Future of Psychotherapy – Trend 5
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The Future of Psychotherapy: Don’t Let These Five Trends Catch You By Surprise ==================================================
brought to you by Casey Truffo, CEO and mentor coach, International Therapist Leadership Institute
Issue Five of Five
Dear Therapist Colleague,
I welcome you to this final issue. I am delighted you have come on this journey with me. I hope I have found some interesting food for thought.
In this issue, we talk about what at first appears to be a simple topic – the therapy hour. But I predict in the future it will be anything but simple.
TREND #5: TECHNOLOGY WILL REDEFINE THE THERAPY HOUR
Let’s take a quick peek at the future of private practice. But first, let’s start where we are.
The therapy hour has been a rather solid mainstay of the private practice. While the actual time in the hour may vary from 45 to 60 minutes, most therapists provide therapy sessions within that timeframe.
There are exceptions of course. Many clinicians do 90 minute intake sessions. Some do 90 minute sessions (say for EMDR work) or two hour sessions for couples.
Further, most therapy sessions are conducted in the therapist’s office. So booking sessions on the hour or half-hour made scheduling easier for the therapist.
With the arrival of technology (along with the important sociocultural changes in our general population), it is a safe bet that more e-therapy will be requested and offered.
Many therapists are already providing e-therapy. Phone therapy has been around for 50 years. Online therapy is becoming more prevalent.
I predict that most therapists will need to embrace some type of technology if they wish their practice to stay economically viable in the future.
What could this look like?
It will take many forms. It might be regularly doing video sessions over Skype. The client and the therapist will subscribe to a free video (or audio) chat service such as Skype. Each will have a web camera (a camera in or connected to their computer) and they will conduct the session in front of those cameras.
Of course, before conducting any type of e-therapy or online therapy, clients will be assessed for appropriateness.
Some therapists are great at writing and will enjoy providing therapy sessions by email. This gives both the client and therapist the option to carefully craft responses – and at the same time can provide a more immediate type of support if the therapist wishes to provide it that way. It will be important to make sure all expectations are addressed before any type of e-therapy or online therapy is conducted.
Instant messaging or direct messaging private “tweets” by way of Twitter will be another way of support for clients. Some may wish to send a quick 140 character question or request through a social networking site. Assuming these are private messages, a quick check in to a therapist might be all the client needs. Again, clinicians will need to assess and choose the correct method of interaction with each client.
Years ago, I worked in the manufacturing industry as a computer programmer. The company needed to have inventory on hand but too much inventory would result in either waste or extra storage cost. Simply put, too much inventory caused problems. The answer was to create a system that made sure we only had in inventory what we needed at any given time. We called it the “Just in time” inventory system.
How does this relate to the future of psychotherapy?
The public (especially the busy and/or the wealthy) will want and expect “Just In Time” Therapy.
That 45 to 60 minute hour often isn’t the right amount of time. How often has a client booked a session and made a breakthrough or found their answer in the first 15 minutes? What happens to the rest of the session? More than once I said, “Well, I am sure there is more to talk about” or “What can we do to help make that breakthrough really solid?” It was about trying to find something to fill the hour. I didn’t want the client to feel her money was wasted since she paid for a full session but was really ‘done’ in just a few minutes.
This will mean that some therapists will have clients on a retainer. These clients will be able to connect with the therapist during certain hours on an as-needed basis.
For example, a new mom or a busy executive might email or instant message the therapist during his or her office hours with a problem or crisis they just encountered. Depending on the contract, the clinician might respond immediately or schedule some time to connect later during the day. The time will be flexible, and within reason, of course, be client-driven. Some may need five minutes-some 30 minutes or more. There will be no predetermined time limit (again, within reason of course). When the client is “done” that session is ended. The client can return to his or her life until the next issue arises for which he or she wants support.
Payment for services will either be on a per-minute basis or will follow the membership format. By this I mean, the client will pay a monthly retainer and then contact their therapist as they need help during the month. Some will be in contact a lot – others not so much. But all will like having the “therapist on call.”
By the way, I will tell you from experience, be very careful when screening clients for just in time services. You may need to re-contract if you find some taking up too much time. Many will rarely contact you but will feel more secure knowing they can.
And now it is your turn …
1) What do you think about offering e-therapy? Do you see it as a way to be of even greater service to your clients? Does the flexibility of it appeal to you or make your uncomfortable?
2) I invite you to consider your current caseload. Which clients do you feel would love the idea of “just in time” therapy services? Could you see offering a couple of them the idea of, for a retainer, the ability to call or email or Instant Message you when they needed help? Trying it out with two clients may help you decide if this is right for you. During this “test,” document what does and doesn’t work in case you decide to do more just in time offerings. This way you will know what to put into your informed consent and policy contracts.
Please share your comments in the box below.
And this brings us to the end of the report series, can you believe it? As we wrap things up let me leave you with this thought.
The future will hold new opportunities for all therapists. I believe we will find incredible opportunities as we and our profession move forward.
Wherever you decide to practice your craft – in your own practice or in another setting, – know the value of what you do. You touch hearts and save lives. What could be more important than that?
As always, I welcome your comments, thoughts and suggestions.
And please know I am holding the vision for you!
With love and respect,
Casey
Casey Truffo
CEO, International Therapist Leadership Institute
http://www.TherapistLeadershipInstitute.com
http://www.BeAWealthyTherapist.com
P.S. Do you know someone else who might be interested in this report? Please invite them to visit http://www.FutureofPsychotherapy.com
{ 14 comments… read them below or add one }
Hello everyone,
I have attempted to do therapy via Skype with a client who moved out of state. The connection was slow, there was a delay in audio and we were constantly stepping on each others sentences. My concern is that the Boards in each state have not caught up to this technology and we don’t know the “rules” on who can provide therapy to whom and where. If I am in Arizona providing therapy to a client in Michigan does it fall under the statues of the state I am licensed in or the state where the client resides? Would we have to get multiple licenses? And since states often have widely held differences in how they see clinical practice how to you know you are doing things ethically and legally. Any thoughts?
Also the just in time might work with certain kinds of clients and not with others (chronically suicidal, borderline personality, dependent personality) who are in constant crisis or who can not maintain boundaries. You could be on the phone constantly or the client would have the expectation that you are at their beck and call so to speak. So it could work but you would have to be careful.
Hi Casey,
Thanks for encouraging me to keep thinking outside of the box. I agree with skype being used when you have an established rapport with the client. My question is about the requirements for the different states. My husband would love to travel in an R.V. and I would hope that I could stay connected with clients while taking some time to travel with him. I was wondering how that would look when you are crossing state lines? Has anyone addressed this issue? Thanks, Janie
Having recently moved from a big city to a small one, I’ve been looking into expanding my new practice to include some form of phone or e-therapy so that clients in remote areas may access my services (being one of the only two Clinical Sexologists in the whole province). Although I’m trying to open myself up to new ways of seeing my work and am willing to adapt to new technologies etc., I feel that as a therapist, my role is also to try to preserve and promote our “tradition”: providing an hour or so every week/two weeks during which a person takes time to stop, sit with themselves and pay attention to what is happening in their lives and within.
I am also uncomfortable with the idea of making myself available for instant messaging etc. I’m worried that instead of fostering autonomy, I’d be encouraging dependency. I also feel that I’d be participating in today’s tendency towards instant relief from discomfort instead of teaching clients to accept and relate differently to their anxiety, self-doubt etc.
All this being said, I’ve been enjoying Casey’s ability to “think out of the box”. I need to be challenged in my ways of thinking. As I’m exploring these new realities, I’m hoping to eventually find some sort of middle ground.
Cheers to all!
Mylène
1. If technology will redefine the therapy hour then technology will define what psychotherapy is.
2. Existential psychotherapy, somatic psychotherapy, and depth therapy will be excluded (made passe) by the technology. Excluded because these modalities are person to person, face to face, and where transference and countertransference are enacted and can be explored.
3. As a result, there is an opportunity for the unconscious to become conscious.
4.The unconscious is the only place where real growth vs. behavior change can take place.
5. Cognitive therapy supported by pharmaceuticals are tailor made for technology and will define what “being human” is.
6. My experience with Skype and phone therapy is that they “work” / are successful if a therapeutic “bonding” has been well established in an office setting.
7. However, the person whom insisted on Skype rather than find a therapist where he moved to, is dissatisfied. He said he would never use it again. At the time, the work served him and I checked in regularly whether the Skype assisted therapy work served him.
8. If my experience with friends and family is a model, then there are many, many difficulties — particularly hurt and misunderstandings — with e-mail therapy.
9. I like Casey’s creative mind and her emphasis on therapy being a business and her using other professions as a model for therapy. However, charging by the minute turns us into lawyers and in a short time the business /$$$ will eclipse the healing function — become foreground. Money is addictive and a symbol of worth and self-worth.
10. In the late Sixties, I was a professional photographer. I did architectural interiors. I started out charging $75 an hour plus expenses. As business improved, I gradually increased my hourly fee to $500/hour. I was feeling really good until I read of a professional who was charging $1000/hr. I crashed and the quality of my work suffered.
11. I’m reminded of a friend who is on panels and does some private practice work where she is paid nearly twice as much for the same hour. She reports that the $60/hr clients receive lesser quality work from her.
Robert,
I completely agree with you & feel that depth therapy, of all kinds, will suffer from this trend, which could be devestating to society at large. While money makes it possible for us to survive/thrive & do this work, too much emphasis on money & trends also hampers such. What’s being forgotten is how important “being with” a client is, as in “limbic resonance” between two mind-bodies (which even Skype cannot do). While the opposite may be the trend, I sincerely hope it’s used wisely, with clients who need counseling vs. psychotherapy. I have always believed that there is room for all types of communication, but many, often unknown, needs might go unmet without face to face time. I do agree with longer sessions for certain populations & frequently see clients for 90 minutes & couples for 120 minutes, but I charge less than the 1st hour for such, as I am not changing clients, issues, working styles, etc. Many clients need to land & relax into introspection & honest interaction, along with time to ease out of such & re-enter daily life. I also don’t think they check out the safety of a therapist or room only during the first phase of therapy, but that on some level it is ongoing, with necessary breeches & repairs being an important part of the the relationship healing process. Trends are trends & frankly, charging by the minute makes me feel more like a hair-dresser than a psychotherapist. Do you want your clients checking their watches for minutes? Also, while quick check-ins, via email vs. phone, seem healthy & necessary, therapists need to have a life & find time to balance such with leisure, family, friends, & their own alone time. As I write this, I’m aware of how much my own on-line time has increased, while other, healthier ways of using my time have decreased. More miss-communication happens via email than any other modality that I know of. Most importantly, a trend is a trend. I try to do what works on an individual basis, monitored by what the client is saying as well as my expertise, while minding & modeling my own self-care. Over-accommodating an already too hectic life-style can seem like adding to certain clients issues, rather than exploring such & experiencing something different, like pausing, reflecting, & exploring a healthier way to live. My comments are not directed towards those in remote areas or clients needing quick advise & guidance. I think these trends are too broad for such a diverse field. It also seems strange to me that one of the trends is an increase in somatic therapy, while this feels more like the opposite. Trends seem to be clashing… Lastly, I do home visits, along with a modest out-call fee, for those who are ill or otherwise qualify. Clients may be asking for more on-line time or shorter sessions, just as they also ask for quick cures to complex, life-long, problems. I don’t think I can always, or should, try to supply what the client requests, as much as I do try, very hard, to accommodate reasonable & necessary requests. Ethics are also involved & need to be applied to new trends. Frankly, I have yet to figure out how other therapists accomplish what they say they do in 45 minutes (excluding child/teen therapy of course), without eliciting the unpleasant client feeling or reality of being rushed in & out. We are all very different. Skype, freq. email & 15 minute sessions will never be my norm, but rather infrequently used ways to accommodate clients in unusual situations. I simply cannot envision doing anything but selling out regarding this latest trend, as truly being with is what I believe cures most relational problems. If this makes me a dinosaur, so be it! Faster & farther away just doesn’t equate to better, or even equal, in my mind.
First, I have really appreciated your insights and your GREAT webinar yesterday! I wanted to comment/question on this article too, which I think is right on the money. I just started an E-Therapy business, and though I’m facing some issues with clients not understanding how it works, a lot of people (once they do understand) are responding that it fits their lifestyle more and more. I offer a mix of therapies and times, and don’t lock anyone in to the once-weekly 50 minute session…which honestly I did up until I started the new job. It has a lot of value, but then again, sometimes the “big stuff” came out at 45 minutes and we couldn’t keep going. It didn’t work, like you said.
My question has to do with “retainers” (fascinating idea) and client expectations. Do you think there would be a major boundary issue with that? I.e. clients expecting you to be available 24/7 even if you were with another client? I guess I ought to find out more about how lawyers do it!
Thanks for your fun and helpful information!
This is the area that I also reacted the most to (in addition to the need for us to make sure that technology as a tool does not cause a problem for our clients and us – e.g. the issue that Skype is generally accepted to not meet federal standards for protecting client privacy). I think there is a big difference between a “retainer” or “membership” model and a “Just in Time” model. The latter is something that I think individual practitioners would be hard pressed to be able to promise whereas the former has promise.
I would also add that my clients have not even hesitated about paying a higher per time unit rate for sessions that are not in the office.
I’ve had a few requests for online therapy but have decided not to do it with new clients at this time.
I like the idea of a monthly retainer. Right now I have many clients who use a 6-session prepayment option for a reduced fee, so a monthly retainer might be a good idea for those who would also like inbetween emails and phone calls, which I’m doing some of anyhow.
This is an idea I am going to consider.
Thanks for the relevant and informative articles. I have just started a limited private practice(6 months ago), and seeing it finally begin to grow is a wonderful thing. After reading your articles I feel more open to using the different technologies. I got my first text message from a client last week, and realized this is how she probably prefers to communicate!
Warm Regards,
Carol
I like the idea of a retainer/monthly membership. I think it could give more value to patients and overcome the no-show problem. However, psychologists have to abide by an ethics code that prohibits collecting payments prior to patients receiving services. So this wouldn’t really work. Any comments on that?
Todd
I use a lot of “techno” therapy bc I specialize with adolescents – they are texting and emailing so I need to keep up (although with a teen daughter myself I was already up to speed on skyping (btw – for those of you interested – just go to skype.com. Download and they have very easy instructions. My daughter had been doing it for months but I only learned about it last year when Oprah did a skype series for a book and I was fascinated. Now she skypes in people all the time! It is great if a patient has transportation problems and can’t make it in…SKYPE the session.
I agree with C, I wouldn’t use skype for an initial patient – only after I had seen them in person and evaluated them. I also text and use email therapy for in between session “Ah Ha’s!”
I believe therapy is changing, if we don’t keep up with what our clients do in real life, we will be left behind. I have always offered phone therapy as well…
Great last article – thanks for the thoughts!
Karen in Colorado
Thanks for the final installment of The Future of Psychotherapy. I learned a lot from all five. In regards to e-therapy via Skype, phone, or email how does malpractice insurance cover these?
Best Regards,
Kevin
I definitely like the idea…flexible! But I would need an “expert” to help with what I have no experience in at all…the contract. I also need a tutor for SKYPE :>)
Hi. My name is Tim Ervin-new to the program. I am a Licensed Counselor in Illinois and am working as a contractor with a Psychologist. My take on e-therapy is that it will be the way therapy as well as other social services are handled in the future. Currently, I use my web site as a supplement for my clients. For example, if I am wearing my career counselor hat, I will refer clients to the career resources page on my site. Here they can take a personality assessment, interest inventory etc… I am using the site to enhance therapy when clients are not in the room with me. I also plan to offer e-books and CDs for payment-thanks Casey Truffo:-]
I do look forward to experimenting with such things as Skype and more advanced media with my clients.
All The Best,
Tim