What therapists earn, by license, and what actually moves it.

The national picture, by license

The Bureau of Labor Statistics publishes median annual wages by occupation every spring. The May 2023 figures, published in April 2024, are the most recent complete set as of this guide's review date:

Source: BLS Occupational Employment and Wage Statistics, May 2023. Read the numbers as medians for people employed in the occupation, most of them on salary in agencies, hospitals, schools, and group practices. Half earn more, half less, and the spread inside each occupation is wide.

What the medians hide

A salary is a wage for hours worked. A practice is paid per session held. That single difference explains most of the gap between what a survey says a therapist earns and what an individual clinician takes home. Four things move the number more than the license:

• How full the caseload is. A clinician holding twelve sessions a week every week earns more in a year than one paid a higher rate for eight. Fill is the lever.
• No-shows and cancellations. Every empty slot is unpaid unless someone carries that risk for you.
• Payer mix and who does the billing. Commercial, Medicaid, and self-pay reimburse differently, and unpaid claims cost time and money when they land on you.
• Documentation and administration time. Hours spent on notes, credentialing, and chasing claims are hours not paid.

Setting and hours matter too: after-school and evening hours with children and teens fill; midday adult slots compete.

Salary vs per-session, in months

The clean way to compare a salaried role and a practice is a month, not an hour. Take the salary, divide by twelve, and set it against a month of sessions actually held times what each session pays, minus the time you spend on the business. A rate that looks high per hour with an empty calendar loses to a steady calendar at a fair rate. Our pay page walks through the month-over-hour view without publishing rates.

By state

BLS also publishes each occupation's median by state and by metro area. Medians are higher where the cost of living is higher and where commercial payer mixes dominate, and lower in rural and heavily Medicaid states, with exceptions in both directions. Rather than reprint a table that ages every April, use the source directly:

• BLS OES: mental health counselors (21-1018), state and area data
• BLS OES: marriage and family therapists (21-1013)
• BLS OES: mental health and substance abuse social workers (21-1023)
• BLS OES: clinical and counseling psychologists (19-3033)
• BLS OES: nurse practitioners (29-1171)

For a telehealth practice the state that matters is the child's state, and per-session pay on Emora does not change by state.

Notes for the eleven Emora states

Emora works in eleven states today (see where we work). Within them, the same pattern holds: metro medians run above state medians, and clinicians who work after-school hours with children and teens report fuller calendars than the occupation-wide averages suggest. The state licensing pages describe each state's licenses and compacts; the pay conversation is the same everywhere: sessions held per month.