9. 82% of therapists who see couples haven't received particular training in doing that work, so they approach it much like they approach individual therapy. The first thing you learn when you do pursue advanced training in couples work is that approaching it like individual therapy will oftentimes actually do more damage! You want a therapist who has invested the time and money into learning how to do the work you're paying for, the work that can change your life for the better. And most therapists who have made this investment don't accept insurance. (See above!)
10. Don't compare a therapist who sees couples but has very little or no training in working with couples, who accepts your insurance so you only pay a $20 copay, to a therapist with extensive and costly training in working with couples who doesn't take your insurance. That's not an apples-to-apples comparison. Compare therapists with similar levels of training and experience, and you'll see most of us are in a similar range and don't accept insurance. (See above!)
11. The fact that there are no guarantees in couples counseling argues for paying cash for someone with a lot of experience instead of using insurance for someone less qualified.
I can't promise any specific couple that coming to therapy with me will definitely restore their relationship. The system I use has a success rate of about 75%, but that's assuming a couple is attending sessions regularly and working hard on applying the new interventions they are learning at home. There are no shortcuts in relationship counseling -- you're going to have to ultimately do the work. So you'll want to prioritize finding a therapist who 1) knows what the work is; 2) knows how to show it and teach it to you; 3) knows how to assign homework that will really help you apply that skill at home in your normal environment.
12. I have found a great deal of my work as a couples therapist is helping couples understand why they are struggling to do the work at home. You can learn principles of sound relationships in a book, along with the exercises you need to practice in order to change your habits and improve your relationship. But if and when you get stuck, you'll need someone who can help you figure out what's going on, and this will require the very training most therapists who accept insurance will not have.
13. Since I see couples exclusively, my sense of competence as a professional is based almost entirely on the extent to which I'm able to actually help couples get the results they want. So I have not only a financial incentive to help you, I have deeply personal reasons as well. When you see a therapist who accepts insurance and sees a broad variety of clients, they will also be concerned about their competence with anxiety, depression, eating disorders, bipolar, ADHD, or whatever other issues they work with. None of that matters to me -- I measure myself only by the standard of whether and how well I help couples.
14. There are of course exceptions to this, but generally the old maxim holds true that by and large, you get what you pay for.
15. It's usually more about how you think about the issue than specifically about the money. If you had a sick child, and there were only a few doctors who could treat them, and the treatment was quite successful but still not approved by the FDA and therefore not covered by insurance, you'd get the treatment, right? Of course, we'll do anything for our children, pull out all the stops, and we should!
I think people should do that for their relationships as well, and that might not mean choosing me as their therapist. Maybe a couple finds someone else they pay a similar fee to whose training and experience they feel better about. All I'm saying is I don't think this is an area where couples want to put the money first, I think they should put the relationship first and follow that priority wherever it leads.