The idea that clients should pay at least a small fee for therapy in order for therapy to be effective has been around for a long time. But it doesn’t hold up as well as you might think.
This is one of those things that I learned in grad school and simply accepted as truth for a long time. And then I was startled when I actually looked into it. Not only does forcing clients to pay even a small amount for therapy not help outcomes, some evidence suggests it makes outcomes worse.
We’ve all been dropped by clients at some point in our therapy careers. It may be due to scheduling, payment for services (or lack thereof), your specialty or theory of choice, your interventions, or just your own unique personality. That is all OK. It is OK to lose a client. In fact, there are a number of situations when losing a client may be beneficial. When a client drops you after you were challenging them in session, it may make more sense — at least sometimes — to consider it a success than a failure.
I’ll share a personal example here, from earlier in my career.
When a piece of technology works well and makes life easy, that doesn’t mean that the building of it went well or that the lives of the builders are easy. Many in the technology industry struggle with symptoms of anxiety and depression. In fact, they struggle with these symptoms much more often than the general population.
Working 50-hour weeks for months on end, having limited interactions with others, feeling multiple levels of oversight, and constantly being unsure whether your project will be used or scrapped — technology professionals experience all of this, typically with little or no recognition for their work. (Think about it: You probably use Gmail, but if you don’t know them personally, how many Google employees can you name?)
If you’re a therapist in private practice, you’re probably listed on Psychology Today. For better or worse, it’s the 800-pound gorilla of therapist directories: It gets a ton of traffic, which means its pages show up high in search results, which generate even more traffic.
Despite owning the market, the Psychology Today directory is not necessarily well-liked. Its user experience looks and feels dated. While advanced searches are possible, the main search page only allows searches by name and location. Therapists and clients alike sometimes grumble that the information therapists can share on their profiles is limited.
For a new generation of online therapist directories, the failure of Psychology Today to improve its product represents a tremendous opportunity.
California suffers from a severe and worsening mental health workforce shortage. In fact, much of the US is in the same boat. There simply aren’t enough qualified mental health professionals to meet our country’s needs.
At the same time, therapists in private practice often complain about their local markets being saturated. There are so many therapists in some places, it seems, that it’s hard to get a career off the ground.
As it turns out, there’s truth to both of these perspectives.