It is not uncommon, when going through the initial stages of a self-referral that a client exclaims ‘Do you mean I have to pay for this?’ when we discuss their contribution. Alternatively, someone may interject with some vehemence that they thought we were a charity, implying that therefore, the counselling should be free. Understandably, others often point out that this should be provided for free under the NHS anyway. However affordable we aim to be, for some clients who may well benefit from the help we offer, the lowest rate remains beyond their means.
In a world where prices for goods and services keep creeping up, and incomes certainly don’t for most people, the cost of counselling may feel like a luxury that is completely out of the question. At times the buy-in is there but, there are simply too many pulls on already strained purse strings. Sometimes people struggle to understand how a chat, as counselling is sometimes described, can possibly make a difference in the first place. Additionally, perceptions of what is needed vary enormously. For some an hour is too long and weekly is too frequent. For others an hour is too short and it seems impossible to be tied to the same time on the same day for weeks on end. For some twenty sessions seems excessive, for others not enough. Why be so prescriptive then?
Predictability makes our world safe because we know what to expect. Whilst an element of flexibility can be useful, regular therapeutic input supports best chances of getting to a desired outcome. It is a little like training the body, regular practice makes progress. Whether it is feeling difficult feelings or doing things differently, fundamentally, training the mind also needs regular practice. The impact of the previous session is gently compounded over time. Sometimes, at first, this is imperceptible. Clients even report that they feel worse in the early days. If you’ve ever tried running, can you remember what your muscles were telling you after the first attempt? If you persevered, you likely got fitter, eventually.
To try and detangle all this, I will say first that counselling is much more than just a chat. It is a craft slowly developed through many hours making sense of theories of human development, of what enables change, of how we relate to others (and many more), alongside more hours of placement practice with close monitoring to ensure safety and effectiveness. In short, Counselling/psychotherapy training is costly, financially of course but also emotionally and intellectually and sometimes relationally.
The counsellor is trained, overs years, to listen to all that you are conveying, what you say of course, but also what you don’t say, what you persevere with and what you don’t, the tone of your voice and that of your silences, how you talk about others and how you talk about and to yourself. They help you pick up patterns and use how you are in therapy as an indication of how you are in real life. They are there to help you open up full stop, open up to your experiences (all of them), open up to different perspectives, open up to change, open up to others, open up to a future you cannot even begin to imagine. They are there to help you take responsibility for your own actions and what they contributed to in your relationships and your life. They help you zoom in when needed and take a broader perspective when you are stuck in the minutiae of life. There is more of course but this gives you a flavour of what goes on in the background in a therapy session to make it beneficial.
To make sure that the work remains useful, in training and after, therapists have regular supervision with more experience and specifically trained supervisors. At times, professionals seek their own therapy to manage the impact of their work and the challenges in their own lives. This is part of the commitment to the work remaining safe and has a cost too of course. Continuous professional development is an ethical requirement. That too comes at a cost. This is why, whilst in certain circumstances therapy may be fully funded, it is never free. In an organisation, there are staff costs, premises cost, tech costs, insurance costs so a service can be provided. Cogwheel’s mission as a charity is to make counselling more affordable and accessible to as many people as possible.
Most people would not expect an electrician, barber, dentist or surgeon, all trained and qualified professionals, to work for free because the work is needed and if they really cared, they would. We all seek a bargain and yet understand the food shopping is going to have a cost that we do not have the power to change however expensive, even unaffordable, we believe it is. In many cases, there is a psychological shift to be made to recognize that therapy has a value in monetary terms and that you, the client, are worthy of this even when there are many things competing for funds in your life.
Whilst this argument cannot stand in cases of extreme poverty, therapy is an investment in your mental and emotional health. As you likely know, the mental impacts the physical and vice versa. That makes it an investment in your physical health. With work, communications can improve, relationships can be attended to meaning this investment returns dividends relationally too. The gains can be tremendous when persevering. Clearly it is not a miracle cure neither and does indeed require work that is at times painful and challenging.
So, indeed, I’m afraid we are a charity and there is a charge. You may want to ponder on this next question: You don’t have to pay for this clearly, can you afford not to? And for good measure, have a think about the costs of not going ahead.
