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Editor's Note By Rich Simon

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Keeping Private Practice Alive

These days, many noble and once well-remunerated occupations, like journalism and magazine publishing (to name a couple that strike especially close to home here at the Networker), seem in danger of declining into economic irrelevancy. And, not to unduly shock anybody reading this, but the financial prospects of therapists don’t look too hot at the moment, either. Not only are we told there are way too many of us—600,000 mental health professionals nationwide—for the population to sustain, but managed care has done its best to shrivel whatever pittance we used to be able to count on for our services.

On top of this economic reality, therapists must come to grips with the fact that their client pool—the potential market for what they do—has changed, and changed dramatically. The old idea of therapy that many of us, at least those of us over 40, were taught to practice seems completely anachronistic in today’s culture. For most people who spend their days zipping at warp speed from stimulus to stimulus, thought to thought, traditional therapy—the prospect of spending years in weekly 50-minute sessions holding meandering conversations with a largely silent therapist to achieve insight and self-knowledge—sounds ridiculous, if not flat-out crazy. Who has the time? Who has the money? Who cares?

Many therapists still don’t get this. They know business is down, but they don’t know what to do about it. Besides putting up a website, they carry on as if it were 1980-something and their potential clients today were just like the clients who sought therapy three or more decades ago.

As the contributors to this issue make clear, people seeking therapy today are not the supplicants of yesteryear, who considered the therapist to be the expert on their mental life, expected him or her to be in charge, and more or less meekly acquiesced to the basic rules of the therapy game: they came on time, didn’t tell the therapist what to do, and didn’t ask embarrassing questions like “What can you offer me and how long will it take?”

In contrast, today’s therapy consumers are likely to “interview” different therapists before the first visit—the way you interview a potential employee, or grill a salesperson about the value of the product being sold. They announce ahead of time what problem they want to work on and how fast they want it resolved (often within a session or two). If they don’t like the answers they get, or don’t find the first session appealing or intriguing enough to try it at least once more, they walk, knowing full well that there are plenty of other fish in the therapy sea.

The crucial question that this issue poses is how exactly our practices need to change if we want to continue doing therapy for a living. Whatever our allegiance to our cherished theories and models, the time has come to reconsider how to attract and keep clients long enough to get the process off the ground and running. We must face the fact that in an age where virtually everything is for sale, we have to learn to sell what we can offer.

If we wish to stay professionally alive, it’s time we recognize that the idea that we must choose between being dedicated clinicians and being smart business people is a false one.

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1 Comment

  • Comment Link Wednesday, 16 October 2013 12:25 posted by Karen Scott

    I understand the need for the topic but can't help to see it as a form a manipulation/game play to attract and retain clients; most whom have serious trust issues. I saw my first "therapist" in handcuffs on the news while I was seeing him. Therapy costs a fortune for a 45 minute hour; not to mention the client has to do most of the "work". Soild mental health is undervalued by our society (take a look around). The EC's mentioned sound like arrogant brats who need to be educated about their famliy foundations, i.e pipe down and get out of your own way/listen fist. When an authentic potential client comes knocking and is ready, the teacher will appear. I've had many intense verbal exchanges with my therapist about being strung along and she is very good about clarifying the theraputic dynamic. I have also done a tremendous amount of reading to understand the process, etc. I do believe it is imperative to explain "things" initially, because most clients are lost/scared and it comes off as "educated". It's as though they come to therapy with the behavior/attitude that may be their main roadblock anyway.