'All you do is sit there and pull in €100 an hour.' If only he knew
Stereotype of being wealthy is a myth, writes a psychotherapist who reveals the challenges of private practice
I was walking my dog the other day and met a fellow regular park-goer. Somehow we got to talking about an expensive holiday destination, and my friend made the comment "You can afford it, I'm sure... wealthy therapist that you are!" Harry's not alone in assuming that the job of a psychotherapist is a cushy one. "All you do is sit there and pull in probably €100 an hour." I've heard that one a few times.
It's that time of year when many people decide as part of their New Year resolutions that they're finally going to make an appointment to see a therapist. And while there's a definite perception out there about the kind of person they may see, the realities are quite different.
We're a bit of a secretive profession - while people in most other lines of work might protest or speak openly in the media about things like pay and conditions, therapists don't. We're all mindful of not revealing too much about ourselves because it's part of our responsibility not to burden our clients with our own stuff. Which is why I'm writing anonymously.
But there are several misconceptions about us that it might be useful to clear up, as well as highlighting the challenges of the job - not least of which is financial.
You might imagine, for example, that psychotherapists see clients back to back like doctors; but actually the most I would see each day is four, with a maximum of 20 a week - that's the safe-practice guideline for UK psychotherapists, who work more deeply with issues and over a longer time period than counsellors. If you saw, say, six to eight clients each day, you wouldn't last very long without burning out and you wouldn't be doing a great job.
My usual fee is €65, but I do see some on low incomes for €55 - so you can work out the limits of my gross income very easily and you'll see it's not exactly high or commensurate with my education and training (eight years), or experience. And frequently I wouldn't have a full 20, there are always cancellations, or regular clients on holidays. Then, of course, I have to take into account, like others who are self-employed, the loss of income during my own holidays or sick leave. So the reality for many therapists is that a lot of the clients they are seeing are probably earning a lot more than they are - though I'm confident they imagine it's the reverse.
Recently, I had a new client storm out after just 10 minutes when I informed her of my cancellation policy. Because therapy is a weekly commitment, I ask for five working days' notice (I don't charge if we're able to reschedule within the same week). It may sound a lot but it's the only way I have of protecting my income.
It doesn't help that psychotherapy and counselling are just about the only professions in the health care sector that are required to charge VAT of 13.5pc once our income hits €37,800. Doctors, psychologists and even physiotherapists are exempt. Effectively it means that most psychotherapists cap their income just below €37,800. In fact, you'll find that many therapists maintain a different day job, seeing just a couple of clients in the evenings precisely because of how hard it can be to build up a practice and make a good living. And full-time jobs are very hard to come by.
Among the expenses involved in maintaining yourself as a therapist are indemnity insurance, professional body membership fee, advertising and supervision costs. All practising psychotherapists are required to be in ongoing supervision, usually every two weeks - so in my case, that's €80 per supervision session. Then while I work from home, many therapists have to rent a room to see clients. A colleague pays about €700 a month on room rental.
And as part of my continuing accreditation requirements, I have to complete a minimum of 30 hours of continuous professional development each year. While we are not currently State regulated, we do our best to regulate ourselves through the two main accreditation bodies - the Irish Association of Counselling and Psychotherapy and the Irish Association of Humanistic and Integrative Psychotherapy. This means attending seminars, further training, keeping up to date on latest research and reading lots of books, all at further expense.
I'm currently undertaking training in a particular approach that focuses on the advances in our knowledge of the brain at a cost of nearly €3,000 - as well as the loss of income incurred through the days at the course. But understandably, you might be wondering: "How do you fill a day with four sessions?" However, the time spent in session is probably only 60pc of my working day, with 20pc spent on self-care and the other 20pc on preparation, upskilling, supervision and practice management.
There's of course the preparation immediately before seeing a client, and writing up my notes afterwards. I also need to leave ample time between sessions to decompress - perhaps stretch, meditate or putting on loud music and dancing out all the trauma and unconscious communication I might have been exposed to in the previous hour so that I'm fit to see my next client.
For example, often a client may have difficulty owning particular emotions and so there's an unconscious projection of what they are feeling into you.
In one session recently, I was suddenly hit by intense feelings of fear and nausea; the client I was with was describing a traumatic childhood experience but was disconnected herself from the emotion of it.
At these times, it's extremely challenging because of course I can't burden my client with my own discomfort - what she's effectively asking me to do at these times is to contain those extreme feelings for her, so I have to work to calm myself while not distancing from her. It takes a lot out of you, and might help explain why so much of my time has to go into self-care.
You could say that being a therapist is more of a way of life than a job - it means always making sure to eat well, get enough sleep, exercise and meditate.
It means I have a responsibility to my clients to have a good handle on my own fears and developmental wounds and see my own therapist when necessary - so that when a client's story overlaps with mine, I don't get swept into my own inner world.
I didn't get into the profession to make money, but I did have an expectation of making a living that matched everything I had done to become a psychotherapist and everything required of me on an ongoing basis.
It's an amazing job and despite everything I've just said, I love it.
But private practice psychotherapists throughout the country are carrying an immense burden of responsibility with little in the way of State support - including supporting those who are actively suicidal.
I'm not sure what the solution is, but the current system is not ideal for therapists or clients.
I do know that there are a lot of unscrupulous people out there who have set themselves up as counsellors on the back of a six-week course who really hurt my profession, and I can only hope that regulation promised from the start of next year will go a long way towards affording accredited psychotherapists the status, greater job options and job protections they deserve.