MARRIAGE THERAPY: COST, LENGTH, INSURANCE, SUCCESS RATE?
© 2020 Richard Chandler, MA, LPC, Masters in Psychotherapy, Licensed Professional Counselor
As a marriage therapist and couples’ counselor who specializes in marriage therapy, questions about the cost, frequency, number of sessions, insurance coverage, and success rate are common. People want to know these factors so they may be confident about beginning marriage counseling.
Although the most accurate answer to all of these questions is, “it varies,” the following information may be helpful if you, or a couple that you know, are considering marriage therapy.
What is the Cost of Couples Counseling?
Although the cost for marriage therapy varies a great deal based on the education, experience and locality of the marriage therapist, a low of $60 and a high of $200 is a typical range. My rate here in St. Cloud, MN is $135, with a sliding fee scale of $95 - $135.
Most marriage counselors charge by the session, with payment due at its conclusion. Acceptable forms of payment for most marriage counseling professionals include credit card, check, and cash.
Typically, the cost of a session involving two people is the same rate as for an individual session. But this is not always the case.
A More Extended Session-Length May Increase the Cost of Each Session
Most psychotherapists schedule on the hour. Insurance companies generally only pay for 45-minute or 50-minute sessions. Because most therapists work with insurance companies, scheduling appointments an hour apart is typical. But with two people in the room, rather than just one, it often takes longer to do productive work within the session than it does with individual therapy. It frequently takes more time due to bickering and getting past feeling defensive when a husband or wife has been critical of their partner.
Like me, many experienced marriage counselors find that scheduling on-the-hour is not as effective when doing couples counseling. It is not uncommon that couples’ counselors schedule their sessions every hour and a half as I do in my practice.
The Education of the Marriage Therapist May Impact the Cost of Sessions
Most states have as many as six mental health licenses. All of those licenses in Minnesota and most other USA states permit the psychotherapist to practice marriage therapy.
The underlying Master’s degree level training needed to earn a “Marriage and Family Therapy License (LMFT)” is considerably more extensive and focused on couples than the coursework preparation for the other mental health licenses. I had the underlying courses to obtain both the LMFT license as well as a Licensed Professional Clinical Counselor license (LPCC).
My primary psychotherapeutic work is devoted to helping committed couples. I elected to get a Licensed Professional Counselor (LPC) license because I did not want to diagnose clients with mental illnesses to help them with their careers, relationships, and marriages. I also wanted a higher degree of confidentiality for my clients than is possible when therapists are required to upload their client’s confidential information, including each session’s treatment notes, to insurance company data banks.
Because insurance companies and governmental agencies do not typically work with LPC’s, it was the ideal license for me, despite having the training for obtaining a Licensed Marriage and Family Therapy license.
Lower Cost Therapy is Often Due to Counselor Inexperience
Like many people new in their business or profession, less experienced people often charge less than those with years of experience. New practitioners need to make a start, and one way to appeal to potential clients is to offer services well below market value. When you see low fees for marriage therapy, well below $100 per session, practitioner inexperience may be the primary reason.
Specialization in Marriage Therapy Can Justify a Higher Session Fee
Specialists in many fields command higher fees than generalists. Therapists who do not specialize may work with a wide age range in clients, from children to people experiencing geriatric challenges. Another common way to be a psychology generalist is to work with a wide variety of mental health challenges.
As a specialist in couples counseling and marriage therapy, I have been able to gain greater insight into how to work constructively with couples with significant challenges to remaining romantic partners. Infidelity, anger, low trust, parenting disagreement, and conflict with in-laws and relatives are just a few of the complex issues faced by couples in distress. Had I not focused on marriage therapy, I would not have the experience to be as effective. Specialization in marriage counseling is a reasonable factor in commanding a higher fee for psychotherapists.
Urban vs. Rural Location of the Therapist Impacts Cost
If most of the practitioners in a locale are towards the low end, or the high end, of the $50 - $200 session rate range for marriage therapy sessions, therapist location is often the primary variable in cost. The costs of living in a city tend to be higher. The salaries and hourly wages for urban residents are also typically higher. In general, smaller town marriage counseling is likely to have the lowest fees. Medium-sized cities tend to have session fees priced in the mid-range. Larger cities often have the highest session fees.
Online vs. In-person Marriage Counseling Can Impact the Pricing of Marriage Counseling
There has been a significant rise in online marriage therapy as an option. Although I primarily work with couples in my St. Cloud, MN office, some couples have also worked with me remotely. Doing both telephone and video-based marriage therapy versus in-person couples counseling has given me the experience to know the advantages and disadvantages of both.
From my perspective, in-person marriage counseling is superior. The nuances, the body language, and the ability for couples to interact directly with each other contribute significantly to the effectiveness and progress of couples counseling.
Larger national companies are now doing couples counseling. They recruit practitioners who do not wish to have the expense of renting a professional office or the cost and work involved to attract their clients directly. Consequently, those online practitioners earn significantly less than they might receive if they had independent in-person practices.
Because those corporate firms pay substantially less for their counselors, and since they do not have the expense of renting physical office space, they can be lower cost. But bear in mind that the quality of online couples counseling as compared to in-person marriage therapy may significantly differ.
What Might Be the Financial Cost of not Seeking Professional Marriage Counseling?
The following list provides a few of the many potential financial costs of not beginning marriage therapy:
- The cost of not making financial decisions together. When couples are not communicating all that well, often one of them will begin having financial infidelity of some kind, such as spending with credit cards unbeknownst to their partner
- The cost of renting an additional living space if the husband or wife moves out
- The cost of divorce attorneys, which can range between $5,000 - $20,000 per person in Central Minnesota
- The cost of having to sell a large joint asset quickly, such house or a boat, in order to settle a divorce
- The increased cost of daycare when one of the partners, or a partner's relative, is no longer available to watch their children
- The cost of paying state and federal taxes as a single person rather than as a married person.
Questions of Length in Marriage Therapy
Questions on length in couples counseling encompass the factors of session length, frequency of session, and the overall number of sessions a couple might have before the marriage therapy concludes. Along with cost, time factors may weigh into your decision to enter into relationship counseling.
How Long Does Each Session Last?
The most common length of each marriage counseling session in the United States is about 50 minutes. Most psychotherapists schedule on the hour, leaving only 10 minutes to jot down a few notes and take a restroom break. It may be closer to 45 minutes if the marriage counselor is also responsible for scheduling the next appointment and transacting the payment for the session.
A minority of marriage therapists provide their clients with a full hour of therapy by scheduling every hour and 15 minutes. Doing so is a more honest representation of therapy time than stating that sessions are an hour in length when, in fact, they are scheduled on the hour, allowing for only 50 minutes.
An even smaller percentage of couples counselors plan client sessions at intervals of 1.5 hours, allowing sessions to run a little over an hour when helpful. All of my sessions, with individuals and couples, are scheduled every hour and a half. I have the flexibility to continue the session, when helpful, rather than having to cut it off.
What is a typical frequency of sessions in Couples’ Counseling?
Every other week is a standard frequency in marriage therapy. It allows couples enough time to incorporate what they learn in counseling sessions into their routines and communication with each other. This frequency also helps mates keep forward momentum. When there is too much time between sessions, it is easy for couples to fall back into their old patterns.
In my practice, I find that with couples whose marriage is on the verge of suddenly ending, as can be the case with infidelity, angry, aggressive outbursts, or severe threats of divorce, it is best to see the couple weekly until they stabilize. Once there is less likelihood of a sudden exit by one of the partners, an every-other-week schedule will follow the initial weekly sessions.
As partners can incorporate what they learn in marriage therapy into their daily lives, it is usual for them to get along much better. Therefore, the frequency of sessions may be backed down. In my practice, I encourage every three weeks for a few sessions, then monthly for some time, so improvements continue, and old patterns do not re-emerge. Another three or four monthly sessions could be ideal before ending the marriage counseling.
While the time frames outlined above are typical, the frequency of sessions is impacted by unpredictable schedules due to the health of the couple and their kids, babysitter, and daycare complications, holidays, changing work schedules, and a great many other unpredictable factors.
How Many Sessions is Common with Marriage Counseling?
The number of marriage therapy sessions that couples complete before concluding varies widely, ranging from one to as many as 20 sessions. Knowing the average number of sessions is not necessarily helpful, because couples often end their couples counseling sessions prematurely for a variety of reasons, including:
Financial stress. They are getting along better, and one or the other declares it “good enough.” The pain of not getting along is less than their perceived pain of paying for marriage counseling.
One of them has observed that his or her partner hasn’t put marriage therapy suggestions into action and concluded that additional sessions are a waste of time and money.
On the other hand, a good many couples are committed to healing their relationship and stay with counseling until it concludes by graduating from marriage therapy. The couple now has the confidence that they have learned the tools and acquired the skills to be able to continue being happy together without the professional facilitation of a marriage therapist.
Why Doesn't Insurance Cover Marriage Therapy?
The reason insurance does not cover couples and marriage counseling is because trouble in your relationship is not a diagnosable mental illness. Insurance, including government coverage, only covers diagnosable mental illnesses.
Mental Illness is paid like a physical illness
Here is what the difference is: By law, mental illnesses are now on par with physical diseases. What makes a psychological issue eligible for payment under insurance and government programs is that it is diagnosable as a mental illness and treatable using either psychotherapy, medications, or both. For insurance to pay, the psychotherapist must directly treat your diagnosed mental illness. This is very different from helping a couple communicate better or to heal the relationship from infidelity.
Would Insurance Cover Marriage Therapy if a Diagnosed Mental Illness Impacted Our Marriage?
Although, in some cases, a primary contributing factor to not getting along could be a diagnosable mental illness, it rarer than not. If that would be the case, after diagnosing you or your partner and beginning individual therapy, the other person could be brought in to the 'individual counseling session' from time-to-time to support the changes the person with the diagnosed mental illness is endeavoring to make.
Bringing a mate into an individual session here and there is not marriage counseling. The psychotherapy's purpose is to understand more deeply what the person in therapy is working on, and their partner's role in helping rather than hindering their progress. Insurance pays for that individual session where a romantic partner is present as it does with any other 'individual session.'
The Risk of Attempting to Pay for Couples Counseling with Insurance
If you call a therapist to inquire about couples' therapy, and that person, or their staff, tells you that your insurance can pay for your couples counseling, your insurance company would falsely believe it is individual counseling as described above.
The only way to have your insurance plan pay for your couples' counseling is to misinform your insurance company. They cannot know the truth about the true nature of the work that you and your partner are doing together, or they would not and could not pay for it.
If a counselor engages in misinforming your insurance company, and your insurer discovers that you have been doing marriage therapy rather than treatment of mental illness as individual therapy, they are likely to deny payment. In that case, you would owe the counselor 's firm.
The unexpected bill could be quite large. You may have had quite a few sessions before your insurance company figures out that the counseling was not treating diagnosed mental illness, and you learn that they had denied the claim.
Even though you must pay on your own, counseling to help your romantic relationship is probably worth it for you and your mate. Marriage counseling is still much less costly than ending your relationship.
Is the Success Rate for Marriage Counseling Predictable?
Although it is impossible to accurately predict whether or not marriage counseling will heal your relationship, there are predictive factors as shown by the renowned marriage researcher, John Gottman, PhD.
Research Studies Show Factors that Predict Whether Marriages Last or End in Divorce
In a research study by the Iranian Journal of Psychiatry in May of 2018, the John Gottman method for couples is evaluated.
In their paper outlining their research, the authors list several critical factors Dr. John Gottman, has identified as being essential for couples staying with their current romantic partner. They are:
- A ratio of positive interactions outnumbering negative ones of five positive, or higher, to every negative interaction
- A willingness to share their inner world with their romantic partner, including thoughts, wants, and feelings
- Mates express a high degree of interest in the inner life of their partner, including their mate's ideas, beliefs, emotions, hopes, fears. And, most importantly, how each feels about the other
- Both express appreciation and admiration for their partner
- The relationship shows movement towards each other, rather than distancing from each other
- Criticism, defensiveness, words, and gestures of contempt (like eye-rolling) and stonewalling behaviors (like refusing to communicate), are absent
- The couple devotes time and attention to increasing their friendship, emotional, and physical intimacy
I teach all of the above critical factors to my couples. The success rate of couples in marriage therapy is dependent on the extent to which both partners:
- Are willing to no longer engage in relationship-sabotaging behaviors, despite how they have communicated and behaved in the past
- Have become dedicated to consistently engaging with each other through espressions of goodwill, positive communications and helpful actions
Alcohol, Marijuana or Drug Dependency Dramatically Lower Successful Couples' Counseling Outcomes
As a marriage therapist, I must know if chemical dependency is a factor in a couple's difficulties. My criteria for alcohol is the number of drinks or 12 - 16 oz. beers a person consecutively drinks. I'm not overly concerned that one or two drinks in a day will hinder a couple's progress. In my view, any more than that will prevent the couple from getting better. Here is why:
- In many instances, severe problems in the relationship, such as angry outbursts, infidelity, and financial stress, were contributed to by inebriation with alcohol, drugs, or marijuana. The spouse, and even the person with chemical dependency themselves, cannot trust that the same or similar problems will not reoccur if the substance dependency continues.
- A big part of success in relationship therapy is increasing each partner's insight and their unimpaired access to their higher mental processes. When people use drugs that alter their minds or use alcohol at even low levels of inebriation, insight, and access to higher mental processing is diminished. This diminished access sustains for weeks after an instance of inebriation. People who stop indulging often say that it took them two to four weeks before their mind cleared.
- Responsibility for making real change in behavior does not occur when a person chooses to escape rather than stay with the discomfort of changing behavior. The habit of not facing one's problems, but instead escaping into inebriation, gives evidence for the person indulging, and their mate, that they are not ready and not willing to be accountable.
A Couple's Inside Distance Invites Outside Intimacy
My work as a counseling therapist is to encourage this rekindling and help the couple clear their barriers to long-term happiness. When mates are doing well together, they are sharing their lives as a romantic couple, rather than having most of their identity and energy tied up in being mom and dad (to pets as well as children), or grandma and grandma. The ingredients for being a happy, romantic couple retain much of the excitement and delight of courtship. Those ingredients include new shared experiences, lots of talking with each other, a good deal of affection expressed physically, and of course, sex.
But when mates have distance between them, the opposite may be observed:
- The couple has stopped thinking of each other as their boyfriend or girlfriend. Instead, their identity is about kids or grandkids and not each other.
- There typically has been an absence of new adventures together, including travel, seeing movies or plays, and going out on dates
- In-depth conversations with each other have diminished or even stopped (other than when arguing).
- Frequent touch, hugs, kisses, hand-holding, and body closeness is at a low level, if at all.
- The couple now has a low-sex or a no-sex marriage or romantic partnership.
Inside distance contributes to outside intimacy, which is an openness to another person outside of the marriage— this longing for friendship, adventure, affection, and sexual desire can render a romantic partner vulnerable to infidelity. Unless both people in the current relationship are committed to rekindling the romance that initially brought them together, the success rate of marriage counseling is likely to be on the low side. My work as a counseling therapist is to encourage this rekindling and help the couple clear their barriers to long-term happiness.
Loose Boundaries Invite Romantic Entanglements with Others
Inside distance is not the only contributing factor. In my work with couples who did not succeed in healing from infidelity, another significant factor has been "loose boundaries." When working with a couple in which one of them had an affair (including inappropriate emotional entanglements, flirting, texting, snap chatting, sexting, and messaging), the harmful behavior has continued to some extent.
Despite my emphasizing the importance of establishing iron-clad boundaries to keep their relationship safe, the offending partner has kept up some level inappropriate communications with people outside of the romantic partnership. Those sustained loose boundaries may be due to several factors that I explore with the couple. But unless the "loose boundaries" partner stops this behavior, the couples counseling will not succeed in healing the romantic partnership.
The Professional & Personal Experience, Education, Skill Level and Neutrality of Your Marriage Therapist
When there are very different perspectives or some problematic history, such as due to infidelity, to work through, the education, experience skill, and neutrality of the couples counselor is a significant factor in becoming a happy couple once again. In my phone consultation with one or both partners, before scheduling the first session, questions about my credentials and experience are sometimes asked.
A common question is whether or not I am currently married. The answer is yes. I am and have been happily married since 1995. Before getting married, we also lived together for three years. My current marriage to Bonnett Chandler is not my only experience of being married. When I was in my very early 20's, I had a year of living together, followed by a 15-year marriage that included having three children (who have been adults for many years).
The experience of being in a marriage that did not work out, alongside my current happy and fulfilling romantic partnership, informs my work with couples.
The Commitment to Do Things Differently as Shown by Real Action
Of all of the variables, in my view, this is the most critical one for determining the success rate of couples counseling. Without the willingness to do things differently, and that willingness proved by observable action, the other factors will not lead to real change.
What many spouses do is to complain about their partner, insisting that he or she must change. But only pointing out what their mate needs to do without taking responsibility for their communications and behavior, it is unlikely that the couple will have success with renewing their relationship through marriage therapy.
Many More Variables Can Impact the success rate of Marriage Therapy
There are many variables that impact how well couples therapy will work for your mate and you. The following are also significant factors that I have found in my couples' counseling practice:
- Allowing Others to be Overly Involved in Your Romantic Partnership
- Putting Relationships with Children, Friends, or Family Members Ahead of a Mate
- Equal vs. Unequal Power Balance in the Relationship
- Behaviors Consistent with a Personality Disorder
- Mental Illness in One or Both Partners
- Has Your Relationship had Dramatic and Frequent Highs & Lows Cycles?
- Willingness vs. Unwillingness to Question and Change Beliefs
- Cultural and Gender-biased Beliefs
* Telephone and video conferencing sessions may be arranged if there is a barrier to meeting face-to-face. Although couples counseling isn't covered by insurance, our rates are affordable. We also have a sliding fee scale with reasonable minimums. We do not ask financial questions to qualify for our sliding fee scale. You simply choose the amount that is comfortable for you and your budget.
* We Welcome & Affirm LGBTQ Individual Clients and Couples.
* We respectfully serve African-American Clients
We have reasonable rates and a sliding fee scale.
Call or Text 320-223-9481 for a no-cost consult or to schedule Click Here for Driving Directions
1204 7th St S
St Cloud, MN 56301
Our office building is just south of Tech High School and overlooks Lake George. Parking is very near our building for clients both in the back and the side of our building.
This is also the office of our business consulting service, Strategic Leadership Consultants of MN