Why Does Sex Therapy Cost So Much and Why Don't Sex Therapists Take Insurance?

Understanding the Real Costs of Specialized, Private Care

If you've ever searched for a sex therapist and been surprised by the cost—or noticed that most don’t accept insurance—you’re not alone. It's a common question:

Why do many sex therapists charge so much, and why don't most take insurance? 

In this blog post, I’ll break down the reasons behind these fees, help you understand what you're really paying for, and offer some ideas on how to make sex therapy more affordable.

1. Sex Therapy Is a Highly Specialized Field

I and other Certified Sex Therapists undergo extensive education and training far beyond what’s required for general counseling or talk therapy. We hold advanced degrees in clinical counseling, psychology, or social work plus years of specialized supervision and training for additional sex therapy certifications costing an additional five figures from organizations like AASECT (American Association of Sexuality Educators, Counselors and Therapists).

This niche expertise allows sex therapists to address complex concerns such as:

• Low desire or mismatched libidos

• Erectile dysfunction or premature ejaculation

• Avoidance and conflict dynamics in relationships around sex

• Pain during sex (also called dyspareunia)

• LGBTQ+ affirming and kink-aware therapy

• Healing from sexual trauma or shame

You're not just paying for a session—you’re investing in thousands of hours of specialized knowledge and actual experience that few therapists are trained to offer.

2. Therapists Who Don't Take Insurance Can Offer Better, More Confidential Care

Many sex therapists choose not to accept insurance because doing so can limit the quality and confidentiality of care. Here’s why:

• Insurance companies require a mental health diagnosis to reimburse therapy—often not applicable or appropriate for sex-related concerns, or add to stigma/pathologizing.

• Session notes may be reviewed or audited, compromising client privacy.

• Treatment options may be restricted to what's deemed "medically necessary" by the insurance company, not what's actually best for you. Delay, deny, defend profitability.

  • Allow me to nerd out really quick. At best, determining what is "medically necessary" will be based on data and statistics, despite the glaring fact that human sexuality has historically been difficult, if not impossible to research without bias, exclusion of minorities (have you noticed studies almost always focus on "male" and "female" in the sample)? Studying the effectiveness of therapy especially sex therapy is even more niche, especially if you consider pharmaceutical companies fund most research and talk therapy doesn't make 'em money.

By working outside the insurance system, sex therapists can provide personalized, stigma-free, and fully confidential care tailored to your unique needs.

3. Private Practice Costs Are High

Running a private therapy practice involves significant overhead:

• Liability insurance (similar in ways to malpractice insurance)

• Continuing education and fees to stay certified, on the cutting-edge of care and licensed -- you do this double for sex therapy certification on top of licensure

• Marketing, scheduling software, client management systems, technology and devices, primary and backup internet, a completely quiet atmosphere with total privacy

• No paid time off, sick leave, or employer-sponsored benefits like group health insurance

Many therapists set their rates to ensure they can sustain their practice, continue training, and serve clients without burnout. This is especially true for solo practitioners who don’t have institutional support and most of us are still paying off student loans.

4. You're Paying for More Than Just the Hour

Although it might feel like you’re paying for a single 50-minute session, therapy includes time spent:

• Preparing for your session

• Reviewing case notes

• Creating resources or personalized strategies

• Referring you to medical professionals when needed and/or collaborating (if requested)

• Maintaining ethical and legal standards, consulting with other therapists

• Multi-Perspective Education so you don't have to spend session time teaching me

Sex therapy is deep, often emotional work that requires energy, focus, and continuous professional development. If you've ever been to a therapist who doesn't seem to have their own self-care/life figured out, you know that a therapist's time outside of sessions directly impacts the quality of the care you receive.

5. The Chance at a Corrective Therapy Experience: Highly Specialized Training Centered on Harm Reduction

One of the most heartbreaking things I hear from new clients is how they’ve been harmed by previous therapists—often unintentionally, but the impact matters. Whether lack of knowledge about sex, sexuality or gender diversity, insensitivity to trauma, bias against poly/CNM or pathologizing kink, many people come into sex therapy with wounds caused by past care. Or maybe the therapist never asked about any of the above, and so naturally you didn't think to or feel comfortable bringing it up either. Maybe you did bring it up, and found yourself educating the therapist when the focus should have been on supporting you.

This is exactly why I’ve invested in rigorous, ongoing training in areas such as:

• Sexual health and functioning

• Gender and sexual diversity

• Trauma-informed therapy

• Kink and non-monogamy affirming care

• Decolonization, anti-genocide and anti-oppression framework

• Neuroscience, research despite its many limitations, and the long history of harm done by the huge systemic failures of the medical system, government and global dynamics

6. What Can You Do If Cost Is a Barrier?

I understand therapy is a significant investment. Here are a few ways to make it more manageable:

• Use out-of-network benefits: Some insurance plans reimburse a portion of therapy costs under what's usually called "Out of Network Outpatient Therapy Services" on your EOB. I am happy to provide a Superbill (a fancy receipt) regularly for you to submit.

• Use your HSA or FSA: I accept both and can provide documents showing usage for therapy for you to provide to your workplace.

• Budget for 3 sessions or 6 sessions at first to see if we can move the needle on what you're hoping to accomplish in therapy (or may even meet them, no guarantees of course) and come every other week or less often. If you're in this boat and let me know, we can find more experiments to try or resources to check out between sessions!

  
  

Final Thoughts on Sex Therapy Costs

While the cost of sex therapy can seem high, it's important to remember that you're investing in specialized, ethical, and deeply personal care. Working with a qualified sex therapist can have a profound impact on your emotional well-being, relationships, and sense of self. We all deserve a vibrant, meaningful life with loving relationships and pleasure in the many forms we desire (sexual or not!)

If you're curious about sex therapy or wondering whether it's right for you and in Colorado, I'm here to help. Reach out to schedule a consultation or ask about options that fit your needs and budget.

Let's do this!

A little vulnerable BTS for you: Setting a therapy fee is tough and I have had to work through my own guilt of not being more accessible. Because of this, I've spent a lot of time thinking about the ethics of money. I am pushing through the fear that this blog may come off as defensive or *shudders* elitist. It reminded me just how many subtle, insidious messages we get about money: shame around talking about it, charging it, having it. Placing a monetary barrier on people from getting help sucks in general. An important value of mine is that all people should have access to therapy including sex therapy. But... that doesn't match the current needs to survive, let alone thrive, in our for-profit society.