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Apr 12, 2016

Counseling Practice Today

The biggest change between counseling today and 10 years ago (other than the DSM 5, the issue of bullying, self-mutilation among teens, internet addiction, unmarried adulthood, a better understanding of human sexuality and a few hundred other things) is that 10 years ago people would call a practice and sheepishly ask, “do you accept my insurance?” If the practice didn’t, then the caller would still schedule and pay out of pocket.

Today, with mental health parity and the Affordable Care Act, not only do most people have insurance — they want to use their insurance. And the sheer number of counselors willing to accept insurance means that building a full caseload of clients willing to paying out of pocket is now very difficult.

There are exceptions: Some markets are exceedingly affluent, or there’s a shortage of clinicians. And there are also some people so talented and gifted (and charismatic), they’re full and turning clients away. But they’re the outliers!

The rarity of the outlier is what some clinicians don’t realize. They’re told by a guru that they can build a cash caseload. Maybe they take a course where they’re taught to promote themselves on Facebook. They leave that course, try to recruit clients and feel like failures when they can’t get full.

They’re not failures; they just don’t realize they’re swimming against strong market currents.

The Next Five Years

The industry is on the verge of a complete upheaval.

What’s happened in emergency medicine; with Doctors Express, MedExpress; chiropractic, with The Joint and several franchise systems; and massage therapy, with Massage Envy, Massage Heights and others — is going to happen in behavioral health, too.

Up until now, behavioral health (i.e., counseling) has been a severely fragmented industry, predominantly run by individual clinicians or small group practices. Some are well managed; though many are not (case in point: I decided to start Thriveworks after calling 40 therapists and reaching 40 voicemails in a row).

You’re going to see investors get interested in the behavioral health/counseling space. You’re going to see hospital systems provide more outpatient mental health services. There will be brand names in our field, and larger operations popping up across the US.

Some counselors are going to hate them. First, they’ll say these new practices are the “McDonald’s of counseling.”

Then, they’re going to hate them because some of these new practices will provide better customer service, evidence-based treatments, medication management and a host of services a standalone practice cannot offer.

Can you name a brand of therapy centers other than Thriveworks? If you can’t today, you probably will be able to within the next 5 years.

The Next Ten Years

Disclaimer: A 10 year prediction is difficult. Within the next 10 years, however, I think we’re going to see more services provided by bachelors-level and pre-licensed providers (this is now happening in Europe).

For example, if someone presents a common problem (like depression or anxiety), he or she will first meet with a lower-level provider— perhaps by video — for a set number of sessions. If those sessions don’t result in positive outcomes, only then will they meet with a more senior clinician.

It’s going to be tech-support for anxiety: the person on the other end of an electronic line will be trained on specific troubleshooting protocols. In addition, treatments in general will be developed around what is proven to be effective with a specific disorder (e.g., CBASP for chronic depression, DBT for clients with borderline personalities). Less attention will be paid to overarching counseling theories (e.g., Humanistic, Psychodynamic, etc.).

Within 10 years, we’re also going to see the rise of computer-mediated treatments where there’s no provider interaction whatsoever. Feeling anxious? Step-one might be to take four modules of an online CBT program.

One Last Thing

Don’t fear change! Counseling has a bright future. It’s a field that people are excited about. Clients, communities and even politicians are excited about improving mental health services; and the stigma of counseling will continue to decrease in the years to come.

People ask me: “Is there hope for counselors?”

My answer: “Yes!”

Like I recently told my clinical manager at Thriveworks Counseling Richmond, “You think counselors have it good now? You don’t! Counselors are underpaid and overworked. They struggle to provide quality care at clinics where lead paint is peeling off the walls. Post-masters, pre-licensed counselors often have nowhere to go to get the clinical hours and supervision they need for licensure. Counselors are going to be more than okay as the industry evolves.

We’re on the cusp of very positive and exciting times in our field.

What do you think? Do you agree? Leave a comment below or tweet me!
Anthony Centore, Ph.D., is private practice consultant for the ACA, founder of Thriveworks Counseling (with locations in 9 states), and author of the book, How to Thrive in Counseling Private Practice. Anthony is a licensed counselor in Massachusetts and Virginia. Find him on Twitter at @anthonycentore or @Thriveworks.


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