Clinician's Digest I

While the "empty chair" was once identified as a popular Gestalt therapy technique, for many therapists today, faced with empty appointment hours and diminished clinical case-loads, it's become a symbol of the struggles of private practice. Now a recent survey offers a clearer picture of the larger issues facing the psychotherapy profession.

In a study of 50,000 people published in the American Journal of Psychiatry examining national trends in outpatient psychotherapy use across a 10-year span (1998-2007), Mark Olfson and Steven Marcus found that just over three percent of the general U.S. population use outpatient psychotherapy services in a given year, but during that time period, clients are spending less time and money on psychotherapy. While the cost of almost everything from a cup of coffee to a gallon of gas has increased in the past decade (in 1998, gas prices were just over $1.00 per gallon!), the average expenditure for psychotherapy service declined by nearly $30.00, to an average total of $94.59 per visit. Furthermore, during the same period, the average number of visits per client dropped to just under eight sessions, and overall expenditures on psychotherapy dropped by nearly $4 billion.

At the same time, however, spending on mental healthcare on the whole has actually increased. So where's the money going? According to Olfson and Marcus, "The distribution of mental health outpatients has shifted in recent years toward medication-only…