How Therapists are Killing the Field of Psychotherapy

How Therapists Are Killing the Field of Psychotherapy

Psychotherapists- you matter. Psychotherapy is powerful. However, if we as a profession don't start making some changes, our profession is going to die off. 

A Rant From a Therapist:

(Shared with permission) "I have this friend back home who worked at a medical office that shares a reception area with several therapists in the building. They have repeatedly mentioned that most of the therapists –regularly– run late to their sessions because several of the clients think they are the receptionist for their therapist and often ask, "What's taking so long?," "My appointment was at such and such time," etc. They noted that even when there's gaps in-between clients, the therapist will take off somewhere and show up late for the next appointment despite having a time gap to recuperate the time offset that happens when a session in a series of appointment get messed up from someone being late. They also noted that they have witness these therapists say, "Sorry I'm late. I had an emergency" so frequently over the last year that they are suspicious of the legitimacy of the excuse." 

The receptionist was reluctant to ever pursue therapy for himself. Why? Because he had the impression that therapists aren't professional or able to be relied on. Through a series of circumstances he finally reached out, made an appointment with a therapist- not one in the building, and showed up on time. And guess what? The therapist was almost an hour late... and they had an emergency... 

Did The Therapist Have an Emergency? 

We may never know. What I know from talking to a lot of therapists is that this isn't terribly uncommon. While emergencies do happen to every therapist, being almost an hour late shouldn't happen. Being consistently late to sessions shouldn't be the norm. 

Does Time Really Matter? 

Truthfully, if it was just lateness that was the issue, it might not kill the field. However, what I've found with talking to a hundreds of therapists over the years is that the tardiness is a symptom much bigger issues. Therapists are consistently overextending themselves and saying yes to things that they can't follow through on. 

Be Honest

The truth is, these therapists start with altruistic goals. They want to help and support as many people as possible. They take on a few too many sliding scale clients, they accept insurance contracts that reimburse a little till poorly, they schedule a few too many clients than they can handle.... it starts to spiral out of control quickly. 

Therapists Unite

Therapists of the world- if you want our field to survive the onslaught of other healing modalities-it starts with you. Sit down and be clear about your responsibilities as a business owner: accounting, billing, scheduling, phone consultations, returning emails, making referrals, responding to referrals, marketing, networking, training, responding to crisis calls, bringing on past clients in crisis, referring out new callers, researching, consultation, supervision, paying taxes... 

I know it might feel like a lot when you start to list it all out. It is. Being a therapist in private practice is an honor, and a responsibility. Therapists who do private practice well are honest about how much time and energy they have to give and ensure that their schedule allows time for all of the above (and more). And yes, that often means scheduling fewer clients than they'd be able to see if they didn't need to do any of those tasks. 

It Isn't Just Lateness

Many of the therapists who I talk to who are struggling with lateness are also struggling with boundary setting, business planning, keeping up with progress notes, billing, and so much more. The truth is, these issues will absolutely bleed into the clinical work. Yes, it is grist for the mill, but I think there are much better issues to be bringing into therapy then a therapist who can't make time for a client. 

When therapists are honest, vulnerable and willing to make change- it can have a beautiful impact on the clinical work. If you have struggled with starting and ending on time, if your notes are over-due, if your schedule is out of control, if your drowning financially- please make a change. Your clients really want you to make a change. They want you to step up to the plate and be fully present for them. They need you. 

Tips to Be Fully Present

Here are a few strategies to get you on track in your private practice. 

1. Develop a business plan. These plans aren't just about making money- they are about ensuring you can survive financially while doing excellent clinical work! Develop a clear plan that you can stick to. 

2. Develop a clear schedule. Your business plan should tie into your daily and weekly schedule. If you are seeing clients in a traditional hourly model- you have to honor your part of the contract. That means showing up, on time, fully present. Yes, there are emergencies, but if they happen regularly- this is a sign that you may need to be scheduling longer sessions with clients, longer gaps between clients, seeing fewer crisis clients, or making some kind of change. We are NOT doctor's offices. We aren't seeing 20 people an hour, 6 hours a day. People are carving out 50 minutes to work with us- period. 

3. Reach out. Get consultation from peers, get supervision, hire a business coach if you need some nitty gritty help on how to make your business plan doable. Stop sharing reasons why this is ok, and start writing down why this needs to change, and how your clients will appreciate it. 

We've got free live webinars every month for therapists, and a vault of 10+ hours of training- so you can't say you can't afford to get support! 


Miranda Palmer

I have successfully built a cash pay psychotherapy practice from scratch on a shoestring budget. I have also failed a licensed exam by 1 point (only to have the licensing board send me a later months later saying I passed), started an online study group to ease my own isolation and have now reached thousands of therapists across the country, helped other therapists market their psychotherapy practices, and helped awesome business owners move from close to closing their doors, to being profitable in less than 6 weeks. I've failed at launching online programs. I've had wild success at launching online programs. I've made mistakes in private practice I've taught others how to avoid my mistakes. You can do this. You were called to this work. Now- go do it! Find some help or inspiration as you need it- but do the work!