Many of us were drawn to our profession because we wanted to help people . . .
. . . but what happens when fewer and fewer people seek your help?
With the economy and people having busier lives, a lot of practices are starting to see a steady decline in clients coming in on a regular basis.
And attracting new clients isn’t any easier.
Even graduate schools have started to add marketing ideas to the counseling and clinical psychology curriculum. But many seasoned practitioners in the field now don’t have that advantage.
Meanwhile, other forces are competing with psychotherapy.
In 2010, the American Psychological Association put out an article entitled, “Where Has All the Psychotherapy Gone?” and the results now confirm current trends. It revealed how fewer and fewer patients, instead of seeing a therapist, were opting for pharmaceutical treatments alone.
According to a 2008 study, 57.4% of patients, particularly those with anxiety, depression, and childhood-onset disorders, received medication only – with no psychotherapeutic interventions.Another recent study done with soldiers found that a majority preferred self-administered and more portable interventions (like MP3 downloads of guided imagery) rather than an office visit to receive one-on-one services.
And some people in need of treatment are skipping licensed practitioners altogether and opting for coaching (an entirely unregulated industry).
So where exactly does that leave us? What can we do to stay alive?
There is a way for you to take back control. Your connection with people is important and they can benefit from your services.
But it might require you to rethink the way you deliver your service.
Perhaps it means that you might totally want to rethink it.
I was recently leading a workshop for some of the top authors and speakers in our field. Over the past 3 years, I’ve been helping some of my colleagues use the same reaching-out tools that NICABM has been developing. In the workshop, I suggested that participants separate the content of their expertise from the format of their service.
Another way to say this is to separate your content specialty from your mode of service delivery.
For instance, these were world-class experts in mind/body medicine, trauma, couples counseling, and hypnosis – and their predominant formats for delivering their expertise included writing books, attending conferences, speaking to large audiences of practitioners, and leading workshops.
Your expertise might be in those areas as well, or it might be something else, such as working with veterans, survivors of sexual abuse, or people with chronic pain.
Right now, your format for service delivery might be to see patients one-on-one . . . or perhaps as couples or in small groups. Or you might be teaching graduate students.
But in order to keep up with the changing dynamics of current practices, your mode of service delivery may have to shift.
You may need to start thinking more flexibly about the format you’ll want to use in delivering your expertise.
Plus, there could be so many potential benefits.
You would be reaching more people from all over the world who could benefit from your expertise.And you could have more free time for yourself and more flexibility in your professional schedule.
We’ll be explaining more about how to do this soon, so stay tuned.
In the meantime, let us know how you feel about your practice as it is now.
Would you be willing to try something new to reach more people? Would you like to arrange your own schedule and have more free time?
Please share your thoughts in the comments below.
I have been able to refresh my private practice as a psychotherapist by taking extensive coach training with the Institute for Life Coach Training, which specializes in training psychotherapists to become life coaches. As a Registered Social Worker with an MA in counseling psychology, I really didn’t think I would be entering into a profession that had it’s own significant body of knowledge, but I was mistaken. Much to my surprise, I learned a great deal about the forward moving, accountability and vision oriented aspect of coaching, which built upon work I was already doing. (The profession of Life Coaching was actually started by psychologists who looking to enhance their work, without the diagnosis orientation and volumes of paper work required in the US.)
The client base is different and I still practice both psychotherapy and life coaching but I am careful to separate the modalities. There are some clients who would prefer life coaching or relationship coaching to psychotherapy or couples counseling so it can actually benefit the marketing opportunities. As Virginia mentioned, coaching has its own professional regulating bodies and many coaches prefer to identify with those regulations; the International Coach Federation is a good one to look at and they certify the programs of specific Coach Training Schools. I am also a Board Certified Coach and coaches with a psychology background are often sought out. I find that practicing both coaching and psychotherapy has energized my private practice and provided a welcome variety and more client possibilities.
That is a very, very worrying trend…We all know that pharmacotherapy alone is not a cure….A sign of individuals in society getting gradually more and more disconnected from others…? Schools rely more on student contact with electronic media rather than with teachers, same for universities…we can see tis on school buses and public transport, and in our living-rooms… Thank you for this article, Ruth. I feel that this is a great idea: to diversify the way one can help people and pass on skills and expertise. After a few decades of being an individual therapist my friend suggested to me “you should write a book..” But… I don’t think I can write a best- seller. But running work-shops for practitioners, passing on the skills I have gained and knowledge I have discovered…Yes that would work for me! And hope that would be useful to a number of my colleagues.
Always open to new ideas and formats – have really benefited from your brain lectures. I feel there is a need for what you are discussing and, yes, times are different and change is surfacing and we need to be ready.
I am wondering how this idea might fit into the new Obama care concept that may be affecting private practitioners down the road. Specifically, that we may need to be part of of a medical group in order to continue practicing. Thank you, Aimee Bunin, LICSW
I am ready, skilled and open to expanding my treatment possibilities. I have much more to give than I’m able to within the confines of out-patient mental health.
i do agree about the situatton you have describred i my self have began to use direct communication through the e/ mail not yet charging but may be i
will have to do it as regular option .
I think a lot of what we are up against are several dynamic forces that as a field we struggle with. Without going on forever I will address just a few. Psychotherapy has an immense cultural idea or meme that surrounds it, fed by a passive murmur of pop psychology, self help, hollywood, and a deep belief that change can occur simply through will power, thinking, or some quick fix. From this belief we are in an invisible sea of clients who want a silver bullet to cure their human condition and cure it quickly and of course this is loaded with lots of shame and embarrassment when this fails. With this is the cultural shame of needing or asking for help. Clients come to us with a whole conscious or unconscious belief about the craft and a belief about their condition, which is fairly archaic and incongruent with their need to stop suffering “NOW” and the belief that this should come quickly. So we are in idealogical competition with the grand drumbeat of modern industry and the promise of new science. As a professor of undergraduates, I teach the up and coming youth about Somatic psychology, in which I include the viens of NICABM. They love the combination of science, experiential learning, and the opportunities to safely and genuinely connect. Many of them have gone on to graduate programs that specialize in Somatic Psych. What I glean from this opportunity is a glimpse in the deep need our population has to once again believe in the potent power of psychotherapy to aid us in becoming more capable to honestly engage the human condition rather than cure it. From this there are so many burgeoning opportunities to assist, aid, and reframe, via niche work, the roll high quality psychotherapy has in our culture and in this very specific time period. I spend many hours in my classes in exposing these niche opportunities for students and there is a movement of intrest with growing numbers in my classes. I believe this intrest is less of a reflection of my skill and more of a reflection of the hunger of the youth to have a hopeful modality of change. Lets us all become creative enough to spark an intrest in the power and hope of high quality psychotherapy. Thanks for listening. Scot Nichols Bellingham WA
I currently see individual clients in a private practice setting. I specialize in physiological psychology using a wholistic approach. Using the science of the heart ad a backdro, I teach people skills and strategies to regulate their emotions, physiology, and behaviors. I often see lives change fairly rapidly. I would love to be able to reach more people with more ease and flexibility and also do that more lucratively.
I’m looking forward to hearing your thoughts on ways to stay ahead of the changes in our profession and in the world. I have noticed a change in my practice about four year ago – right when the recession hit. I love doing workshops, but find it challenging to get a big group to attend.
I am always interested in finding new ways to work. My practice is a constant concern for me .
I am currently an individual therapist. I’m open to trying any ideas of service delivery, but I am also concerned that some of the free enterprise ideas I’ve seen feel like a bastardization of the work.
I’m also seriously thinking of retiring after working in the field over 30 years. I enjoy what I do but the field isn’t what it used to be. Thankfully I have someone to do my billing in my private practice, but dealing with treatment that’s insurance-driven is more than challenging to live with. I’m curious about what suggestions may be offered. I have found that over time many “things” come back in different packages but am always hopeful and interested in learning something new.
I do think we have to learn how to do new things. Since I’ve never been really in the “normal” billing world I had to learn how to market, sell etc. If yo’ve got new ideas I’m always open. I just did a training for entrepreneurs like me and the concept was instead of selling sessions, selling outcomes, selling packages. I just can recommend it! It’s a bit harder, but worth the while!
I am at the other end starting up and agree with the thrust of the discussion.
In the outside world they call it having a niche for your business – competitive advantage over your competitor.
I am seeking out small business owners and offering them Critical Incident Debriefing and Employee Assistance Programme.
Two recent cases were an employee going to a customers house and finding them dead and an employee turning up to work bruised having been assaulted by their ex the night before. One organisation has used me a lot as their previous provider would not return their phone calls until 24-48 hours after an incident. If I can’t see someone that day I offer 1 15 min call between sessions and arrange to call them after they finish work. Just calling them 2 or 3 times during the day can be enough.
I offer business a free one hour presentation to their staff about self care and briefly explain when grief/loss can become depression or trauma. This has opened a number of doors and has resulted in a number of new people coming for counselling. So far for every presentation I average two counselling sessions from it or have been asked by others to give it and be paid for the presentation.
CHRONIC PAIN REDUCTION: In addition to being an EMDR counselor, and a DBT counselor, I teach people who suffer from chronic pain how to use Chi energy techniques to noticeably reduce pain. Many people who have learned my skills report having complete relief from chronic pain. I would like to be able to share this program with millions of people. I have created a Chi energy work pain reduction program that contains video and written material to teach these skills. The cost is $200 for the entire program. To order you can reach me by email at mc2004@cox.net Thank you, Andrew. Andrew E. Henry, MA, LPC. P.L.L.C.
Yes, I am open to new modalilties for sharing the wealth of knowledge now available to mental health practitioners. i look forward to discovering what innovations other practitioners are finding successful in reaching more people. I am hopeful that the future allows for more mind/body connection, and that the spiritual component of healing is consistently honored.
Always willing to try something new and to learn. At the moment my practice is starting to reach more and more people so I am happy with that. However, the more persons we can reach the better it is for everyone.
I, too, see the changes that you discuss. I am fortunate to be an “Embedded Behavioral Health Clinician” who is contracted through my county government/staffing agency. I work in three county agencies (Health and Human Services, Emergency Management, and the Sheriff’s Office) so I can see first responders and their families at no cost/co-pay; can meet with clients outside the normal business hours; and can manage a large Peer Support Network in our county and region. This has been extremely successful for the past three years and has been a cost savings to employers and clients. I also work with our local Employee Assistance Network (EAN) as we often refer clients to each other. Our law enforcement peer network can be seen in a June youtube video titled “The Buncombe County Peer Response Network.”
Even though I am retired, these on-line chats, topics and suggestions are important to me and help me keep in touch with what is currently happening in our field.
Thank You!
I have noticed the trend. People read about vitamins and minerals, self “medicate” and go to Costco to buy some, whether it’s good quality or not. There is so much marketing about cheap solutions on the internet that people rarely seek good counsel any longer… and people look for free advice, which is often “freely” given by non-experts, who just read a book and learned to market a chapter.
I have written books based on 40 years of research and personal experience, but once again, find that people want free advice when it comes to health. I’ve met people who took a one-week class to become hypnotists, who then promise the world to sufferers through clever marketing… which leaves me in the financial dust with Interactive Guided Imagery that I studied for 2 years (which lives up to its promises, unlike most weekend hypnotists).
I am strongly considering getting out of the field altogether.
I hear you Danielle, and it must be discouraging. But wait until Monday to make your decision about leaving the field. We’ll be putting out a video that we’ve been working on that presents some new ideas. Hang in there.
Ruth
I practice in Massachusetts and am on 6 insurance panels and do my own billing, which is often a nightmare. Insurance companies can be very difficult to deal with and at times, I’ve suggested they should compensate me for all the extra time I spend chasing down payment for my services! .Less than 1% of my clients are self-pay or are using their out of network option.
However, I continue to have a full case load (mornings and early evenings) and frequently have to turn people away. Referrals come through insurance panels and word-of-mouth, so I guess I’ve been lucky so far. I’m still very curious about the new outreach methods Ruth refers to, especially if they offer more flexibility and fewer hours!
I am a “healer”, and a therapist, but I don’t like using either of those words, so I am trying to find language that is more aligned with my practice.
I also work in Mexico, speak very good Spanish,and live there part time. I am looking to have three geographical areas where I can practice my work, with people and animals, and teach workshops.
I’d like to live in those areas part time and travel.
Mississippi has little to offer therapeutically, and I find the population enjoys the pharmaceuticals for both themselves and for their animals, and are generally not open minded about non-invasive or alternative treatment. Louisiana is a bit more open. Mexico is very open to non pharmaceutical treatment, and I am looking to establish myself there more as a healer.
I am starting to offer a series of private sessions that include several modalities, to assist a person in several ways, but mostly through body and spirit connection,and artistic and service extension.
I am looking to work with others, and present workshops with other therapists. I realize that joining personal people lists, connections, and ideas is the way to go.
I’m a coach, and it is not a completely unregulated industry. If clients come to us and need psychotherapy, rather than coaching, we refer them to someone with that expertise. Coaching is goal-directed, present and future oriented. Coaches don’t ask, “Why are you this way?” but rather, “What do you need to get to your goal?”
Just wanted to clarify that. Coaches do have credentialing bodies, have to go through training, supervision, written and oral testing, and are required to advance and up-date their training through acquiring continuing education units. Check out the International Coach Federation to find out more about this. People who specialized in two coaching areas, ADHD and Wellness, have further training, supervision, and testing to gain certification.
Much of therapy (for lack of better word) is goal – directed these days…I think that’s the trend for all of of us. As for credentialing bodies…are they voluntary?
This could not poisbsly have been more helpful!
It sounds like you are a high-integrity coach, willing to refer out the folks who need more help than you can provide. There are plenty of coaches practicing in Austin, Texas who have little to no training. They just hang out a shingle calling themselves coaches, build a website, and start seeing clients. I also know of coaches who consider themselves healers, and who do attempt to tackle psychological and emotional client issues that should be referred out. To my knowledge, there is no mandatory training or credentialing process for coaches, and no ethical guidelines. I do think the presence of life coaches encroaches on the client population for trained counselors and psychologists.
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I’ve been looking for another word for “therapy”. My primary practice is DCF children and families, severe trauma, including child sexual abuse. I do not participate on insurance panels. I’m am very creative and effective in the delivery of “treatment’ but they are involuntary clients required to be in treatment, who are told or interpret that mandate as “you need therapy” No-one wants to hear that and there are still a lot of myths about therapy. It does not describe what I do. I am also a Reiki Master Teacher, I work in hospice care and I write and deliver original workshops, seminars and trainings ….on many topics, but primarily speaking to the principles of The Foundations of Healing…that underlie wellness and all modalities of treatment and intervention. I am more and more working with people who are spiritually awakening, conscious. I’m looking to grow and expand my markets. Interested to know what you have to say. I don’t come from a lack mentality and seek that in my coaches and mentors.
Diversification and focused service referrals have become major supports regarding the counseling and psychotherapy aspects of my practice. I’m looking forward to reading the comments and then watching as NICABM presents the “something new” featured in this intriguing blog by Dr. Buczynski. For several months I’ve been incorporating the concept of Implicit Emotional Memory that I learned about in a workshop by the Coherence Psychology Institute: NICABM is a key component of my implicit memory archive because it is one of the most solid evidences I have that there are people who are intelligent and creative and who share a commitment to helping our clients/patients live better lives as well as helping us practitioners have a more robust experience of our professional activities. What I’m guessing will be major components of this “something new” include things I’m already doing: A) Helping people recognize that there is a pool of expertise that we counselors/therapists are in contact with; B) We hold in high regard the time when they come to the office physically for one-on-one appointments; C) We are vetting for them a selection of options available for at-home support that they can access in between visits; D) We are able to give input to their search for other types of support such as nutrition, physical body support approaches, etc.; E) We can devote a percentage of their appointment time to checking in about how they are managing the wide range of options that they may choose for what I call their “health menu.” For me, NICABM has become part of my groundwork as I deal with choices about how to give clients/patients the benefits of New Brain Science. Reading this blog today is especially encouraging as I look at summertime and develop longer-term plans for my practice. I’m looking forward to your announcement about something new. Keep up the great work!
I have seen a dramatic change in my practice in recent years. Majority of calls and emails are from people looking for someone in network for their insurance. I refuse to be on panels but my billing service will submit for anyone who has and wants to use their out-of-network benefits. Fewer and fewer plans it seems even offer out-of-network. Part of how I resolved the decline in my practice was to take seriously how many people were contacting me who have State Insurance. I became a provider for the State. The state doesn’t pay MY fee but I have for the most part not regretted making myself an option for all the folks with State insurance who kept finding their way to me. I would very much like to increase my income and lessen my hours at this point in my career. The priority for me is though that if it isn’t a means that makes me feel happy…..I won’t do that either. My ideal….of course…….more money, less work, still happy.
In Lebanon, most psychologists who are practitioners who have their own clinics need to do something else along side because financially it is not enough. In addition to clinical work, they either teach part-time at universities or work in hospitals or be consultants in schools. They all end up being stressed out because of the over-work and spreading themselves out. Most psychotherapy work happens in the afternoons and early evenings because clients have work. And if he or she took a vacation, there are lots of clients drop-outs. So how can a psychologist really have time for himself, relax, organize his/her work, control drop-outs, and live decently?
not so different in Canada!
This is what’s important Lina and Anne, finding a way to use your advanced training and expertise and make a good income without trading your time for dollars. That way you have time for yourself and your family.
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