There is a war on psychotherapy. Insurance companies and managed care companies are doing their best to improve their profits while limiting the professional independence and incomes of psychologists. This is a war that should be fought on all fronts.

However, while there is a war taking place on the practice of psychotherapy as we know it, a war is not taking place on the application of the skill sets of psychologists in the private sector. Opportunities for the psychologist in independent practice are virtually boundless and are only limited by resistance to change and level of willingness to adapt to the marketplace.

Walfish and Barnett (in press) point out that as small business owners it is important for the private practitioner to understand that the nature of our business is always evolving. How I practiced 25 years ago as a newbie, or ten years ago as an established professional, and how I practice today in a new city are all different. I have no idea how I will practice ten years from now but I am sure that it will not be identical to how I practice today. Jeff Barnett and I indicate that changes in public policy and market forces call for a mindset of adaptation to achieve long-term success in private practice. We suggest that an unwillingness to adapt would likely result in frustration, bitterness, and burnout for private practitioners.

The best selling business book, Who Moved My Cheese? (Johnson, 1998) provides an interesting parable of resistance to change in organizations that I believe applies to the practice of psychology in independent practice. Consider these observations from Johnson:

• Having cheese makes you happy
• The more important your cheese is to you, the more you want to hold onto it
• If you do not change you can be extinct
• Smell the cheese often so you know when it is getting old
• Movement in a new direction helps you find new cheese
• Imagining yourself enjoying your new cheese leads to it
• The quicker you let go of old cheese, the sooner you find new cheese
• Old beliefs do not lead to new cheese
• When you see that you can find and enjoy new cheese, you can change course.

Johnson further provides the “Handwriting on the Wall” which notes: (a) change happens; (b) anticipate the change; (c) monitor the change; (d) adapt to the change; (e) change; (f) enjoy the change, and (g) be ready to change quickly and enjoy it again and again.

As psychologists our skill set goes well beyond providing long-term insight oriented psychotherapy to individuals in our offices. We are skilled in assessment and diagnosis, consulting, research, teaching, writing, and can apply these skills in a wide variety of settings to groups of people who want to purchase our services. We are problem solvers for people who are in need of having problems solved.

Most psychologists hate managed care. Paradoxically, the majority of psychologists participate (or want to participate, especially early career professionals who frequently ask, “How can I get on panels?”) on managed care panels. However, creative and entrepreneurial psychologists in private practice utilizing their skill set have found ways to earn money outside of the purview of managed care. In 2001 I presented a paper at the APA meeting which identified 180 such activities of private practice psychologists rationally grouped into ten separate categories. These included: (a) Business Psychology; (b) Consultation To Organizations; (c) Fee-for-Service; (d) Forensic Psychology; (e) Group Therapy; (f) Health Psychology; (g) Psychoeducational Services; (h) Services to Government; (i) Teaching and Supervision, and (j) Miscellaneous (Walfish, 2001).

This past summer, Jane Le and I replicated this study seven years later and identified 175 income producing activities engaged in by private practice psychologists that fall out of the purview of managed care (Le and Walfish, 2007). Write me at psychpubs@aol.com and I will forward complimentary copies via e-mail.

I hope we win the war on psychotherapy. We should go all out to take the power away from those groups that want to limit the provision of psychotherapy and profit by doing so. At the same time, I think it imperative that private practice psychologists understand that whether we like it or not, somebody has moved our cheese (and someone is always moving our cheese!). We can adapt and flourish or we can resist and become extinct. As psychologists, we are not entitled to make an excellent living. Industries and specific skill sets can become extinct or devalued. We have to heed the wisdom of Johnson’s parable and see the handwriting on the wall. The skill sets of psychologists are so varied and far reaching in application only those resistant to change will find themselves without any cheese to go with their wine.

References

Johnson, S. (1998). Who moved my cheese? New York: G.P. Putnam.

Le, J. & Walfish, S. Clinical practice strategies outside the realm of managed care: An update. Paper presented at the meetings of the American Psychological Association, San Francisco, California, August, 2007.

Walfish, S. Clinical practice strategies outside the realm of managed care. Paper presented at the meetings of the American Psychological Association, San Francisco, California, August, 2001.

Walfish, S. & Barnett, J. (in press) Financial success in mental health practice:  Essential Tools and strategies for practitioners. Washington DC: APA Books.