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Harnessing the Winds of Change - Page 2

I hear a lot about the state of private practice. I've been a psychotherapist in private practice for 20 years, and have worked as a business coach for therapists for the past 10. My practice-building books sit on the shelves of graduate-school libraries and the bedside tables of senior therapists. I write a monthly e-mail newsletter that goes out to 6,000 therapists, many of whom write back, telling me about their situations. I cross the continent giving practice-building workshops and seminars, teach teleclasses to groups of therapists every week, and individually coach a dozen therapists at any given time. A large part of my clientele has always been newly graduated therapists, struggling to get established. But starting in 2003, more senior therapists began contacting me for help. These therapists had spent decades being secure in their client count and reputations—but all of a sudden, they were hurting. "I thought I was beyond this," was a common refrain. "Once again, I'm having to beat the bushes for new clients, and I'm having trouble paying my bills," senior therapists reported to me, feeling embarrassed and defeated.

I kept watch, wondering what it meant for the profession as a whole if our most expert practitioners were having trouble keeping their caseloads full. Then, last year, Psychotherapy Finances, a newsletter for behavioral health providers, released an industrywide survey of those in private practice and confirmed my observations. After 20 years of relative income stability, the financial picture for psychotherapists it described was dismal. With managed care on the rise, senior professionals surveyed, such as social workers, reported an inflation-adjusted 22-percent decline in overall income since 2000. Those who depended on indemnity insurance or self-pay clients reported problems keeping their caseloads full. A combination of factors led to the decline, but I'm convinced private practice stands at a crossroads of viability today.

Private practice has been the delivery system of choice for psychotherapy over the last century, for many reasons. It offers clinicians necessary autonomy and reduces split transference, so that communication between clinicians and clients is direct and honest. It helps define the methods we use, and allows us to shape the direction of treatment. It's always been a way for a seasoned therapist to afford a decent living.

How we protect and position our practices will have consequences for our profession. It's up to us to read the signs of change and respond, so we can control and craft our future. This can be an opening for a long-overdue evaluation and self-renewal, or a missed opportunity. As Bob Dylan suggested, our answers are blowin' in the wind.

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