Marketing Your Therapy Practice: Is There a Formula?

What Brand is Your Therapist?  by Lori Gottlieb
"Does psychotherapy have a branding problem?  How do you brand deep transformation  -by no longer doing deep transformative work or by remaining aloof?  We have an opportunity here to look inside of ourselves and get clear on what we each individually want, how we want to work, what we are committed to, ways we might have become inflexible in our own psyches attached so stridently to one way of working and marketing.  Psychiatrists, Therapists and Coaches have value.  No one way should be thrown out.  Rather we get to be open and curious about what comes up inside of each of us in response to other ways of working and grow from the exploration."
-Traci Ruble


by Traci Ruble, Licensed Marriage and Family Therapist

Website: www.traciruble.com


     The day after Thanksgiving an article came out in the New YorkTimes by author and journalist turned psychotherapy intern, Lori Gottlieb, that set my therapy community abuzz.  Some felt hopeless others felt relieved in response.  I was so curious by it all, I had to know more so I crafted a survey, sent it out to every therapist I know asking them about their thoughts on the article and surveyed them about their marketing practices.   I asked for a 3 day turn around and in 3 days I received 29 responses.  After reading all of your responses, I knew I was not going to be able to keep my commitment to have this darn article ready the Monday following the survey.  I really took in each one of your replies and let it stir inside of me for almost three weeks now and have written several iterations of this blog (I am not a journalist). 

     Lori’s article was written in true journalistic fashion – drawing some broad brush strokes about the therapeutic industry, I suspect to cause the exact stir that it did.  I personally, do not agree with all of Lori’s article but while I share being newer to the field with her, I have a long career in sales and marketing.  My intention is not to pick on Lori, though, nor to put myself out there as a guru of marketing, rather I want to hold myself and Lori and every therapist who is marketing with a lot of compassion because just about every aspect of doing this profession has a process piece in it for the therapist.  Lori outed some of her fear about “becoming” and her longing to have a full practice “quickly” and when that longing did not get met she felt like she had to compromise her authenticity.  Don’t we all face our own internal demons stepping in to this work?  What were and are yours? 

     Here are some of the initial stirrings inside of me around Lori's article...and truth be told, I will delay this article even more if I try to address each one and I can't say I want to jump to conclusions but stay open as best I can.  Nonetheless, the questions were:

1. What kinds of marketing mucks up the therapeutic "container" if it does at all?
2.  Is the culture really wanting a quick fix?  If so what does broken mean and what does fixed mean? 
3. Drugs, coaches and psychotherapy: What does the marketplace know about each?  Are we competing for the same clients?  Are therapists being out marketed?  If so why?
4. Why are therapists not as savvy about the business side of their business?  What is hard about charging what coaches charge?  
5. There are many ways of growing?  Does it serve to claim one way is "better"?  Why do you, I, we believe in the way of working we do?  How is my therapeutic work inflexible and flexible? Why?
 6. What makes a good therapist?  

     I think the piece that got the strongest response from my one on one conversations with you was the quick fix notion or “fast food” therapy.  For me, I do wonder about the ten years it took me to get licensed and the minimum wage pay I received during that time, the exams, the personal therapy etc and a peer of mine can go get a coaching certificate in 9 months, take no exam to determine if they are competent and charge double what I do and well I get freakin’ jealous.   I met a coach this weekend and she laughed gratefully at how she could do whatever she wanted.  That she was entirely outcomes driven.  I could feel my own scream “that isn’t how it is done” but is that true?  Are either of us “right”?  I think there are shadow sides to any way of working and we have to be willing to take stock and cull the depths of our own fixations and inflexibilities.  So I sat and talked longer with her and learned more about her and her work rather than dismissing it as junk food because I felt jealous or "better trained".  I made a different choice to remain open. 

          I believe there is room for many ways of doing healing or growth work.   I do not agree with Lori’s initial sense that one has to compromise herself to build a practice. I was mad and sad Lori felt she had to.  While I appreciate Casey Truffo's offerings, she in no way "has the corner on the market" as one survey respondent said on successful practice building.
  
Does psychotherapy have a branding problem though?  How do you brand deep transformation  -by no longer doing deep transformative work or by remaining aloof?  We have an opportunity here to look inside of ourselves and get clear on what we each individually want, how we want to work, what we are committed to, ways we might have become inflexible in our own psyches attached so stridently to one way of working and marketing.  Psychiatrists, Therapists and Coaches have value.  No one way should be thrown out.  Rather we get to be open and curious about what comes up inside of each of us in response to other ways of working and grow from the exploration.

I also think if we believe in our way of working we do have to build a bridge to potential clients and how that is done is very personal and there is no formula.  A few  colleagues of mine have no website and just get referrals through their personal network and their practices are full.  I also know them to be kick ass high integrity therapists so that could have something to do with it.  Honing our own skill set is part of marketing.

     What about my marketing?  It would be weird, the gal with the new fancy pants website, not to say something about my choices.  I have a blog, use twitter and have videos and I wanted to know when I took on writing this article "Traci why do you have that stuff?  Is it your own narcissism, fear, compensation for something? Authenticity? Excitement? Play?"  

     I like to market.  It is connective.  I believe in my work so I don’t feel like I am acting bigger than I am and I also get frightened about not having enough clients and have to gut check every thing I put out so it is not coming from fear.  I don’t think my marketing dilutes the container but it does impact the container.   In my work, it becomes more material to be worked with.  That being said, I do consider the container when I Tweet or blog.   And admittedly, I do have to balance authentic bigness with my fear based compensations.   I own that wholeheartedly and work in earnest to know myself here by still investing in therapy, consultation and training.  My bias is good therapists are always seeking and growing and asking.  Good therapists are open and flexible rather than dogmatic that one way is the right way.   

     About my corporate sales and marketing career...   The best sales people I have ever worked with: Larry, Bill, Lisa, Randall, Nancy, Mike and others - all taught me that selling is not about manipulation or being something that you are not but fully and completely partnering with customers, understanding their strengths, weaknesses and together clarifying their overall intentions and vision for their businesses and taking collaborative action to make the vision a reality.  Therapists who I know with successful practices are those who aren’t using a marketing formula but whose marketing approach is congruent with who they are.  Marketing is about congruence, authenticity and professionalism in how we communicate our skills and respond and interact with potential clients.

     That being said, I do wonder how many budding therapists, like Lori, do not realize that running a private psychotherapy practice is running a business and like any business start-up, it requires time, money, and a business plan  - the whole bit.  And that leaves me wondering, why are we pushing the business aspect of psychotherapy out of our conscious awareness? What is that for?   I see it happen a lot.   It would be good if graduate programs did not just teach about marketing and business but the intersection of the skills and the process of how the business side impacts the work.  I consult with some therapists and that is the main component of our dialogue - the possible choices and which ones feel congruent to them.  

Let's Dive In To the Survey Results
First, check out version one of the survey here.  No new responses will be calculated but I learned from this survey some missing elements and have created a second version.

 Please take version two of the survey here.  
If you would like to receive an email of the results, please email psychedinsftherapists@gmail.com and the details will be sent to you.   If you would like to share this URL with others please email to your network. The URL is again: http://www.surveymonkey.com/s/BY3TX5G.  I will shoot for a February 1 update.

We had 29 survey respondents.  15 of the 29 had been in practice less than five years or were interns.  Only 6 respondents had practices more than six years.  An aside about my interpretations: I did not purchase the survey monkey package so I had to do the analysis by hand.  There is more that can be asked of the data if someone wanted to code it.  Any statistical coders out there, by all means, I will gladly give you full access to the survey results to further code the data.

What questions was I most curious about?
1. What correlation was there between time spent marketing and how much money therapists were making aka vacancies in their practice?
2. What correlation there was between depth oriented vs solutions oriented approaches and practice health?
3. How the practices of newer therapists versus seasoned therapists were doing?
4. What kinds of marketing therapists were engaging in?
5. What feelings came up for other therapist, besides me, in response to the article?

What questions did I not measure for that I wished I had?
1. What types of marketing are the most fruitful for you?
2. Do you anticipate dedicating more hours per week to marketing in the future?
3. What kinds of marketing will you never do and why?
4. How long have you been actively building your practice?
5. How and why did you set your fee as you did?

Quantitative Findings:
Orientation
14 Psychodynamic (three who are also eclectic in that group but psychodynamically rooted)
13 Somatic, Humanistic/Experiential, Transpersonal
2 CBT

There was no correlation between style of working and number of vacancies.

Experience
15 Therapists had 0-5 years of experience
8 Therapists had 6-10 years of experience
3 Therapists had 11-15 years of experience
2 Therapists had 16-20 years of experience
1 Therapist had more than 20 years of experience

There was a correlation between vacancies and experience.  The higher the number of years of experience the lower the number of vacancies per week that therapist had.  It can be surmised that practice building takes time.  Remember, Lori Gottlieb started getting discouraged after three months.  I know for me, I was a private practice intern for 6.5 years and so I had that advantage once licensed.

Marketing Hours:
3 Therapists spent 4 or more hours per week marketing
11 Therapists spent less than 1 hour to no time marketing per week
11 Therapists spent 1-2 hours per week marketing

There was zero correlation between number of hours per week spent marketing and number of vacancies.  Rather it was the kind of marketing that was engaged in that had the biggest impact on fewer vacancies. See below.

A surprise about hours per week spent marketing:
I was personally surprised by how little time most therapists put in to marketing their practice per week, especially considerring that everyone but three had vacancies in their practice.  What would the world look like if therapists marketed collectively in a more profound way to impact public perception of the field?  I know CAMFT is doing some of this now.

Successful Marketing Activities:
Activities of 0 vacancy therapists: 3 of the 29 surveyed fit in this category
All were unique in therapeutic style, fee range and time spent marketing.  None, however, were in the 0-5 years of experience.
All three had Linked In accounts.
Two had websites, one did not.
Two of the three had a Psychology Today listing.
Training and Consultation as well as collegial networking were true across all three  0 vacancy therapists.
None of these therapists tweeted or blogged.

Activities of 1-3 vacancy therapists: 9 of the 29 fit in this category
All were unique in style, fee range, time spent marketing and years of experience.
All had a website
All but one had a Psychology Today Listing
All networked with colleagues either through training and consultation, CAMFT, Listservs or other professional networking.
4 tweeted.
2 had Facebook pages
2 had blogs.
1 used Google Adwords
2 had a branding consultant

Summary of Effective Marketing across therapists with 0-3 vacancies per week:
1.  Referrals from colleagues either from training and consultation or networking along with a Psychology Today listing were the two common threads across all therapists who had the fewest vacancies.
2. A website and Linked In account were the second common threads.

I think for new therapists the most important correlates are that you have to spend less time marketing per week, the more experience and network you have.  If you do not have the experience, those that were successful had to put in more time per week marketing and it was best spent, it seems, through consultation, training and a web site, psychology today listing and linked in account.

It would also be good to do some qualitative research on those therapists' actual websites who had the fewest vacancies to find out if this "specialization" idea Truffo discusses rings true and if pitching solutions versus talking about depth work rings true.

Qualitative Findings:
Here were some select survey respondents feelings about the article that match the majority of responses. What do you think?

Survey Question:
What feelings, thoughts, reactions, ideas came up for you in response to Lori Gottlieb's article?

Survey Answers:Frustration that graduate school never taught me anything about how to create and run a business or market myself. As for branding, I'd rather just be myself.

Good summary of the dilemma and the changing market.

While these ideas may seem new to Gottlieb as a new therapist, I've been struggling with the same issues for the past 30 years. Yes the field has changed, but I don't think old fashioned psychotherapy is disappearing. Casey Truffo has some useful ideas, but it's a mistake to think she has a lock on the future of therapy, as she promotes herself to have.

...I understand a lot of the marketing strategies, many of which I practice, but I also think it's colluding with the modern/western medical model of having a quick fix, which is not a lasting solution. I think there's a middle ground to being current with technology and still practicing depth work with people....

...I understand the "quick fix" thing for sure, for myself and my clients but we get through it. A fair amount of new referrals that I see will ask "how long does this take?" so yes, its a reality. But does that mean we should give them what they want? No. Rather, it is a chance for education and holding and relationship and time. TIME, how about an argument for time. Something so few of us have experienced and certainly the folks I see who are traumatized, time has actually stopped for them, at least in the nervous system. I would love to read a rebuttal:)

... I wonder if these "marketing" people are using an outmoded model of marketing - the Bernays-ian model of appealing to urges that remain unconscious, rather than what seems to me to be evolving in the world right now: a movement towards deeper engagement with ourselves and the environment. Also there is always a market for those who are clear in what they are doing, especially when the tide is turning another way. I almost felt like, "good, more room for me with people who do not want fast food therapy!"  Perhaps I am just someone who is most comfortable in the margins of things. I think all of it amounts to a kind of binary. It is important to be able to tell people what you do. Psychoanalysis HAS been overly vague and arrogant in explaining the change process, and there HAS been a correction needed, in my view, around the power of the open-ended psycho-dynamic therapist as a kind of neo-mystic not having to explain how therapy will help. However for me, it's an over-correction based on insecurity and possibly wealth-envy to try to promise results as a life coach does....

It was interesting and made me feel like I'm doing a lot of things right but also made me think I should do more with social media like Facebook. I also think I'd like to add a coaching component to my practice.

I think that there need to be more communication and a growth in public education about what therapy generally offers, if you want to call that re branding  However, it seems that Ms. Gottlieb doesn't recognize that having a private practice is a cultivated practice of deepening one's value through a growing depth of participation and understanding in what it is you are offering. This investment here isn't primarily on branding, its an investment in having a valuable product, one that people may not know of yet. Growing one's skill and capacity as a therapist (our product) takes time to cultivate, and is not the quick fix that she is reacting to in both her perception of clients and her own quick fix relationship to what she thinks she has to offer. While learning to market oneself is important to supporting a private practice, professional integrity dictates that you invest more in having something to offer. This is the basis for helping people grow their own value, a point Gottlieb seems to miss.

I feel a little tired and defeated by the idea that I have to incorporate things I don't like (coaching, brief therapy) in order to be financially successful....

I think colleague relationships through marketing are important, but not as important as the therapeutic relationship. I come from a previous career in marketing, so I'm sure that has helped me to build my practice, but I also believe it's the authenticity of the therapist that results in having a thriving practice. If you believe in yourself and love what you do, and are competent and ethical, the clients will come and stay. I don't think we need to offer online consultation sessions or have a Facebook page to thrive. One last thought, the author was a MFT Intern and didn't disclose that. I found that interesting.

In a culture that is insane, healing can feel anachronistic. It would be surprising if it wasn't so. Sitting in a room, two people, phones on mute and paying attention is counter-culture. I am glad there are still people who do it. Still the question is very valid how we connect to our audience and communicate the benefits of the services we offer. In some way marketing is not that different from working with a new client. We have to meet them where they are, join, and find ways to connect to what motivates them to do the often uncomfortable work of personal transformation.

I enjoyed it and I think it is true. I have specialized in being known for a trauma EMDR therapist and I believe that has helped me stand out and keep a full private pay practice with no sliding scale.

...People like Casey Truffo and Alison Roth, both quoted in the article, seem more interested in helping therapists make more money, not be better clinicians....

Wow - glad she is putting into words the gist of what is happening in our profession right now... Although it's frustrating, it's also a reminder to go with the flow of change and technology. I'm glad i just got a coaching certification in a specific target market !

I think branding and niches are important. I also think it's wise to diversity our offerings (create products, offer consultation, teach, etc.).

Honestly, indignation was the immediate emotion. Then a sense of recognition as I know coaches who charge more. A sadness that the deeper work isn't seen as valuable.

I had some fear about how I might appear to other therapists. I have had many poor experiences within the therapeutic community about this topic. I find that people get confused between marketing, creativity, public exposure, and the therapy relationship. When I started to take responsibility for who I am and what I wanted to be in the world, my skills as a therapist improved. That was feedback that I received from my clients and my peers. That change included a different kind of presence in the world, online, in my career . . . I can't erase that or hide it from people who are currently clients or those I have served in the past. Its led me into several discussion about contact, modality, marketing, and the sanctity of the therapeutic relationship. One thing I know is that it doesn't threaten my clients or disrupt their therapy as much as I was afraid of, due to my training.

      To wrap this up, I want to thank you!  Thank you for taking the survey and/or for reading this now. Initially, after I sent the survey out I felt exposed.  But as the responses starting coming in, I felt really touched by you all.  This psychotherapy profession is so humbling for me because frankly I have met some of the smartest and most heartfelt people in my life and I get to be in community with you.  You all challenge me to stay open and flexible in how I view myself, this work and the world and I hope I can do the same -  a very vital way to live.    


Traci Ruble is a Licensed Marriage and Family Therapist in private practice near the San Francisco MoMA.  She works with adults individually and as couples working on their relationships.  She also leads online mothers' groups, consults with therapists about marketing and is founder of Psyched in San Francisco.  You can learn more about Traci on her website: www.traciruble.com.

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