Surviving the Revolution

By Butler, Katy | Family Therapy Networker, March/April 1994 | Go to article overview

Surviving the Revolution


Butler, Katy, Family Therapy Networker


The adaptations necessary to make it in the competitive world of managed care go against many therapists' psychological grain.

ALL THROUGH THE 1980s, THE phone kept ringing and the money rolled in. Like many of his colleagues with established reputations, a psychotherapist we'll call David Cornfield had more than enough clients. He did high-impact, short-term work with families and individuals, and whenever clients left, others called to take their place. He charged what the market would bear as much as $200 a session and earned more than $200,000 a year. His practice took care of itself. Then, in 1990, with a confidence that now looks like hubris, he took a sabbatical to live in the country, rethink his life, work with low-income families and train other therapists. He came back two years later like a figure in a fairy tale who has stayed too long at the fair.

Cornfield found a new office and called old clients and friends. The phone rang a few times. A few new clients came, but his calendar had long blank spaces. He called established therapists and asked for referrals. Nothing happened. "My practice just hung there at about 15 people a week, going up to 20 and then down again," he says. This year, he earned a third of what he earned in 1990.

While Cornfield was away, a few large managed care companies and health maintenance organizations had come to dominate the Boston health-care market. No longer did employer-sponsored insurance programs freely hand out $3,000 a year for therapy, with few questions asked. Managed care companies now paid the bills, and they had signed up panels of therapists to work at a discount panels that were now closed. To make things worse, the economy had tightened, there was a glut of therapists, and fewer people had the cash to pay for therapy out of their own pockets.

Cornfield's phone continued to ring only sporadically. Last year, confused and embarassed, he turned to Linda Lawless, a marriage and family counselor and a marketing consultant one of dozens of marketers who help anxious therapists negotiate the rapids of a changing economic world Many of them, including Lawless, are former psychiatric nurses, experienced in dealing with big bureaucracies. Their therapist-clients, like Cornfield, on the other hand, have spent their lives working for themselves like village shoemakers who once sewed shoes to fit each patron's foot. They quietly built reputations; their work spoke for itself. They didn't have to clearly define what they did or promote it aggressively to executives carrying briefcases and wearing suits. Somewhat bewildered, they have turned to marketers to help them negotiate the transition from craftsperson to "provider," and to draw the attention of the distant conglomerates who now pay the bills and funnel the clients. In a few brief years, everything has changed in this profession, and in the future, the marketers say, it will change even more.

Lawless advised Cornfield to begin with the basics. As she does with all new clients, she helped him identify what he does best, establish a specialty, get a clear, well-designed business card, and get his name out into the community. She recommends her clients go to conferences and join chambers of commerce, shake hands, talk to community groups, give free workshops in schools, run low-priced, introductory therapy groups and weekend workshops, and teach adult education classes.

In the old days, that was enough to prime the pump and introduce personable, qualified therapists to a geometrically increasing base of potential clients. But today, the real "customers" are managed care executives, not individuals. Therapists can no longer rely on the kind of promotion that works well in a village atmosphere. The managed care companies are corporate bureaucracies with their own needs; they demand different skills of therapists than individual clients do, and they require a marketing strategy all their own.

Even to get a foot in the door with them requires a familiarity with the tools of rapid business communication. …

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