveness has risen from 30% to now over 70%-92%!
That's great news!
That myth fries me for two reasons: First because they have a point. If a professional isn't properly trained, as in the past, the success rate is no better than 1 in 3.
But they're dead WRONG and ignoring the fact that science-based couples therapy is 70-92% effective.
Demonstrated, proven effective.
It makes for good advertising when trying to sell their products, but it doesn't make them an expert, either. Don't hesitate to investigate what education and training any author or retreat leader has when considering a psychoeducational ebook, video series or in-person program they're selling.
Now when you see Google ads proclaiming "Marriage Counseling Doesn't Work," you'll understand what they mean.
Asking how much marriage counseling costs is a bit like asking how much a car costs. Used? A BMW? A Ford Escort? You can get a car for $100. But how good is that car? Will it need expensive repairs?
Similarly, you can get someone to see you in weekly marriage counseling for $25, (like a barber who'll perform surgery...) but who'll be doing it? How trained are they? How likely are they to help your marriage?
And unlike a car, your relationship has two people who can independently make a decision to "run well," collaborate with the couples therapist or even put effort into changing their behavior and the marriage.
Even free Marriage Counseling costs too much if they cause you to divorce, intensify your fighting, or leave you even worse off then you started.
State-licensed psychologists, psychiatrists, social workers, marriage and family therapists and mental health counselors can all legally provide couples therapy. All will have, at the very least, a master's degree in their chosen discipline and must achieve a passing score on a national licensing exam. After those minimum standards are met, additional state requirements may vary widely.
For the most part, the degrees will dictate part of the fees you will pay. After all, a psychiatrist must attend medical school and consequently will have larger student loans to carry than a psychologist. They can be excellent at prescribing psychotropic medication because that is their training.
In turn, a doctoral-level psychologist with four years of schooling, and a subsequent clinical internship and post-doctoral placement will have more intensive psychological training than a two-year masters-level social worker, marriage and family therapist, or mental health counselor. And have a larger student loan to manage, so will charge more for their services.
While getting an advanced degree is expensive, it is still inadequate training to be a Couples Therapist.
A degree alone shouldn't govern your choice when selecting the right couples therapist. Couples Therapy is a challenging profession, and few psychotherapists (even Marriage and Family Therapists or MFT's...) choose to specialize in it. It requires drive and a passion to work with couples. And, it requires an education you're not likely to find in any degree-granting program.
If a student is interested in studying couples therapy while in school, they have work to do. Many must seek out additional coursework and locate appropriate clinical placements that specialize in treating couples.
Of the four counseling programs I've worked at, every one offered no more than one survey course, often an elective, in Couples Therapy. Coursework in Sex Therapy is rarer, even in MFT's programs.
Because insurance doesn't cover couples therapy, many universities and training clinics don't offer specialized training in couples therapy. Also, private practices are sometimes poorly equipped to provide the extensive training students need in working with couples.
So you have to really be motivated to become a specialist in this area. Training after graduate school is most often necessary to develop these skills.
I believe you are not going to know if someone is a good couples therapist and worth paying for just by checking their degree.
But investigate their degree in any case.
There are a lot of people claiming to help couples who don't have any training or mental health degree AT ALL...
Many people without credentials go by titles such as: "lay counselor" "marriage coach" or "intimacy coach." There's no license for those designations. In some states, even the word "psychotherapist" isn't a protected title. So buyer beware.
It's just too easy to pick someone with a colorfully enticing website that has no real education or skills to solve your marital problems.
Next, ask what marriage-specific training the therapist has.
People now know the two names which are the "Gold Standard" in couples therapy: Drs. John Gottman (The Gottman Method) and Susan Johnson's method (Emotional Focused Couples Therapy or "EFT"). These pioneers in couples therapy have published many books for the general public. You can read these to determine if you prefer one approach over another. Or choose a therapist with training in both of these methods.
These pioneers do more than write books for the public. They offer relatively expensive specialized training in evidence-based treatment for professionals. Professionals serious about becoming couples therapists attend these trainings to hone their skills.
Marriage counseling with a professional completing evidence-based training costs more because of this specialized training.
Specialists cost more than generalists in any medical setting.
Look for skills beyond the introductory level. Advanced training (Level III+ in The Gottman Method and Core Skills in EFT) requires the clinician to practice couples therapy while learning the model, not just reading about it.
That's an anxiety most "All Purpose Therapists" prefer to avoid.
You have to do your homework, and learn something about couples therapy to find a good couples therapist...
Time is money, and when it comes to couples therapy, a shorter session isn't time or money well spent.
When you compare fees between one therapist and another, ask how long the sessions will be. Most professionals work in 45-50 minute sessions because it fits their schedule nicely. They see clients on the hour and write a few notes in between. And insurance pays for therapy in that interval, so everything's fine, right?
If most counselors see couples in 45-50 minute sessions because they are generalists on insurance panels, they are trying to fit couples therapy into a box it doesn't belong in.
While longer sessions increase marriage counseling costs, they are proven by research to be more clinically effective. In fact, intensive marriage retreats are becoming increasingly popular for that reason alone. The 50-minute hour was designed for individual therapy. "One person to one therapist." There was a time people thought it was not even ETHICAL to see two people at the same time in the same room!
Carefully trained couples therapist have higher fees because they prefer to see you in longer, evidence-based lengths of 80-90 minutes. You'll get more done each week, and it will be worth the additional costs.
Certification in either model is even more costly to you and the professional. It requires not only hours of post-licensure clinical supervision, but also requires the professional to submit videotapes of their work to a central training institute.
The Couples Therapist's work is reviewed and provided feedback on the quality of their skill. They only certified if they pass a standard of excellence.
Some states have several Certified Gottman Method Couples Therapists (fewer than 300 practice worldwide) or EFT Therapists (perhaps 1000 worldwide). And unfortunately, some states or countries have no certified Gottman or EFT Couples Therapists.
If you can't find someone certified in your area, consider traveling for a Couples Retreat with someone who is.
And if cash flow is a big concern, making travel impossible, look for someone with at least Level I & II Gottman training or the Externship training in Emotionally-Focused Therapy. That should be a minimum standard before someone claims to be "trained" in either of these two science-based models.
Or seek out an Intern who is working on certification. It is well worth your time to investigate....so you can work collaboratively with your therapist.
And if those costs aren't outrageous enough, make sure you ask for an "assessment."
If they don't know what you're talking about when you ask how much their assessment is, you're not talking to a trained Couples Therapist.
A Gottman assessment is held over 2 individual and 2 conjoint (couples) sessions. It requires you to complete an extensive written assessment online, which is scored and analyzed. It will run you between $650-$1100, but it will shorten your treatment.
You'll understand what you'll be working on and why from a scientific perspective. And maybe learn that couples therapy is a bad first move for both of you.
An extensive assessment looks at how your relationship compares in many key areas to couples just like you. When you complete it, you may realize things are bad, but they Aren't That Bad. In other words, you'll realize that the kids are well cared for, no one is being beaten, drugs and alcohol aren't clouding the picture, or the affair wasn't the third in a series, and this one is happening with your sister...
And more good news: you probably believe that your marriage is worse off than it really is. Based upon this little known psychological marital phenomenon, couples famously focus on the negative and ignore the positive. Without proper training, it's almost impossible for the untrained ear to know the difference between an angry "productive" fight, and a destructive one. They may sound the same, but they're not. And your relationship may seem hopeless even to an untrained therapist!
I read on the internet that you can hire a couples therapist for $50. I know of no couples therapist who would see a couple for 80 minutes and charge $50, except in financial hardship cases in a public clinic or University clinic setting.
Would you expect quality care for (let's do that math: $50 / 90 minutes) 55 cents a minute? Fifty dollars will cut your lawn or clean your (small) house. The average plumber costs $45-$150 an hour, (a trade without the burden of college loans...) A short visit to fix a backed-up septic can run $350 (ask me how I know...)
In contrast, when you hire a couples therapist, you are not paying by the hour, you're paying for someone who can save or improve the most important relationship in your life.
And it's not going to be cheap.
An average couples therapist with formal institute training and a decade of experience is going to run you about $125-$200 for a 45-minute session, depending upon the area of the country you live in.
But you don't want sessions that brief.
You want a pro-rated session of 80-90 minutes that is going to run you closer to $250-$300. OUCH.
You also want to think about your marital work as a "holistic treatment," not as a series of individual "sessions." A marriage that spent 6 years in trouble isn't going to magically turn around in 4 sessions.
A professional assessment will tell you that. How long depends upon a variety of issues:
It surprises a lot of people to learn that the length of treatment doesn't depend upon how many issues you have or how badly you fight.
Good couples therapy teaches you HOW to fight and HOW to resolve the third of your issues that can be resolved and how to manage (not resolve) the other 2/3rds. After that, managing them one-by-one takes time, but not necessarily therapy time.
You're learning a strategy to cope with challenging differences. You'll be learning where to place your time and emotional attention, and what to ignore.
You'll also be learning what's going to change in your relationship, and what's 'baked in the cake.'
It's hard to say just how long good couples therapy takes because there is not a lot of it happening out there. But right now, that's changing. We're in a renaissance, as more and more generalists (All Purpose Therapists) are recognizing that they just can't see couples as an add-on to their individual private practices.
When either or both partners have mental health issues like depression, bipolar disorder, PTSD, ADD, or Aspergers, these "comorbidities" need targeted treatment (often in individual therapy) and management. This will also impact treatment length.
Initially, most trained couples therapists will want to see you for a concentrated block of time for "traction." If you are being seen weekly, that's 6-12 sessions of 1 hour 20 minutes each.
Understanding and applying the concepts being introduced can be challenging for some couples. There is so much misinformation out there about what effective couples therapy is, and how it's done. Couples come in with false expectations, and helping them to understand why they are there and what the goals are can be a task in and of itself.
There is also a lot to cover, as the average couple waits over 6 years before asking for help. After about 6-12 weeks, spreading out the sessions is common. When treatment is complete, "relapse prevention sessions," spaced 6 months apart, have been scientifically demonstrated to improve skill-retention.
That will come to about $3000-$6000 for a therapist with advanced training and approximately 10 years of clinical experience. Perhaps twice that for a therapist with certifications in an evidence-based model and 20+ years of experience. The choice is yours. And because training is so important, you can find clinical interns or transitioning professionals who will charge less, but still do right by you both. Do your research and check their formal training.
Before you throw up you hand up, consider this:
And I'll be honest with you, it's gotten harder to spot a good couples therapist.
What do I mean?
You used to be able to tell someone who does good marriage counseling from the "me too" All Purpose Therapists by asking: "What approach do you use?" And if they had no idea what you were talking about, you could go on to the next person on the list.
But more and more, even intelligent consumers, once they hear the words "Gottman" or "EFT" ask no more questions. This happened to us recently when we tried to locate a regional weekly therapist for one of our Intensive Couples Retreat clients.
We asked the therapist we were interviewing about his model of couples therapy:
"I use Gottman." he said.
Do you have training in it?
What level of training?
"I went to a lecture."
When asked why he didn't seek out more structured, formal training at the Gottman Institute, his reply was illuminating:
"I've got no time for that."
And neither did we. We hung up and moved on.
Of course, we knew that any single lecture was introductory at best for a serious professional, but he was smart enough to know what the public wanted and pretended to give it to them.
That's a big shift in how "All Purpose Therapists" present themselves, from even 2 years ago.
Another site claimed that their therapists were certified by three initials that spelled out their organization. It would be like us claiming we had: "CTI Certified Therapists."
Of course, with two certified Gottman TRAINERS on our team, we could train our own therapists. But they'd still be Gottman trained and not "CTI" trained. Why that organization doesn't simply insist the therapists on their team get authentically credentialed is an unanswered question.
And, not surprisingly, those "ABC Trained" therapists were exceptionally inexpensive for their 50-minute sessions.
Unfortunately, it makes it much harder for couples in trouble to find the help that they need.
To qualify for our organization (Couples Therapy Inc.) as a referral source, we look for at least Level One Gottman Training (two full days) and Level Two Gottman Training (two full days), as well as a significant ongoing commitment to seeing couples in their practice. These are the criteria we use to recommend a local therapist to our clients.
Clients are easily fooled by therapists who say their work is: "Gottman informed" or "uses Emotionally Focused Therapy." But this is not the same as those who proudly list the actual certifications they have achieved in those formal training institutes.
It's expensive. Figure you can hire:
You can also save money by purchasing of a block of sessions all at once. Many therapists will offer blocks of 6-12 sessions for 5%-20% off their stand-alone rates.
Doing so has advantages to both of you.
Yes, you save money, but more importantly, you have a set schedule of regular attendance at the start...when it's most important.
The therapist is helped because they save on accounting and scheduling costs.
It's a win-win.
This idea of buying Marriage Counseling sessions in blocks of time is new, so ask your marriage counselor if they offer this type of discount.
Financial costs are just one consideration in the decision to hire a marriage counselor. Most people recognize that a skilled couples therapist doesn't compete against other couples therapists, but against divorce attorneys. When looked at from that perspective, financial costs appear much less costly than the multi-generational consequences of living in a miserable marriage. Or divorce.
Dr. K is the President and CEO of Couples Therapy Inc. She maintains her Intensive Couples Therapy practice over the winter in Miami, Fl and the rest of the year in Boston and on the edge of the Berkshires in Western Massachusetts. She is a Gottman Certified Couples Therapist, has advanced training in Emotionally Focused Couples Therapy, and has been a AASECT board-certified sex therapist from 1982-2017. She continues her work in sex therapy.