Sixty-two percent of therapists in private practice say they have no plans to raise their fees in 2026, even though the therapists who did raise fees in 2025 reported nearly $20,000 more in median revenue than those who held rates flat. Call it caution if you want. This desk calls it a decision, repeated every year the same way, to protect a client relationship that was never actually at risk, at the direct cost of income that was.
The excuse is protective. The math is not.
This is not a new pattern. Therapists have been telling surveyors for years that they intend to raise their rates. Most don’t follow through.
That means roughly two out of three therapists held their rates flat in 2025, in a year when nearly every other cost of running a practice moved in the opposite direction. The gap between “I plan to” and “I did” is not about whether the practitioner can justify the number. It is about what the practitioner assumes will happen the moment the number changes. Almost every therapist who avoids a fee increase names the same fear. The client will leave.
Rent, continuing education, liability insurance, and practice software have all climbed for years running. A rate held flat since the practice opened is not a neutral choice. It is a pay cut, applied automatically, every single year, to the one person in the room with no one negotiating on their behalf.
The client who leaves was never the one keeping the lights on.
The fear treats every client relationship as equally fragile, and equally worth protecting at the cost of the practice’s own sustainability. It rarely holds up. Clients who have built a working alliance with a clinician, who have made progress, who trust the process, do not typically leave over a fee increase handled directly and given reasonable notice. The ones who do were often already price-shopping, already ambivalent, already one budget conversation away from ending treatment regardless of what the therapist charged.
Some of the hesitation is not irrational. Therapy is a trust-based relationship built on emotional exposure, not a transaction like a haircut or a gym membership, and raising a number in that context can feel like introducing money into a space that is supposed to be about something else entirely. That discomfort is real. It is also not a reason to let a rate sit still for four years while every other cost in the practice keeps moving.
Meanwhile, the practitioners who do raise their rates are not watching their practices collapse. They are earning more than the ones who don’t.
The client who would leave over a reasonable increase was never the client keeping your practice afloat.
— Practice & Opinion, Business & Therapy
Heard is careful to note that this is a correlation, not a proven cause. Fair enough. But a therapist who raises their rate is, by definition, a therapist who has stopped avoiding the conversation. That alone tends to travel with the kind of financial attention that shows up in the rest of the numbers.
What the avoidance actually costs
Nearly $20,000 is not an abstraction. It tracks, for the therapists who raised their rates last year, with the difference between a practice that covers its overhead with room to spare and one that quietly loses ground every year it holds still. Framing a fee increase as a risk to the relationship gets the relationship backward. The therapeutic alliance is not so fragile that it cannot survive a clinician being paid fairly for the work. Treating it as though it is fragile is itself a signal. Not of care for the client. Of discomfort with being the party in the room who is allowed to have needs.
There is also a quieter cost that does not show up in a single year’s revenue figure. A practitioner who waits three or four years between increases eventually has to make up the distance in one large jump, the kind that actually does provoke sticker shock and actually does risk the relationship. The therapists absorbing the smallest, most survivable version of this conversation are the ones who have it every year, not the ones who put it off until the number becomes unavoidable.
The prescription
Pick a number that reflects what the work is worth this year, not what it was worth when the practice opened. Tell existing clients directly, with reasonable notice, without an apology folded into the sentence. Some will ask questions. A small number may leave. Most will stay, because the relationship was never the fragile part of this equation. The fee was.
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Researched and assembled with AI assistance. Reported, verified, and edited by the Business & Therapy editorial team.