Consumer-Driven Therapy: What Happens When Our Clients Become Our Customers?

Article excerpt

When I began a course of therapy 25 years ago with an analytically trained psychologist, I no more considered myself an informed consumer , shopping around for a good therapy "product," than I believed I had the right to openly question any of the other (mostly male, always white) Authorities in my life--doctors, lawyers, professors--who clearly had far more expertise about what was good for me than I did. I stumbled into my therapist's office on somebody's recommendation, assuming she was wisdom incarnate, then spent a session or two being interviewed by her to see if she would accept me for treatment. As relieved as if I had passed some sort of exam, I settled into therapy, securely nestled in a good indemnity insurance plan underwritten with a pro forma diagnosis of adjustment disorder. It never occurred to me to question my therapist's credentials or theoretical orientation, or ask how long it might take, or what our treatment goals were. Nor did I ever dream of calling her by her first name. She was, from beginning to end, Dr.-----, I was her patient--from Latin, meaning "to suffer."

My, how times have changed. If yesterday's typical psychotherapy seekers were supplicants at the font of therapeutic wisdom, some therapists say that in today's buyer's market, potential clients are more likely to size up therapists like skeptical shoppers scrutinizing the undoubtedly fake Rolexes of a street vendor. "People call up all the time and interrogate me about my credentials, my theoretical orientation, where I went to graduate school, how many cases like theirs I have seen, how many sessions it will take, sometimes even whether or not I've ever been divorced and whether I'm a born-again Christian," says Mary Kilburn, a psychologist in private practice in Raleigh, North Carolina. "Some are calling around to find the lowest rate for therapy--presumably, they will go with the lowest bidder." Sometimes, says Kilburn, the grilling seems to accompany a barely concealed spirit of suspicion, even hostility, to the practice of therapy, particularly if she cannot immediately estimate the number of sessions that will be necessary for a particular complaint. "They make me feel like some kind of con artist if I tell them I would need to hear more about their problems before predicting how long it will take."

In the old days, clinicians didn't have to treat the marketplace with any respect because they didn't have to convince anybody to buy anything. Today the tide has changed--yesterday's supplicant has become today's elusive and inconstant buyer.

The distrust that some therapists experience from potential clients may only be the negative manifestation of the growth in public interest in, and familiarity with, the culture of therapy. Over the past 20 years, consumers have been powerfully influenced by the explosion of the pop psychology media market, and many of the ideas they acquire from the marketplace they also bring into the clinician's office. "It's likely when people call, they will ask us whether we do codependent therapy, what we think of the false memory debate, whether we read Men Are From Mars, Women Are From Venus , whether we specialize in some issue they've seen discussed in the media," says California psychologist Art Kovacs, who conducts workshops on attracting self-pay therapy clients. My former therapist would have been inclined to dismiss any such marketplace gleanings as not serious enough to warrant precious therapeutic time, but today Kovacs and other therapists listen respectfully, carefully, without impatience, answering any and all questions. On at least one occasion, Kovacs has spent more than an hour on the phone discussing a best-selling psychology book with a prospective client before even seeing him. …


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