As if the change in earnings these measures brought about weren’t hard enough, competition to be in private practice to find clients has become increasingly fierce. According to former American Psychological Association president Nicholas Cummings, one of the field’s most accurate prognosticators of market trends for nearly 60 years, there’s now a massive oversupply of private practitioners: estimates of the number of masters-level therapists in the United States average about 600,000. Also, the costs of running a practice haven’t gone down, so therapists still need to pay high rents and other fees. For some industries, the challenges of a changing market are seen as a basic business 101. But having little formal education in business, the average therapist in private practice is facing hard times and is vulnerable to these multiple pressures.
This isn’t to say that most therapists don’t see the handwriting on the wall. Many have stayed current with the changing economic trends and are trying to make a go of it, but often in their own haphazard way. They know they have to do something. They just don’t know what exactly to do, or when or how to do it, or even if they want to. Even when therapists learn some marketing strategies or attend a business class, they often feel like fish out of water. Many recoil from what they’re being told they must do to survive: promote themselves and their services.
Does this mean therapists ought to throw in the towel and go into another line of work entirely? No. As I tell the hundreds of therapists I meet with and coach in their businesses each year, it is possible for them to do good, satisfying, genuinely healing work, hold onto their ethics, and get paid regularly and fairly for what they do. But to accomplish these things, they have to change the way they approach their practice. The belief that they can fill a practice with long-term clients who come to sessions each week and don’t question the length or expense of treatment probably belongs to a former age. They need to understand the changes in technology that are bringing in new types of clients with different expectations and needs. And, like it or not, they’ll have to become comfortable with the idea of joining thfae ranks of other entrepreneurs and implementing solid business planning and marketing.
The Good News
The good news is that therapists in private practice are determined to find ways to stay afloat, and many are eager to adapt. Those who are sufficiently stout of heart and open to the challenge of learning the business and marketing principles of successful 21st-century practice will find that they can not only learn these new skills, but also excel at them. I’ve seen many therapists who insisted that they’d never be good at business come to enjoy being proficient businesspeople and making more money in a streamlined, organized practice, which enhances their ability to do their best work.
Despite all the factors undermining our earning potential as therapists, the market for our services is poised to grow. The Centers for Disease Control estimate that around 25 percent of adults experience a mental health issue in a given year, and 50 percent of Americans will experience some mental health issues over their lifetimes. So it’s fortunate that the Affordable Care Act will provide one of the largest expansions of mental health and substance-use disorder coverage in a generation, with an additional 32 million people receiving coverage. Additionally, crass as they may seem to therapeutic traditionalists, media shows like Dr. Phil, Celebrity Rehab, and Oprah have pulled therapy out of the societal fringe and into popular culture, making it less taboo, less mysterious, and ultimately more acceptable.
Thanks to the Internet, therapy is now increasingly accessible, too. Google can find a therapist in any zip code in just a few clicks, opening doors for potential clients seeking therapists and leveling the playing field for therapists seeking clients. With minimal expense, any therapist can achieve online visibility, and many of the ones I work with as a business coach report that upwards of 50 percent of all new clients are finding them online.
The New Breed of Client
While online accessibility allows therapists to get found, the people who find them represent a kind of client different from the ones who used to come through referrals from doctors or trusted friends. This new kind of client can search multiple listing at a time, rapidly book and cancel their appointments on the web, and rate their therapists online with starred reviews. In general, they act less like patients willing to assume the traditional role within the therapeutic model and more like Walmart shoppers scanning the aisles while checking their mobile phones for better deals. In turn, therapists are waking up to the reality that relating to online shoppers for therapy services requires new skills.
Harriet, a marriage and family therapist in Chicago, knew that she needed to advertise her private practice and was told that having an Internet presence was an important first step. So she hired a designer to build her an attractive site and listed her practice in Psychology Today’s online directory. Sure enough, clients found her and called to book sessions. But that’s when her trouble started.