Client and Business Considerations in a Tough Economy

The current economic climate affects both the clinical and business pieces of our practice in many ways.  In addition to what one might expect, such as increased client anxiety over money or a decreased caseload, I have noticed many unexpected changes and influences. 

When I began my private practice last April I never imagined I would be leaping into the worst economic climate since the Great Depression.  It’s akin to diving into what you think is the deep end of the pool only to find out the diving board has been moved to the shallow end and you are now splashing around with the kids.  To thrive, one must adjust to the changed conditions, and be willing to let go of preconceptions. 

How has the business piece changed?  Running a counseling business is hard work in any market.  Practitioners must be sales people, marketing people, accountants, schedulers, office managers and case managers in addition to being clinicians.  Tough economic times simply means we need to perform all of these roles better than ever; specifically, better than the other 100 or so therapists in the Tampa area. 

Current economic conditions only serve to exacerbate the shift already in progress from the medical model to the consumer model.  This means being creative, flexible, and clinically efficient.  Now more than ever, our business focus must be on creating a great customer experience.  We must make the counseling experience as convenient as possible for the consumer.  Some ideas are: working evenings and weekends, returning calls within 24 hours, accepting credit cards, creating payment plans/reducing fees, and creating groups, which are more lucrative for the practitioner, and less expensive for the client. 

We must also reduce our expectations with regard to caseload and income.  It will take longer to reach our ideal client in today’s market and so we must plan on spending more on advertising, or advertise in more creative ways such as visiting doctor’s offices or doing a free workshop at our local church; and, my personal favorite, providing a complimentary assessment session. 

Another way to draw in your ideal client is to create a niche --- what makes your practice uniquely you?  What will draw people to you that they can’t find anywhere else? 

Economic pressures also affect clients in some unexpected ways.  Couples who would have divorced in better economic times now cannot afford to split up.  They cannot afford two households, so they are sometimes forced to stay together --- In separate bedrooms.  Under these tense conditions, forced togetherness can create resentment, making the situation worse.  Rather than “should I stay in this relationship?” their focus becomes “how can I cope with this bad situation?”  This can lead to unhealthy but convenient coping behaviors such as substance abuse.

But other times they take a second (or third, or fourth…) look at their relationship and say, “perhaps this is worth just one more chance.”  Unable to turn away from each other, the couple begins to remember what brought them together in the first place.  In addition, sometimes they begin to become united against the pressures of the world, instead of divided against each other.  This thrills me as a couples counselor.  The couple begins to create a new relationship that helps them cope.  They begin to meet each other's needs instead of looking outside the relationship.

For many couples, increased economic pressure highlights issues they may already have, particularly with money.  Common money issues such as conflicting priorities and disorganized finances can be obscured when there is plenty of money; it simply doesn’t matter that much.  But, suddenly lose half your income and these problems become glaringly obvious.  The most minor budgeting decisions are now crucial.  Couples not accustomed to discussing money now must do so under very pressured conditions.  A combination of their inexperience in this area of communication combined with the sudden criticality of the issue can easily overwhelm them.  If they don’t get it right they can lose their house.  I spend a lot of time helping my couples talk about money.

Not only must couples be better money managers, but also a loss in income means less distractions like redecorating the home or going to restaurants.  Suddenly there are a lot fewer options.  Couples accustomed to their crazy-busy lifestyle must dial it back or face serious economic ramifications.  The focus becomes less on material acquisition and enjoyment and more on themselves and the relationship.  Perhaps viewing their relationship mirror for the first time, they may not like what they see.  But what they see is true and that is the perfect starting block for change.

What about the individual client?  They, too, are affected but perhaps in more predictable ways.  Anxiety over losing or finding a job, reduced pay, decreased opportunities, etc. can cause a lot of stress.  I explore with the client what they can do that is low or no cost to reduce their stress.  Examples are exercising, calling a friend, reading a book or taking a bath. 

Depending on the client, cognitive approaches can help.  I explain to them that they cannot change the economy, but they can change the way they perceive it.  I then proceed to challenge words like “never” and “awful.”  I reframe.  I point out strengths that they have used in tackling other similar problems in their past. 

I also may ask about the client’s spirituality.  If they have a strong spiritual base I work within that, exploring with the client how their spirituality addresses their fears.  If they do not, I will introduce them to logotherapy and Viktor Frankl’s book Man’s Search for Meaning.

The great irony of all of this is that the poor economy means people need our services more than ever, but have never been less able to pay.

Last but not least is the practitioner.  As the primary “tools” for our clients, we must keep ourselves in good working condition.  We may be experiencing similar stresses as our clients, but we cannot let that affect our work with them.  In addition to our own personal stresses we must absorb clients’ stresses, which can also reverberate against our own.  Therefore, extreme self-care is a must.  Practice what you preach!  Do the same things you tell your clients to do.  If you tell your clients to exercise, then you should exercise.  Read, go for a walk, call a friend – these things work just as well on practitioners as they do on clients. 

What have I learned from running my own business over the last year?  Tolerance, boundaries, and gratitude.  I have learned to be understanding when people cannot afford to come every week, or want to cut therapy short due to finances.  I have learned that it takes longer and requires much more advertising to reach clients, which ultimately results in reduced profits.  I have learned to be tolerant of people cancelling or rescheduling often and at the last minute, or not showing up at all.  I have learned to establish boundaries by developing and enforcing fair and consistent office policies around these issues.  But, most importantly, I have learned to have gratitude for being my own boss, making my own decisions, controlling my own destiny and not slaving away somewhere in an agency.