Factors Which Conspire Against the Success
of a Psychotherapy Private Practice in the 21st Century


Joe Bavonese, PhD

There are a number of factors which exist for psychotherapists in the 21st century that are making it more difficult than ever before to prosper. Some of these factors are discussed below:

  • Managed Care: we're all familiar with managed care insurance companies whose fees are 20-40% lower than average psychotherapy fees across the USA, and severely limit the number of sessions authorized for psychotherapy.
  • The Economy: since the stock market bubble burst, and accompanying recession, many people have been reluctant to spend money on other things than necessities. This can make it more difficult for private practitioners who rely on fee-for-service payments for a significant portion of their income.
  • Free Help and Advice: in the past decade, free non-professional (and even some professional) help has become ubiquitous. There are endless sources of information on the Internet, as well as talk shows on TV and radio such as Dr. Phil, Oprah, and Dr. Laura. Many consumers don't realize that these radio and TV personalities are not actually performing psychotherapy on the air.
  • The Rise of the Coaching Industry: Psychotherapy Networker magazine recently reported that there are approximately 10,000 coaches of various types working in the USA. Leading writers in the coaching industry admit that there is a great deal of cross-over in the work of psychotherapists and coaches, but they also add that coaching has none of the stigma of therapy. Clearly there are many coaches who are now dealing with issues which used to be the exclusive domain of mental health professionals.
  • The Increasing Use of Medication Instead of Psychotherapy to Deal with Mental Health Issues: in 2008, over 123 million prescriptions for antidepressants were written in the USA alone, accounting for sales of over $26 billion. Antidepressants are now the most prescribed class of medications in the United States. Over 2/3 of these prescriptions were written by MD's who are NOT psychiatrists. Clearly, Americans have a great preference for the seemingly quick and easy route to mental health, despite research findings which suggest psychotherapy to play a major role in successfully dealing with many mental illnesses.
  • The Rise of Complementary and Alternative Therapies: more consumers are turing to various alternative therapies to deal with mental health issues, including such methods as yoga, energy work, bodywork, meditation, vitamins, and herbs. A 2009 survey conducted by the National Center for Complementary and Alternative Medicine (NCCAM) and the National Center for Health Statistics (NCHS, part of the Centers for Disease Control and Prevention found that 36% of Americans used alternative therapies in 2007, spending over $67 billion in the process. To many of these people, psychotherapy is seen as old-fashioned, boring, ignoring the body-mind connection, and unlikely to lead to permanent changes in functioning.
  • Demographics: the baby boom generation, the highest percentage users of psychotherapy of any cohort in the 20th century, is moving out of the age of prime psychotherapy use. They are being replaced by an entire generation of young adults raised on TV, computers, Internet, Facebook, instant messaging, text messages and email. In short, a generation used to quick responses and fast results.
  • Graduate School Training Still Largely Ignores Business and Marketing Issues: despite all of these factors, most Master's and Doctoral training programs pay little attention to training clinicians for the realities of the highly competitive business world they will soon find themselves in.

Conclusion? It's more difficult than ever to be successful as a psychotherapist. There are more and more services competing for a smaller population base, and most of us have little or no formal training in how to start, develop grow or run a business. That's the unfortunate reality that thousands of psychotherapists face today.

To get beyond a mediocre standard of living as a psychotherapist in the 21st century, it is essential that you master basic business practices. Business skills are now as important -or some say more important - than clinical skills. And business skills may ultimately be of more impact than anything else you learn to enable you to provide the services for your clients that brought you into this field in the first place.

If you're interested in improving your business and marketing skills, check out our program entitled The Business of Psychotherapy: Creating Your Ideal Practice, which is a comprehensive training in all aspects of business and marketing for psychotherapists.

For more information contact us at:

info@uncommonpractices.com or (800) 940-0185.