Rebranding Therapy for the Modern Day

Leaving the DSM Behind, Boosting Creativity, and Reinvigorating Your Clinical Work

William Doherty

To understand the challenge our field faces today, we first need to recognize that psychotherapy as we know it came out of the particular cultural milieu of the mid- to late-20th century. But the culture has moved on, and we haven’t adapted very well. As a result, we’re suffering the same fate as many other professions that have declined in their cultural support and public clout. The most obvious of these is medicine: even though people may like their own doctor, surveys indicate a drastic decline in public admiration of the medical profession.

The profession of psychotherapy grew rapidly in the late ’60s and ’70s. We saw the rise of psychologists, clinical social workers, marriage and family therapists, counselors, psychiatric nurses, and others kinds of therapy practitioners. There was a sense that psychotherapy was in the vanguard of a social movement exploring new ways to tap into human potential and help people heal.

As we moved into the ’80s, therapists began to embrace the medical model and DSM. To get paid through the medical system, we made a kind of pact with the devil. Psychiatry, which had been in the forefront of many innovations in mental health, accelerated its long retreat from psychotherapy. Although we rode that biomedical gravy train for a while, escalating healthcare costs proved unsustainable, and HMOs and managed care began to be more dominant in determining the way therapy was practiced.

The result was that the most innovative side of our profession began to get pinched in. There was no longer time for observation teams with video and one-way mirrors; no more cotherapy, no teams pooling collective wisdom on difficult cases. Instead of focusing on the moment-to-moment process of therapy, training reverted to “you tell me how your case went.” And then many of the innovative, free-standing psychotherapy institutes that had sprouted up couldn’t keep paying the bills and had to close.

That’s when Big Pharma became ascendant. We couldn’t compete with the corporate marketing power of the pharmaceutical companies, and we found ourselves increasingly in league with the medical model at a time when the culture was turning away from personal development, social change, and human transformation.

People today, particularly the younger generation, want immediate knowledge and quick results, and even when they see a therapist, they resist the traditional idea of being a “patient.” They’re forming virtual communities of special interests in everything from celebrities to childhood vaccinations and attachment parenting. And communities of color, who have traditionally avoided therapists’ offices, are showing no obvious signs of warming up to us.

So while the culture has moved on, we haven’t moved on with it. Many of us are practicing in another century for another culture. It’s still unclear what we have to offer in a world that’s both hyperconnected and fragmented.

What to do? Here’s a road map to a future of relevance.

Assume a future of abundance, not scarcity. Collectively and individually, we have something amazing to offer people living in the buzz of the 21st century. There’s a growing hunger out there for authentic ways to live and connect---or in Freud’s eternal terms, to love and work. We’ve barely tapped the market of people potentially interested in psychotherapy.

Start pivoting away from the DSM and insurance. Getting in bed with the DSM gave us temporary pleasure, but then we became monogamous with the medical model, one of the least creative forces in today’s culture. The more you can free yourself from the vice of medical necessity and payers who stand between you and prospective clients, the freer you’ll be to innovate and attract the clients you can help the most. The physicians most interested in referring to therapists care about how their patients are functioning in the world, not about DSM diagnoses.

Specialize, don’t generalize. The only way not to be a commodity is to distinguish yourself by doing one thing exceptionally well. You can still see clients with other problems, but market yourself as an authority on something you love to do. The new breed of therapists are touting their expertise and passion for adoption therapy, reproductive-issues therapy, hoarding therapy, skin-picking therapy, and running therapy. People don’t care about what model we learned in graduate school, but they do care about whether we understand how they’re hurting and how we can help them.

Brand yourself. I never thought I’d use the b-word in print, but there you have it---brand. In today’s world, the only way to garner attention is to have a story that draws people to you. Why did you choose your special area of practice? Is there a personal story, a professional story, or both? Why it is your passion, not just your specialty? When clients come to see you, how might their experience differ from their experience with a generic therapist? If you can answer questions like these on your website and in conversations, you won’t be a commodity!

The therapy stars of the future will be those who so successfully address the needs and engagement styles of the culture that they’ll open up opportunities for the rest of us to prosper in seeing clients one at a time. In other words, the new gurus won’t just be teachers of good therapy: they’ll be marketers and organizers of communities of therapists who attract curiosity and then enthusiasm. To echo Justin Timberlake, they’ll “bring sexy back” to psychotherapy.

This blog is excerpted from “New Choices for New Times". The full version is available in the March/April 2015 issue. To subscribe, click here. >>

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Topic: Business of Therapy | Parenting

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