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The Selling of Psychotherapy

By Rich Simon Anybody who’s been making a living as a therapist in private practice for a while will readily tell you that things aren’t what they used to be. Sure, incomes are down. Reimbursements aren’t what they used to be. Referral sources have changed. It takes more effort and marketing savvy to keep a practice afloat. But many practitioners still carry on as if it were still 1980-something and their potential clients are fundamentally the same as those who sought therapy three or more decades ago.

The September/October Networker, The Selling of Psychotherapy: What Are the Rules in the Today’s Consumer-Driven Market, is dedicated to the idea that there’s something more going on, a fundamental shift in the attitudes of people coming to us for help– the patients of yesterday have become the educated mental health consumers of today. In this issue’s cover story, therapist and business coach Lynn Grodzki provides an eye-opening road-map to both this shift in clients’ attitude and how we as therapists can most productively respond to it. Here’s a sample of Lynn’s take on the sea change taking place in our profession right now:

Just 25 years ago, the psychotherapy field was still at the tail end of the Golden Age of Therapy.

Most clients accepted the challenge of therapy as serious, life-changing work, despite the ambiguity and sometimes mystifying ritual of the weekly or biweekly therapy appointments. Those who asked to know track records, who insisted on dictating what they wanted out of therapy, who tried to put limits on the length of treatment or haggled over fees, were seen as caught in the scramble of their own resistance. Of course, it was hard and expensive and time consuming to be in therapy, but therapists and their clients had a sense of being privy to a secret tool, a demanding yet rewarding process for living the well-examined life.

Today therapists are no longer seen as elite healers, but commonplace service providers of healthcare. The devaluing of therapy has made it more accessible to the public–something most would agree is a good thing–but has created a precipitous change in the way therapy is valued and delivered.

In working with therapists to build their practices, I’ve started calling this new type of client educated consumers or ECs for short. This term helps therapists better understand clients who, despite a lack of education about the methods or history of therapy, possess a deep knowledge about finding and purchasing what they want. To serve these ECs, we need to learn to do things differently—to articulate services more clearly in ordinary language, highlight and concretize the value of therapy, measure and underline progress within each session.

Our September/October issue will be challenging to those of us who first entered the therapy profession because we wanted an alternative to competing in the go-go corporate marketplace. But this issue makes clear that if we wish to stay professionally alive, it’s time to recognize that the choice between being dedicated clinicians and being smart business people is a false one. Or as Lynn puts it, “If you want to dance with the new economy and not get stepped on, you’ve got to be light on your feet, ready to turn—if not on a dime, at least on a quarter—and master some moves you never imagined yourself performing.”

Click here to check out the new September/October Psychotherapy Networker.

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5 Responses to The Selling of Psychotherapy

  1. Katherine M says:

    That is all well and good that we become savvy sales people… but what about organizing ourselves to combat the insurance companies continuing degrading of our fees? There are efforts afoot to do just this in Massachusetts – anywhere else? Is this not a viable strategy and something we would encourage our clients to do to empower themselves?

    • Mike Ames says:

      Your comment is on the target. I’m in Calif. and I’ve haven’t heard of any strategy to combat the exploitation of insurance companies. We desperately need to organize and fight this downgrading of payment for psychotherapy.

  2. Bruce Fredenburg says:

    There is a popular myth that there is a glut of therapists and that we have to accept less if we are to survive. I have heard it said that people either can’t afford it or don’t want it. If that were true, however, people would not be spending about $2 billion dollars a year on self-help programs “Life Coaches”, etc and “Big Name” coaches would not be making $50,000 per day for delivering services that can be better provided by well trained therapists. What I think has happened is that we have abandoned the marketplace to the amateurs (amateur helpers but expert marketers). More importantly, I also think our traditional training institutions, professional associations and regulatory agencies have contributed to the problem by supporting an internship process that teaches us to devalue our worth.

    We go to school for more than 20 years, pay tens of thousands of dollars and often incur large debt to acquire sufficient competencies to qualify for an Intern License. We are then expected to be grateful if accepted to work for approximately minimum wage with the hardest clients in poorly funded, public and non-profit agencies in order to accumulate the coveted 3,000 required hours. No wonder we are so easy to dismiss. How can we expect others to take us seriously and value our services when our professional associations and graduate training programs agree to and collaborate with such an absurd system?

    You may be interested to know that in order to become a CPA, a newly graduated accountant with only an under graduate degree is required, like us, with our graduate level degree to accumulate a certain number of hours under the supervision of a qualified CPA. Unlike our profession, however, they are taught to expect an “adult salary” while completing their hours.

    Our public fiscal policies and general attitudes act as if mental health services are just a nice fluff option and not an essential service Most anyone who has worked in the front lines of a public agency can report that mental health services are barely keeping the lid on the various problems that create potential for explosive violence and social breakdown.

    What do you suppose would happen if this scenario occurred? If all mental health Professionals simply said “We agree. Mental health services are only a fluff and not essential and therefore we are leaving those underpaid positions to become well respected, and thus well paid accountants or computer programmers.” I think that if that ever came about this country could blow apart like the now extinct Soviet Union. Perhaps, though there is a less dramatic and less destructive way to make the case for value.

    Consider this. Insurance companies would have nothing to sell if we as a profession did not agree to participate in their schemes. Also, it would soon be clear that mental health services are essential if our education institutions and professional associations would refuse to acknowledge any qualifying intern hours that are not paid an adequate “adult salary.” They would have to pay us our worth or do without. In our culture you can tell what people value by how they spend their time and their money. Anything less is just “lip service.”‘ What is believed gets done.

  3. Joe McHugh says:

    Bruce, you make some good points. My understanding of our bind with insurance companies, as related by our professional organization in California, is that any coordinated effort on our part to push for better reimbursement would be treated as a violation of anti trust statutes.

  4. Laura H says:

    One significant piece of this distorted puzzle is the fact that the AMA and the pharmaceutical companies are the biggest lobbying organizations, along with the insurance companies. The model of care promoted is based upon the medical model of 15 minutes, as with your PCP, and the psychiatric PCP model has followed suit-it seems to have been monetarily/ethically acceptable by these providers to practice what is requested from their payors-the insurance company. Perhaps the issue is not lobbying for better reimbursement, but the recognition of interpersonal caring services as divergent from the medical model and in need of improved explanation, by lobbying for healthiness by appropriately required care. We are unfortunately set up by the educational process, as previously pointed out,and there is minimal if any time left to think/work creatively on how to impact the future when later working in community settings and just helping clients and ourselves survive.

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