People sometimes ask, “If therapists really care, why do they charge so much?” It’s an important question. Even Sigmund Freud thought deeply about it. He believed that paying for therapy wasn’t just about covering the therapist’s time, it actually helps protect the relationship itself.

Unlike friendships or family, therapy is designed to be a one-way street. The focus is 99% on you. You don’t have to manage your therapist’s feelings or give anything back. That freedom makes it possible to talk openly about fear, shame, guilt, or even attraction, without guilt or pressure.

And this is important: even if you sometimes feel convinced your therapist must want something more, like a friendship, a romance, or a hidden closeness, the truth is, they don’t. Even if they're were not ethical codes preventing a personal relationship, the very structure of sessions make the relationship this clear. You meet only when you choose to schedule an appointment, and you always pay for that time. You have the freedom, and responsiblity, to choose the direction of the sessions, and you have the freedom to not return if you believe otherwise. Those boundaries are not accidental. They are the clearest proof that therapy is not about your therapist's wishes or desires. The caring you feel in therapy is real, but it’s professional. A therapist couldn't do their job if they didn't care; however, it's the transactional nature (i.e. the fee) that makes that possible.

What You’re Paying For
High-quality therapy is more than just “a conversation.” It represents:

• Psychologists often spend over a decade in study, supervision, and specialization before ever starting to see clients.

• The best therapists use proven approaches like CBT, ACT, or ERP, rather than trial-and-error or tik-tok advice.

• Psychologists engage in ongoing training and professional support, ensuring that they are up to date with the evidence.

In short, Freud concluded that you’re not just paying for time, you’re paying for the chance to make it entirely about you.

And the evidence seems to support this fact: Paying Helps the Process
Here’s something surprising: research with cardiac patients found that those who traveled farther for surgery had better survival rates than those who went to their nearest hospital. Every extra 10 miles of travel distance lowered their risk of death after surgery.

Why? Effort and investment matter. When people feel more invested in their outcomes, they are more engaged, they follow through, and they value the process more deeply.

Therapy works the same way. Paying for sessions isn’t just about cost, it’s about commitment. Clients who invest are often more motivated to attend, to do the work between sessions, and to take the process seriously. It’s a signal to themselves that says: this is worth it, and I’m worth it.

WHen clients invest in their own outcomes, the therapy can save them money and stress in the long run. Better focus at work, healthier relationships, and fewer costly mistakes are just a few of the ripple effects available. And when the process is guided by skill rather than guesswork, you get more out of every session.

A Final Thought
Therapy is one of the few places in life where you can speak freely without having to protect or please the other person. Freud saw this as essential. Modern research adds that the effort you put in, including financial investment, can actually improve your outcomes.

If you’d like to learn more about evidence-based support for ADHD, anxiety, OCD, or performance, visit me at Rick-Smith.com.