Keeping Your Therapy Practice Afloat When the Economy is Sinking

While it may feel like it, maybe you didn’t get $85,000 in debt for your PhD just to work for $19,000 a year.

Given the state of the economy, maintaining a viable therapy practice can feel daunting. I know we talk quite a bit on this blog about alternative currency, but the fact remains that most local co-op arrangements will take years to financially bear fruit. So what is a therapist to do?

Brainstorm. Plan. Test. Market.

Here are a few marketing tips for psychotherapists who want to find high net-worth clients.

1. Are you in a state with high debt loads and taxes on the rise?

Take a look at potential state arbitrage rates. New Jersey, California and Florida, for instance, are facing ever increasing taxes and wealthy clients who live there could be feeling torn between sticking around and heading for greener pastures.

The key to keeping your practice afloat is keeping it relevant to what people in your community are struggling with. A little groundwork can ensure you’re offering something valuable and useful to the clients you want to attract:

  • Go to state, township, and school board meetings in affluent districts and observe: What is the mood? What are people upset about? Are the citizens there facing higher business taxes and fewer services, are they torn between leaving the state and staying put? Do they feel like they keep paying more and getting less? Guiding your clients through the smoldering issues of fairness, personal autonomy, anxiety and anger will likely be the bulk of your work.
  • Make a note of frequently repeated phrases spoken by people who fall into your ideal client demographic. You can use these phrases to create your advertisements.
  • Create therapy seminars to handle these specific needs. To address those feelings, design a therapy group expressly for talking about frustration related to how government policies like rising taxes are affecting people’s lives. Talk about the comparative costs associated with leaving the state, staying put, and relocating to another section of the state. Partner with an accountant or tax advisor to do some practical and therapeutic long-term planning.

For this solution to be effective, limit the clients’ tax bracket to 28% and above. Common experience makes a more cohesive group, and inviting a wider tax range will lead to sessions that go off the rails in terms of purpose. You can always create another group for a broader audience that deals with general psychological issues related to finances (like debt stress, or economic fairness) and run it at a different time.

2. Are your clients paying their kids’ university tab?

I paid for university myself, with a little help from my mother at the start. I’ve always been envious of the trust fund kids who had an easy financial ride and no ocean of private university debt to look forward to at graduation, BUT there are trade-offs to getting your parents to pay for your education.

Parents are worried about their kids:

  • Are they making the most of the college experience, or are the little angels drinking and messing around on their dime?
  • Should you pay for their college?
  • When will they learn self-reliance?
  • What about extortion, does that work? (I had a friend whose father offered to pay for everything, including living expenses, but only on the condition that she major in pre-med. If she chose any other profession, she wouldn’t get a cent - not even a co-sign.) What does this do to a parent-child relationship, and is that fair?
  • How can you get your kid to make practical decisions without making them feel like you're wrenching away their dreams?
  • How will family relationships be affected in the short and longer-term? How will this affect kids’ future relationship with money? With trust issues?

You can use your counselling skills to help guide families through this period. Create a seminar -- and then advertise it on professional association and alma mater newsletters, websites and magazines.

3. Are Your Clients Trust Fund Kids?

There isn't much love going around for folks in the top 2% -- or their trust fund children. All the toys in the world can't make up for the stress and isolation that comes from being despised by 90% of the population. If your practice is located in a hyper-affluent town but you yourself are not familiar with this issue, I would suggest reading first-hand therapy stories from "The Legacy of Inherited Wealth," for greater understanding.

The key is to figure out what folks who can afford your service really need, and offer it to them. With a little research and creativity, you can market effectively and provide a meaningful service.



Holy High-Yield Bond Performance, Batman: This is a sticky, tricky issue!

At first, I bristled a bit at the idea of purposely searching out "wealthy only" clients. And then....I got real. You're right - not only do you, as a therapist, need to make money to keep your practice thriving, but also - the "more affluent" among us DO have special needs; to say otherwise is to show reverse discrimination; - and we certainly know better than to do THAT!

While reading this blog post, it reminded me of materials I have come across previously dealing with the topic of the unique challenges faced by the more affluent. In addition to Leigh's recommended reading, and/or if you only have the time/energy for a quick "sound-bite" of information right now; may I offer this web posting as an introduction to the issue:

Now that we have established that it IS a necessary service to provide, as well as a manner to keep you, the therapist, in practice - how do we reach that 28% and higher tax bracket? I have a few ideas, some born of personal experience, some from my own research and education. With the author's permission, may I also suggest:

* Posting your advertisement/marketing materials in places you might not think of initially - the Public Library Bulletin Board; the YMCA or other community center - although the organization itself is non-profit; you'd be amazed at how many "sponsors" - read as "wealthy individuals", not only contribute to the place, but actually use its services and actively seek like-minded, and like-walleted, families in the group activities and fund-raising committees there; and if allowed - the employee lounge of high-salary workplaces such as pharmaceutical corporations, hospital and medical centers, large insurance and investment firms, etc.

* If you are in an affluent neighborhood, or close by, try to get in to see the Guidance Dept. at the local High Schools. Just for five minutes. Give your "5 Minute Presentation" - tailored, of course, to the demographic you want to reach, to the counselors there. And then leave your materials with them. I will guarantee you that even if the parents think they have no "issues" themselves that need therapy; they are aware that either their kid or someone else's kid, is most assuredly in need of "help" - and students are constantly being encouraged to confide in some "trusted adult". For many socially isolated - at least on the inside - students, that translates to the Guidance Counselor or Mentor of school programs. Another way in.

* OK; this suggestion is really tricky, but totally appropriate if done correctly, and could have major return-on-investment for you. Work in Reverse. What do I mean by that? This: contact the local "charitable agencies" in your geographical areas of practice. Due to privacy constraints most won't actually give you a list of their donors; then again - some will, and some are required to - depending on local laws regarding disclosures. But even if they can't/won't give you their donor list - once you explain that you are trying to reach that demographic to provide THEM (the wealthy contributors) with a service THEY need; the agencies may be willing to pass on your information to those donors - with a personal message from you - again, tailored to speak to them and their needs, in particular as regards what is most important to them. This ties back into Leigh's suggestion that you find out what is on the potential clients' mind; great advice. This suggestion here helps you find out what is in your potential clients' heart - to which agencies/causes do they feel a strong enough allegiance to put their money in? Now you know something about them as individuals - and what might be some of their particular issues you could help them work on. They give to the Breast Cancer Foundation (Komen)? Perhaps they, or a relative, have suffered through that and they still have unprocessed emotions over that. They give to scholarship funds for a particular group? They fund travel adventures/mission trips? Veterans, Homeless, Food Pantries, Etc.? Why? Just because they are affluent NOW, and can therefore afford your services NOW, doesn't mean it was always that way for them - and they may have unresolved conflicts from the past - as well as current ones - you can guide them through.

* Don't forget to look in the places that secular people tend to avoid - churches, synagogues, mosques, and alternative places of worship or spiritual community-gathering. Just because these places offer their own spiritual counseling, does not mean that your potential clients' needs are being met there. They may feel uncomfortable talking to their religious advisors about some of their issues; and yet recognize a need - or will recognize a need if the thought were triggered by your offer of "outside" service. Or they may need MORE than what is available through these channels. I know for a fact that both Jewish Family Services and Unitarian Universalists are willing - and do - refer outside their own home network, when appropriate. And, those two "religious-based" groups tend to have, on whole, a significantly wealthier than average membership base. There are others - check around in your local community; try to network with the leaders of these organizations during community-based events.

* One last possibility: if you are a licensed and accredited professional provider, try to get on the referral list for the differing insurance agencies and/or hospital-based referral network systems. Word of mouth is best for most people, but like anyone else in a true crisis, if wealthy clients don't know someone personally and can't get a personal referral for whatever reason, they will use these resources - because they know that such things exist - whereas your "less monetarily gifted" clients may not. Oftentimes, you do not have to actually accept the UCR for the insurance company to be a referral source (only if you want to be a "preferred provider") - you can always bill the client, and the client then submits to their insurance - and MAYBE gets something back - don't get me started on that one......totally different topic. But, your name and number is out there as a choice - and that can't hurt.

We talk often here on Whereapy about the challenge of needing to provide for our clients; and needing to provide for ourselves, too. It has become even more difficult to do so recently; and yet it has also become even more important to do just that. Everyone benefits - in all income brackets - if we can continue to keep a thriving practice that is available to all who need it and are a "good fit" for us. Best Wishes!

leigh's picture

Ha! yes, I went there. great suggestions!

Birds of a feather flock together. Rich people only hang out with their own kind. If you are not PLU you can forget about getting their business.

I think I have to "agree to disagree" here. Socially - yes; you have a point. But when it comes to providing a service - the "rich" people I know and have known - want the BEST - whether that comes from a peer or a subordinate; it does not matter. They expect the best service in any field; because they - as a group; and I do so dislike generalizations - have usually always been able to buy it. With services like medical and mental health, though, money is not necessarily a guarantee of good service, though it helps - which is why the therapist still needs his/her "5 Minute Presentation" to be tailored to the needs of the affluent; if they are looking to add said people to their client base.

everyone deserves good therapy. i have spent 20 years working with poorer clients. moving into private practice forces me to find the clients that will help me to make a living, but i don't leave my poor or working class follks behind. my sliding scale helps people pay in proportion to what they have. the richer clients help make up for the lower fees of the poorer clients. i think this is fair, and i maintain my ethical principles in the process.

leigh's picture

Great point Elizabeth - sliding scale is a lot like a progressive tax system, which is more fair for the those least able to pay.

I really do wish we could take the money issue out of therapy - I hardly know anyone with insurance that covers mental health anymore. Here's hoping for a single-payer system some day.

Unfortunately, Elizabeth, you are in the minority of "good therapists" if you have a willingness to use a sliding-scale fee that is truly reflective of a client's ability to pay, rather than just their "income" - gross or net. What difference does it make if I "earn" even $5,000 per month (serious exaggeration for most of us working class folks, I am sure) if I have a grave illness or disability which results in non-reimbursable medical bills totaling even half of that? Where I am (geographically), one can not even rent an efficiency for one person, let alone a family, AND pay the utilities for less than $1,000 per month - and we haven't even begun discussing food, medications (Rx and OTC), bare necessity clothing-even if bought at thrift stores- and, oh yeah - transportation costs! If I lived in the city, I would not have to maintain a car. But I WOULD then have to pay for public transit. And higher prices on every commodity. Out here in the suburbs, especially those that used to be rural and where the infrastructure has not caught up to the population boom, one NEEDS a vehicle just to get to work, school, the doctor, etc.,. Those costs eat your "earnings" - if you have any at this time - at a tremendous rate of speed. Just when the majority of us are in the most need of good therapy; it has become the least available it has ever been - overall; there are exceptions, of course. Leigh cited a major cause, especially among the employed and insured of us, who theoretically SHOULD be able to access good mental health care: almost all major health insurance carriers have dropped it completely from their coverage; now a client can't even pay "up front" and get reimbursed the measly 50% that was common just a few years ago.

This is a much bigger problem than it seems at first. One can argue all day about single-payer systems; mandated care, what is truly cost-effective, tax breaks, etc.,. In the meantime, when the most vulnerable citizens/residents do not get the basic necessities - and yes, medical care including mental health, IS a basic necessity in today's world in "developed" nations, those same individuals are at-risk for becoming so disenfranchised that they are willing to do destructive things - to themselves, their families, neighbors, and communities. When we stop caring about people; eventually - they will stop caring about us - and others. This will (already has?) show up in the "cultural norms" of looking out for #1; a drop in volunteerism and community participation, and the apathy that is rampant among us today - and not just in "the youth".

It is disheartening to consider that with just a few resources, but more effort, we could re-structue our "system" - health-care being only a part of it; so that once again the USA becomes "a land of opportunity for all". Instead of us quoting outdated history books about what a Great Nation we are, we need to rebuild said great nation. It starts with re-organizing our priorities back to taking responsibility for our own choices, and at the same time helping ourselves and others to make better ones in the future. THERAPY! There is nothing wrong with honest financial success; someday I hope to be living proof of that!:) However, there is also nothing wrong with "sharing the wealth" - and there are so many ways for us to do that!

Many thanks to you, Elizabeth, and others like you - professionals doing everything individually possible - to make the best of an ugly situation. May you be rewarded appropriately for your efforts!