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Shopping For Therapy - Page 3

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“I’m getting discouraged with the new clients who find me on the Internet,” Harriet told me in our first practice-building coaching session. “I can’t seem to satisfy them, and, frankly, they intimidate me. They want to negotiate everything up front during the first phone call, while I’m still trying to connect and understand their issues. They tell me when they want to be seen, instead of asking how I work. They don’t get how therapy is supposed to proceed. And if I can’t ‘fix’ their problem in the first session, they’re reluctant to come back. I’ve been a therapist for almost 20 years, and I’m confident that I know what I’m doing, but these new clients have a way of making me feel insecure and incompetent.”

Harriet’s concerns aren’t just the grumblings of a burned-out therapist: they’re the result of a trend that began several years ago, when an increasing number of clinicians, both new and experienced, started advertising their practices online. As a business coach who works with therapists across the country on all aspects of practice building, I regularly hear them complain about this new type of client they’ve started attracting—one that’s hard for them to relate to and retain.

These clients shop for therapy much as they would for any online product: by comparing, contrasting, and learning as they go. They’re often young, anxious, and used to immediate gratification. And they have no compunction about treating a therapist in the same way they would any other service provider—after all, it’s their time and money. Before booking a session, they negotiate fees or challenge normal established policies they don’t understand, such as weekly sessions and cancellation policies. They want a timeline for results within the first session and get impatient about a lack of immediate progress. Harriet, like many therapists, was frustrated with this consumer-oriented client, while knowing full well that the future of her practice depended on her ability to market to them.

I first heard the term educated consumer in the 1970s, when retail clothing tycoon Sy Syms advertised “An educated consumer is our best customer,” suggesting that sophisticated consumers who understood fashion and discount pricing would prefer his clothing stores. In working with therapists to build their practices, I’ve started calling this new type of client they’re facing educated consumers, or ECs for short. This term helps therapists better understand clients who, despite a lack of education about the methods or history of therapy, possess a deep knowledge about finding and purchasing what they want. In the past, the goodwill and trust inherent in the old referral process used to overcome clients’ need to have a concrete understanding of the therapy process before diving in; today, however, the marketing of therapy relies less on well-placed referrals and more on online presence and visibility, so therapists need to recognize that their website text and design, online photo, and voicemail message educate potential clients, as shoppers, about what to expect. When a therapist is too vague in a website description of services available, or suggests results without explaining all the steps and variables ahead of time, ECs feel skeptical and won’t hesitate to express their irritation and reservations.

Fortunately, if they’re willing, therapists can easily learn to articulate services more effectively in ordinary language, help potential clients understand services within their preferred framework of purchasing, highlight and concretize the value of therapy, measure and articulate progress within each session, and use strategies to help clients stay long enough for them to see a clear return on their investment.

Setting Expectations

When I began working with Jonathan, a child psychologist for learning-disabled children, he said, “Most of the parents of the children I see find me on the Psychology Today site. They email or call and immediately ask how many sessions it’ll take to fix their child. I try to explain that I have to test the child, assess the results, and then determine a treatment plan, but they’re impatient. They have no idea that part of the ongoing work involves more than teaching neurofeedback skills and applying other tools. I also have to forge a relationship, which takes time.”

It’s normal and natural for ECs to want to feel in control of what they’re purchasing from a therapist, so it’s obvious why they insist on knowing exactly what to expect in a session and how long it’ll take. The fact that therapists aren’t comfortable predicting these outcomes doesn’t make it less important to give answers.

I wanted Jonathan not only to be prepared to answer questions from parents openly and clearly, but also to give parents a systematic way to understand his services. His existing contract for new clients was a standard one that many therapists use, outlining policies about confidentiality, procedures for payment, how he deals with cancellations and missed sessions, and informed consent about HIPAA compliance. But there was nothing in his contract to give his clients an immediate sense of what’s available, what to expect, and why to expect it. Thus, I suggested he add a section, specific to his clinical services, that used the idea of packaging.

First, Jonathan needed to do some research about his own practice. I asked him to look through his client data to understand his natural patterns of providing services. In doing so, he saw that over the past two years, he’d spent an average of six months working with each child. He checked his notes to see what he did with the children month by month. Dividing the time into thirds, we then created a package made up of three stages, and named each two-month stage, defining its purpose in easily understood terms.

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  • Comment Link Thursday, 19 September 2013 13:57 posted by Sally Palaian

    Thanks for the great coverage about the business of therapy in the modern day! Psychotherapy Networker is always on the cutting edge with timely issues for clinicians. All three articles articulated exactly what I’ve been feeling lately with my practice.

    As a follow-up to Lynn Grodzki’s article on the new educated consumer, I have one additional comment regarding new couples expecting that we bill their insurance for Marriage Counseling.

    It’s ironic that people somehow have enough money to spend when they plan their wedding and honeymoon.
    They also find enough money to pay for lawyers when they are done with their partner and seek out divorce.
    But, somehow marriage counseling is too expensive for them, and they perceive that they can’t afford it, and must use their health insurance.

    From what I understand this is insurance fraud when clinicians write up conjoint sessions when really it was marriage counseling. I don’t have a large practice but I have turned away 15 couples in the last three months; all insisting that I should bill their insurance for payment. (Including one health insurance executive, no less!) I am sure they found another clinician who was indeed willing to submit the bill to the insurance company and “write it up” in such a way that the insurances will pay.

    Marriage counseling is hard work, I’m not willing to do fraudulent things and jeopardize my license and career for total strangers. Nor am I willing to be bullied into accepting the lower “insurance” rate as payment. I am sad for our profession because so many clinicians believe the florist and the bakery deserve to get full fees, but we do not.

  • Comment Link Wednesday, 11 September 2013 13:17 posted by Jennifer Knight

    Excellent, helpful article. Thanks for articulating the obstacles to building a private practice and practical tools for how to address them and to turn each obstacle into an opportunity for providing better service.