I'm seeing a psychoanalyst 4 times a week and I pay fully out of pocket - in my country we have public health care and it doesn't cover long term therapy unless you have a severe and acute condition.

Most therapists are in private practice and because there is no insurance they cannot set their fees arbitrarily based on what an insurance company would pay but they rather have to set their fees based on what people realistically can pay.

I pay roughly 1/3rd of my monthly income to my analyst though but I feel it's worth it and I can afford it.