Should care be commodified and intimacy bought?
Some thoughts on the uncomfortable cost of therapy
Full confession: When I first began therapy in my 20s, before I even thought about becoming a therapist myself, I used to believe that therapy felt like prostitution.
I would go in. Open up. Cry. Lean into pain. And leave therapy in complete bits. In each session, I would willingly become emotionally naked. I would dismantle the armour plating of my defences and confront what I did not want to feel. Examine what I aimed to avoid.
At the end of each session, I would write a cheque.
There was something about that moment that felt unsettling. Transactional. Vulnerability exchanged for money. Intimacy followed by an invoice. It made me wonder: can intimacy be bought? Should caring be commodified?
For me, the payment felt like adding insult to the injury. Is this what my life had come to? Plugging the care deficit and addressing my unmet emotional needs by paying a professional to fulfil what could not be fulfilled by those who should have cared for me for free, because that was part of the job description?
Of course, people pay for sex all the time, and the prostitution industry is ancient—thousands of years old, in fact. Psychotherapy, by contrast, was conceived in the 1890s—during Freudian times—when Sigmund himself met a hysterical, hospitalised woman whose symptoms significantly eased once she started talking about her traumatic and emotionally charged memories.
Society rarely seems surprised that people pay for sex. Yes, it’s a vice, perhaps. But it’s also an industry that fulfils a human craving. Desire, we accept, can be transactional.
But care is supposed to be pure. We’re taught early on that love should be freely given; that listening should be generous; that comfort should feel natural. The moment money enters that space, something feels contaminated, as if cash taints the sincerity.
Perhaps that’s why paying for therapy provokes such discomfort, and its value is often questioned.
Yes, but what am I actually paying for?
The first time I undertook therapy in my 20s, over a two-year period, I felt this exact discomfort. Yes, I persevered, even though I really resented it. I was poor, working in an entry-level PR job that offered limited satisfaction, and I wished that the money I spent on therapy would really go towards my beer and fag allowance or a spree at Top Shop.
I was too damaged, I thought. What was the point? I never felt better after these sessions anyway. I felt spent, both emotionally and financially. Puffy-eyed. Blotchy from tears. Slightly broken. It was only a few years later that I was able to see how I had shifted and changed to cope with my demons and trauma better.
That’s the thing with therapy … there is no “tah-dah!” moment. No immediate epiphany. No walking around blind (metaphorically speaking), only to suddenly see. Change happens at a frustratingly glacial pace because it takes hours, days, and years of conscious repetition of new actions to undo old ways of behaving, thinking, and doing. And much of these old ways of behaving, thinking and doing, we go about unconsciously. It’s that ingrained.
And so, a (good) therapist holds up a mirror to you. Challenges you. Helps you question the how and what – because there is often little comfort in endlessly asking why. They’ll make you angry. They’ll shine a spotlight on your defences. There will be both rupture and repair, as with any relationship worth its salt. But, crucially, they are the guardrail beside you as you traverse shaky ground. You might only shuffle forward, occasionally freeze on the spot. Sometimes, you might even fall. But they offer safety, solidity – a steady and calm presence – as you navigate a way forward to a more self-compassionate version of yourself.
When I started psychotherapy training years later, and then undertook therapy for a further five years, I really started to appreciate that you’re not actually paying for closeness, or friendship, or even to be rescued.
In therapy, you are paying for something rare: attention that isn’t distracted; care that isn’t entangled with its own needs; closeness that doesn’t require you to perform, reassure, or reciprocate. It is an hour that exists entirely for you, without competition, without the other person subtly steering the conversation back to themselves. Importantly, you are paying for a space where you can say the worst, most shameful, most painful things – and know they won’t be gossiped about, thrown back at you, or used against you. It is a safe space, where words and experiences, mistakes and mishaps aren’t weaponised or judged.
In a world where let-downs and chaos can be the norm, in therapy, you are paying for consistency and safety; for someone who shows up every week, whether you’re easy to sit with or not.
It’s simple acceptance.
Within the containment of the room, you do not have to mask or pretend to be anything other than your true self.
Payment vs. emotional debt
In most of our relationships, care comes with invisible strings: “I listened to you, now you listen to me”, “I helped you — now you owe me”, “I’ve sacrificed for you — don’t disappoint me.” These are not malicious or manipulative in nature, but they are typically human and very complicated.
Therapy replaces emotional obligation with a clear agreement. The financial exchange is explicit, limited, and defined. Once that’s paid, there are no hidden expectations: you do not owe loyalty, admiration, or any emotional caretaking in return. What you receive is honesty, authenticity, and full transparency. Therefore, the money in this context is not payment for intimacy; it protects it. It acts as a boundary around the relationship. There is no ulterior motive. You know what you’re getting.
When the work finally ends, which it will (you just know), it concludes deliberately and consciously, not with a feeling of abandonment, dependency, or confusion; not abruptly, nor from drifting away, nor from ghosting. In fact, it’s quite different from some endings we experience in the outside world.
It’s weird, perhaps, that we have to formalise care in this way. Stranger still, that without that structure, it would so easily become blurred and messy.
But why is paying for therapy so uncomfortable?
Most of us are accustomed to ‘earning’ closeness: being conformist and compliant, interesting and useful, agreeable and non-demanding. Closeness tends to come at a personal cost; it often comes with unspoken conditions. But therapy, as a process, interrupts this pattern and way of being. It can feel awkward and quite unfamiliar to receive focused care without having to perform, impress, reciprocate, or manage the other person’s feelings. But ultimately, it is a professional relationship meant for your growth.
I’m not going to sugarcoat it: therapy isn’t accessible to all. It costs money. It’s exclusionary for those who need it but have limited means. But that’s a whole other blog post; the socioeconomic factors that determine who can and can’t access therapy or become a therapist are discussed in my earlier article for The Big Issue. It’s disheartening and infuriating. Money is a barrier. Yet the psychological investment is much deeper. Can some of us afford not to invest?
The true cost of therapy
When I look back at my twenty-something self, falling apart and then writing that cheque, I understand her discomfort. Superficially, it was about money (or lack of it). But actually, it was about experiencing a kind of care that was clear, boundaried, and not entangled in obligation; and that kind of care is rarer than we think.
If the cost of therapy provokes anger, shame, or doubt, we shouldn’t rush to silence those feelings because there’s information in that discomfort. The reaction makes sense, though the reason for the reaction may not be as obvious as we think. Sometimes the very thing that feels uncomfortable is pointing towards something much more important - a story about self-worth and entitlement, and about how unfamiliar it can feel to be held without obligation.