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Harnessing the Winds of Change - Page 4

To make matters more challenging, the cost of doing business in a private practice remains unchanged from previous years, ringing in at a hefty 30 to 45 percent of a therapist's total income. Expenses such as office space, utilities, phone, internet connection, billing administration, advertising, malpractice insurance, marketing, and professional dues continue to be significant and unavoidable.

Systemic Concerns

As if these problems in building and sustaining a profitable practice weren't enough, we face concerns that have less to do with market forces, and more to do with the uniqueness of our profession.

First, our age. We're a graying profession. The average age for a marriage and family therapist (MFT) is 56, and average age for a social worker is 50. Our profession attracts those seeking a second or third career; as a result, many regard their practices as something between a hobby and a way station to retirement, and are less likely to embrace technical innovations that improve efficiency. For example, half the psychotherapists in private practice don't use a computer. "Too often, at the point of delivery, psychotherapy is basically a cottage industry," explains Klein. "It's someone in a room, doing paperwork, by hand, with little interest or understanding about virtual marketing, high-tech delivery methods, or automated operating systems."

Second, our demographics. Where have all the men gone? In most professions, feminization means a lowering of pay, and, unfortunately, that's been true of psychotherapy. A Psychotherapy Finances survey published in 2000 found female MFTs reporting incomes of 59 percent of their male counterparts, down from 99 percent three years before. Female psychologists' incomes dipped during that period too, from 91 percent of men's in 1997, to 78 percent in 2000. The reason for this trend, according to the survey, is that male clinicians respond more aggressively to managed care, charge self-pay clients more, and work more hours per week than their female counterparts.

Third, our view of our work. Many therapists in private practice wrestle internally with the question of whether psychotherapy is a vocation or an occupation. Is what we do a service (i.e., helping others) or a business (i.e., filling the needs of others for profit)? Unable to feel comfortable about how they view their work, some therapists struggle in a market that requires an increasing degree of entrepreneurship.

To resolve these problems, we need to rethink the business of therapy to come up with newer, more current models of private practice.

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