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What's the Real Question?
Now I'm wondering if this isn't the wrong question. In the economic tsunami threatening to overwhelm us, it begins to seem that the right question isn't "How do I get more individual clients?" That just boils down to "How do I do more of the same?" Perhaps the real question should be "How do I do meaningful clinical work and sustain a good income over the short and long term, regardless of the economy?" Notice that this question makes no mention of attracting individual, private-pay clients.
It now seems to me that the way we automatically think of building and maintaining a therapy practice may no longer be an economically viable way of sustaining ourselves. For the past hundred years, psychotherapy has operated generally as the private meeting of one patient with one well-trained mental health expert for roughly one hour of presumably helpful conversation. Despite our attachment to this model, it isn't the most efficient or creative way of helping people or of making money. Many therapists would like to help more people than they can responsibly jam into an 8-, 10-, or even 12-hour workday. Or they'd like to be able to do something for all the people needing help who can't afford one-to-one therapy by the hour. Then there's the money crunch: even if therapists raise their hourly fees, their total income won't rise by much. In fact, trading hours for dollars means we have jobs, rather than independent businesses—jobs that don't provide retirement plans, sick pay, or paid vacation days. Since our income reflects the number of in-person sessions we provide, a recession that constricts people's sense that they can afford therapy can send our finances hurtling right off a cliff.
The New Zeitgeist
The economic downturn aside, the biggest problem with the old fee-for-service therapy model is that it isn't in sync with social and cultural shifts in how increasing numbers of people think about therapy and therapists. those seeking psychological help today don't think of themselves as patients, or even clients, as much as they consider themselves consumers or customers. They want to be served what they want, on their terms. When they have emotional or relationship problems, they look for a quick, effective solution, which will help them get through a tough time. They're less interested in an intense, open-ended relationship with a highly trained stranger than with a practical, appealing, and reasonably priced product, one that'll provide some short-term relief and maybe a little long-term wisdom.
One reason for the increasing impatience with standard therapy (besides cost, of course) is our Internet-reinforced demand for instant gratification. Last year, my mother-law became ill, and we needed help dealing with her dementia. I'd spent 10 years working with the geriatric psychiatric population, but when it was my family's problem, I wanted information quickly. Therapy might have helped us through the crisis, but it would have taken a lot longer than the hour I spent searching the web to find helpful resources, including free checklists and articles, as well as downloadable material I could purchase online.