“I feel a little stupid, because when I talk about money problems my psychologist encourages me to cut back everywhere except in therapy. She doesn't offer me to distance the sessions. She doesn't offer to distance them or anything, and she is making me keep my eyes behind my ear, because I feel like I no longer need as much frequency as I did at the beginning." Virginia, 27-year-old computer engineer. [the names of the testimonials in this article have been changed to protect her anonymity]
“My psychologist did everything he could to help me and even then I will never be able to repay the debt I owe him. He went twice a week and he let me have it at half price. Afterwards he told me to pay him what he could but for him to keep going.” Priscilla, cultural manager, 45 years old.
“I stopped going to a Gestalt psychotherapist because she charged me black and inconveniently. She gave him the ticket at the end of the session. She made me feel terrible, to be honest.” Cristina, communicator, 42 years old.
The three previous testimonies reflect common situations that usually occur in a specific space, which is generated when money and therapy intersect. The greatest concern and destigmatization around the idea of seeking professional help to overcome mental health problems, added to the incontrovertible fact that public health is not enough to care for all these cases – in Catalonia, there are only nine psychologists for every 100,000 inhabitants, half of the European average, while Spain as a whole is around five – give rise to this reality.
There are more and more people who must pay to have access to treatment in private consultations, and this factor frequently affects the therapy itself. That there may be, for example, a loss of trust on the part of the patient when the therapist insists on maintaining a higher frequency of visits – the question often arises: is he saying this because I really need it or because he charges me more? – or that there is a breakdown in that relationship, always delicate, from a session that did not occur due to an unforeseen event, but that was paid for.
The standard among mental health professionals is that a session that was scheduled and is canceled with less than 24 hours of margin is charged, since the therapist has already committed that hour or 45 minutes. But, although the majority makes exceptions to their own rule, many patients experience it as an unfair penalty.
“One day I couldn't arrive because the Bicing system crashed, I was 20 minutes late, and my psychologist told me that I had to pay for the session,” explains Pedro, a 27-year-old administrative technician. “I know she had explained that cancellation policy to me.” But that transformed our relationship a lot, because I started to see her as someone cruel, almost not very human. My trust was broken because if this person is not able to understand that for me those 60 euros were a problem. I explained it to her in a message, she told me that she left it up to me to pay her or not. I did, but I stopped seeing it.” In this case, Pedro emphasizes that the economic and job insecurity at that time in his life was one of the reasons that pushed him to seek therapy and the anguish that this caused him was a frequent topic in the sessions.
The College of Psychologists does not make any indication regarding the rates for private consultations and prices range from 40 euros, which some professionals can still charge, up to 125 euros per session, depending on the location of the consultation, the type of practice. , the degree of specialization and the experience of the analyst. The most common thing is to charge around 60/70 euros per session in the city of Barcelona, and it is very common for analysts to request or prefer that payment be made in cash.
“In my case, 95% of payments occur by card or transfer,” says psychologist Beatriz Gil, who practices cognitive behavioral therapy and specializes in self-esteem and leadership issues. She charges 125 euros for the first visit, lasting one hour, and 100 for subsequent visits, lasting 45 minutes. “This price may not be accessible to everyone – she admits – but you have to think that behind our fees there are many years of training, practice, dedication. It's not just the 45 minutes, it's the tools and strategies behind it. We see many people spend on clothes, trips, dinners and it is socially accepted, but when it comes to investing in our mental health, reluctance appears.”
Gil agrees to reduce his rate with both new patients and existing patients who may be having a worse financial time. “It is not common for them to ask for it either, because the financial commitment is part of the general commitment that is established when you go to therapy,” he argues. The psychologist admits that money can interfere with the therapy itself but that both parties should seek sufficient flexibility so that this does not happen.
Carolina, a communicator who is now 47 years old, began going to therapy when she was very young, mainly to address issues related to a very complex family environment, which included addiction problems, a diagnosis of bipolarity in a brother, and abusive behavior and father's violent “In my early twenties, I basically lived to pay for therapy, a very orthodox psychoanalytic type. People traveled, they got their license...I invested everything in therapy, that's where all my effort went." Even so, since she went several times a week, she accumulated a debt with her analyst, which allowed her payment flexibility, of up to 4,000 euros.
For a while, they both agreed to stop the visits precisely so that she could save and become independent, for the sake of her mental health, and after resuming them, money once again became an important factor. “It was talked about in therapy. What happened if she didn't pay, how I felt about the money, what I felt the therapist should do if she didn't pay her, if she felt uncared for... and at a certain point she turned off my water. She explained to me that it was an inconsistency, like I was swinging and starting to consider her a colleague. She upset me a little.”
If friction can appear in the treatment between adults, when it comes to private child therapy, new elements usually appear. “There is a lot of mistrust on the part of families, and I can understand it,” says Sylvie Pérez Lima, child psychologist and educational psychologist. “As a lot of work is done through the adult and it is translated into parenting guidelines, many doubts arise.”
The analyst, who works in the public sphere in Martorell, believes that it is good practice when it comes to children to notify of a fixed price for a diagnosis (if there are suspicions of ADHD or autism, for example), which involves several sessions and tests. , which is usually around 500 or 600 euros. From there, in children, a distinction is made between verbal therapy sessions, which are more expensive (about 60 or 70 euros, as in adults) and re-education sessions (35 to 50).
Since the Department of Education grants scholarships for some of these cases that are paid at the end of the course, many psychological and psychopedagogical offices agree to defer payment, which implies that the professional is advancing his money to cover all his expenses, including those derived from the rental of the consultation.
With a public system that it denounces as “collapsed” and insufficient scholarships, it is not even close to covering all the needs in child and adolescent mental health. "And in the end what happens is that many children who need real psychological care are left without being able to access it for economic reasons, and many of those who, according to clinical criteria, would not require serious or urgent treatment are receiving diagnoses and treatment, because They can access them.”
For adults, the Col·legi de Psicòlegs de Catalunya also offers a service little known to the general population, the Psicoxarxa Solidària, which offers psychological treatment free of charge or at a very low price to people who demonstrate that they do not have the financial resources to pay for it.
