Generation Meds

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Why Psychotherapy's Biggest Problem Isn't Its Image

Psychotherapy doesn't have an image problem; it has a financial problem. A response to Lori Gottlieb's New York Times Magazine article, "What Brand Is Your Therapist?" Read More

Sign me up. Reduced pay for

Sign me up. Reduced pay for therapists has also had a huge impact on therapy itself, as "patients" have become "clients" and the client decides the course of therapy. Of course, if the client knew what he wanted, he wouldn't be in therapy. I've had several therapists claim they could fix me up in 10 sessions or less, and I wonder what quality of therapist would make that claim?

Agreed financial issues are big for many of us

I concur wholeheartedly. I have seen many good therapists quit the field entirely, for stable income jobs with benefits or advancement opportunities. I've seen many colleagues that are Master's level therapists switch to pretty much any job, administrative assistants etc and then just do therapy on the side.

The bulk of practicing psychotherapy is done by Master's level therapists, but if you look at the list of lowest paid Master's degrees you continue to see Social work, Counseling right at the top of the list for worst Median incomes.

I've worked at Colleges, Universities, Non-profits, and now private practice...and barring decent pay at Colleges--its been a horrible economic experience. Sure, I know a handful of people who overwork themselves and try and meet with endless amounts of clients and never take time off that make decent money--but the majority of the people I know struggle to make much over 30k per year.

Private practice is no panacea, beyond increased freedom, of course you get no insurance, no sick days, no time off, well you can take time off and get sick if you don't mind not getting paid. Even with a thriving private practice with almost no lulls in clients, its an increasingly difficult way to make a living. The amount of paperwork, billing issues, co-pay issues and all the rest can become very time consuming. To start the new year of 2013 out, I saw the new payment schedule for some of the health insurance companies, guess what they all dropped for Master's level therapists. Some only 5$/hour, but the HMO that manages our Medicaid clients, dropped they pay rate by 35$/hour! I personally referred out and quit taking on new MA/clients last year due to endless frustrations, back audits, and nitpicking over notes, and many other issues.

I explained to my private practice colleagues that the financial insecurity and ever decreasing pay, and my need to do larger and larger amounts of free work, from phone consults, extra paperwork, free therapy and all the rest--that this is my last year. Yes, I knew getting into this that It wasn't a great career choice, but back in the 1990's the avg. reimbursement rate was still close to 90, and more for PH.D's. But wow has the last decade+ been eye opening. I see friends of mine who got Master's degrees or even BA degrees in less stressful fields make double or triple my income.

It's pretty pathetic that I made nearly the same amount of money as a graduate assistant who worked as a bartender at nights to pay my way through school, as I do 13 years later. With children, this just isn't viable. I would never suggest anyone enter this field unless they can go to school with zero debt or close to it, and come from wealth, otherwise you get to become one of the "professional" broke people. Most of my Ph.D colleagues don't want to do therapy much, despite the higher pay rates, since they make easier money teaching classes, doing assessments, consulting etc, with much less stress.

Protocols and all the rest, despite good intentions, will most certainly be used by insurance companies to limit sessions, cut reimbursements and pigeon hole patients--who often times are far more complex than their 'primary diagnosis'. Perhaps when I win the powerball lottery, I'll consider doing therapy again.

When I read the quoted NY

When I read the quoted NY Times article some time ago my first thought was exactly the same: How can there be lack of clients if there are so many people in need of therapy? Thank you for raising this point.

I was participating in the social anxiety support forum for a while and I was surprised to learn so many people do not get any help because they have no money or their insurers don't cover psychotherapy. That all despite the fact that the CBT is shown to be very effective for this condition. Clearly it is money's problem not the image of psychotherapy itself.

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Comments on "Why Psychotherapy's Biggest Problem Isn't Its Image" | Psychology Today

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Katherine Sharpe is the author of Coming of Age on Zoloft.

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