How Much Does Couples Therapy Cost?

Asking about cost early on in the consult process is important. The answer will depend on a few factors. 

What you pay depends on where you live, who you see, and whether insurance treats your sessions as covered care. This guide explains the relevant pieces so you can figure out what you can reasonably pay, and focus on finding a good fit. 

What Determines the Cost of Couples Therapy?

A handful of things account for most of the variation between out-of-pocket costs. 

• Whether insurance applies. This usually matters most.  A covered in-network session and a private-pay session can cost very different amounts. 
• Where you live. Rates follow local markets, so therapy in a major metro area generally costs more than a smaller city or a rural county.
• The therapist’s license and training. Doctoral-level clinicians often charge more than master’s-level ones. Specialized certification in a particular couples model can also raise the rate.
• Session length. Many couples therapists book longer than the standard individual hour, and a 75- or 90-minute session costs more than a 50-minute one.
• Intensives. Some practices offer weekend or multi-day formats, where you might pay more upfront, though less overall. 

We intentionally do not publish a specific range.  Rates change and vary enormously by region, so we don’t want to mislead you.  Two or three consultation calls with providers in your area will give you more accurate information than any averages. 

Does Insurance Cover Couples Therapy?

Sometimes, and we think it’s important for you to know when it is and isn’t. 

Mental health and substance use services are one of the ten essential health benefit categories that non-grandfathered individual and small group plans must cover under the Affordable Care Act. That is why therapy is generally covered. It does not automatically extend to relationship counseling.

Insurers tend to pay for care that treats a diagnosed health condition. When couples sessions are billed as part of treating one partner’s condition, such as depression or PTSD, coverage is more likely. When the reason is getting support for the relationship itself, plans often decline. This is why some couples therapists work privately by default rather than billing insurance at all.

None of this is universal. Plans and states differ, and the only reliable way to find out is to ask your insurer directly about couples or family sessions before you start.

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What Do Deductibles, Coinsurance, and Copays Mean for Your Bill?

Here are three important terms for you to understand your out-of-pocket costs: 

• Deductible. The amount you pay each year before your plan starts contributing. Until it is met, you may pay the full negotiated rate per session.
• Coinsurance. A percentage of the cost that you cover after the deductible is met. Under Medicare Part B, for example, you generally pay 20 percent of the approved amount once the deductible is satisfied.
• Copay. A flat amount per visit, set by your plan regardless of what the session costs. Copays usually apply instead of coinsurance, and are generally limited to in-network coverage.

Most plans also have an annual out-of-pocket maximum. Once you reach it, your plan generally covers the rest of your covered care that year.

What If Our Insurance Does Not Cover Couples Therapy?

You still have several routes worth pursuing. 

• Ask about a sliding scale. Many therapists reserve a portion of their caseload for reduced fees. Worth asking about, and they may take your household income and family size into account. 
• Check your out-of-network benefits. Some plans reimburse part of what you pay an out-of-network therapist. You pay upfront and submit a receipt called a superbill
• Look at your employer. Employee assistance programs often include a set number of free sessions, and some cover couples work.
• Try a training clinic or community center. University programs and community mental health centers often use income-based fees.
• Ask about spacing sessions. Weekly sessions early on help build momentum, and once you are making progress, moving to every other week is a natural next step that also lowers the monthly cost.

Can We Use an HSA or FSA?

Often, yes. The IRS counts psychiatric care and payments to a psychologist for medical care as qualifying medical expenses for care that primarily treats or prevents a physical or mental condition.

Sessions tied to treating a diagnosed condition are more likely to qualify than counseling aimed at improving a relationship generally. We always recommend you confirm coverage with your insurance plan administrator.

How Many Sessions Will We Need?

This is important to factor into the long-term costs.  

Many couples do a few months of weekly work, though it depends on what you are addressing. Ask during your consultation for a rough estimate of length and how you  will know whether it is working. A clinician who cannot give you any sense of a time frame might not be worth meeting with.  Additionally, a slightly higher rate with a well-matched therapist might cost less overall than a less expensive one that is less effective.

How Do We Find Couples Therapy We Can Afford?

Here are a few places we recommend starting. 

Your insurance company’s directory

The cheapest option when you find someone in network when all of the factors we mentioned fit.  Directories go out of date, so confirm anyone you find is still taking your plan.

Mental Health Match

Our matching tool lets you filter by insurance and by budget, and therapists who see private-pay clients list their rates on their profiles, so you can rule out what you cannot afford before getting attached to someone. The matching tool is free and confidential.

Training clinics and community centers

Marriage and family therapists complete 2,000 to 4,000 hours of supervised clinical experience before licensure, and much of that happens in training clinics that see couples at reduced fees. You are working with someone early in their career, under close supervision.