Uncharted waters: Expanding a psychotherapy practice in uncertain times.
“We’ll never make it!”
Glum from Gulliver’s Travels by Jonathan Swift
It started as early as my first year of college, some 20-odd years ago. I was in an abnormal psychology classroom in Boston, eager to finally get moving on my wished-for career as a psychologist that I had dreamed about for years. A professor I was working with at the time (AKA Dr. Glum) seemed determined to crush my hopes and dreams of becoming a clinical psychologist. “You’ll never make it.” “There’s no future in seeing therapy clients unless you want to work 70 hours a week in a community mental health center.” “And you can forget about getting to do research unless you happen to draw the golden ticket and get an academic job, but those are pretty much going the way of the dinosaur too.” While I might be taking some liberty on Dr. Glum’s actual words, there was a clear message she was trying to impart to us. The field of outpatient psychotherapy practice was on its deathbed and we’d better run the other way, fast!
I’ve heard this mantra of “you’ll never make it” throughout much of my training and well into my career. I still hear it today on professional listservs, among concerned graduate students, and even by those of us practicing in the field. Even just this week a colleague on a professional listserv posted a link to short cartoon about the futility of attempting to become a clinical psychologist. I found the video both somewhat offensive and tired– it’s still beating the same old “you’ll never make it” tune.
Of course much of what is being said has merit. We do have the problem of too many psychologists compared to demand. And we do need to be responsive to the changing landscape of healthcare in our country. But, is it impossible for a resourceful, skilled, well-trained psychologist to be successful in developing an outpatient clinical practice in this era? I choose to believe ABSOLUTELY NOT!
In fact, we here at Portland Psychotherapy continue to expand. We continue to invest in the concept that there will be a continued demand for quality, science-based outpatient psychotherapy. And I believe that demand extends to those in solo private practices as well. I know we are often looking for referrals to other providers who practice science-based psychotherapy and are frustrated when our “go to” referrals are often full. There is, and I think there will continue to be, demand for clinicians who are exceptional at what they do.
So rather than giving up, maybe the thing to do is focus on what makes us unique. In the case of clinical psychology, what I think us unique among other mental health providers is our strong foundation in and commitment to science. That means not only practicing “evidence-based” therapy, but also “science-based” therapy. For me, that also means being a true scientist-practitioner, one whose clinical work is informed by research. And just as science is always progressing, so too does our field need to continue to progress.
I maintain that all of the fear-mongering that’s been tossed around for at least the last 20 years is both destructive and disingenuous. Even with the glut of psychologists, it’s not like people are going unemployed. The APA Center for Workplace Studies reports that less than 1% of psychologists (Ph.D. or Psy.D.) can’t find a job. Dr. Glum was wrong! It is possible to develop a thriving clinical practice. It’s even possible to research in private practice, like we do at Portland Psychotherapy. So, if this is your passion, become exceptional at what you do, focus on what makes your contribution unique, and be resourceful. Rather than trying to scare off our competition with the “you’ll never make it” cries, join forces with other like-minded colleagues who are dedicated to being exceptional at what they do, let others know about your excellent work through good marketing, and work together to help support each other.
What is Science-Based Psychotherapy?
Science-Based Psychotherapy is focused on educating therapists and the public about the role of science in the practice of psychotherapy.We will blog about topics such as:
1) How to use scientific thinking to inform the practice of psychotherapy
2) Particular psychotherapy methods that have been studied scientifically, and the evidence — either for or against — those models
3) New findings in basic and applied research that might have implications for psychotherapy practice
4) Research relating to training, supervision, professional well-being, and continuing to develop as a psychotherapist.
While psychotherapy is at its heart an interpersonal enterprise, this enterprise is best informed by scientific findings whenever possible. While we believe that the therapeutic relationship is very important for effective psychotherapy, and we strive to have a positive therapeutic relationship with every client we see, we also believe that psychotherapy is best guided by science. Fortunately, the evidence-base for psychotherapy has grown immensely over the last two decades and now we know a lot more about what works in therapy.
The name of our blog was inspired by the writers at Science-Based Medicine. Like them, we believe that good science is the best way to determine whether mental health treatments are safe and effective. This idea has been the core of the evidence-based psychotherapy (EBP)movement. While the EBP movement has been a positive development in many ways and we are supportive of it, we also think that EBP proponents often focus too much on clinical trials as the primary (or sole) source of evidence for whether a mental health intervention is safe and effective. Lists of recognized evidence-based psychotherapies (for example, the APA Division 12 list) are often based solely on outcome research from clinical trials, and other kinds of applied or basic research are little considered. This is not optimal for the progress of science over time or for guiding therapists about what to do in therapy.
All the authors of Science-Based Psychotherapy are researchers, as well as active clinicians, with years of scientific study and clinical practice under our belts.
If you are looking for lists of evidence-based psychotherapies, here are some resources:
- American Psychological Association Division 12 Website on Empirically Supported Treatments
- Evidence-Based Practice for Children and Adolescents (managed by Division 53, American Psychological Association)
- Evidence-Based Behavioral Practice (EBBP)
- National Institute for Health and Clinical Excellence (NICE)
- National Registry of Evidence-Based Programs and Practices (NREPP)