Psychotherapy Finances

If you’re looking to sell your services to big or small business, here’s some information that can help seal the deal. A new study shows that talk therapy slashes the amount of sick time an employee needs and can also reduce the amount of medical care required.

The British study appeared in the Journal of Epidemiology and Community Health, a publication of the British Medical Journal. It focused on data collected from 152,000 patients in London and Yorkshire. It compared people who sought medical care with or without mental health problems between 2007 and 2009 with people who had sought treatment for mental health issues.

Not surprisingly, people who had untreated mental health problems were five times more likely to be prescribed antidepressants and be admitted to a hospital. They were also 10 times more likely to hand their bosses a sick note excusing them from work than people with no mental health problems. And, they used emergency care more often.

“There were marked differences between those with [mental health problems] and people referred to [talk therapy] and the rest of the registered population,” the authors said. “At a time when there is pressure to control increasing health costs, this study suggests that [therapy] may contribute to reducing health service usage.”

The study was prompted by a new program in the UK called Access to Psychological Therapies (IAPT). The theory was that people who took advantage of the talk therapy would need less overall medical care and would miss fewer work days, and that was borne out.

An additional advantage: IAPT patients who were on medication were more apt to stick to their drug therapies, which also led to better overall health.

- John Nelander, Contributing Editor

Three sessions — that’s how long it should take for the therapist and client to find out whether they are a “good fit.” That and other advice for therapists and prospective clients was outlined in an October 18 Wall Street Journal story.

The article, “Help Wanted: a Good Therapist,” was sort of a primer for people who are trying to find therapy that works. The sub-headline was: “Amind Increasing Choices, How to Know What Treatments Work, When to Move On.”

It’s a concern of most prospective clients, especially those who have never gone in for therapy before. We’ve spoken to clincians who offer a free introductory session, and the Journal story is a reminder that the policy may have some validity as well as some marketing advantages for the practitioner.

The newspaper quoted David Palmiter of the American Psychological Association as saying that good therapy is like “going to a good restaurant. ‘You should be able to peer into the kitchen and see what they’re doing.’”

Experts told the Journal that both clients and clinicians can tell if therapy is going to be effective after three sessions. But Betsy Stone, a psychologist in Stamford, CT, thinks one may be enough.

“I like to push patients pretty hard, because I want them to get their money’s worth, and some people are just too fragile,” she said. “Then I say, ‘I’m not the right therapist for you, but I’ll help you find someone else.’ ”

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The foreclosure crisis is responsible for an increase in depression and other mental health problems, a University of Maryland study released Thursday shows.

The study, published in the American Journal of Public Health, revealed that 20 percent of homeowners who are in default on their mortgage are experiencing symptoms of depression. “We knew of the link but we were surprised by the magnitude of the problem,” Dawn Alley, UM assistant professor of epidemiology, told The Baltimore Sun.

The results are based on a nationwide survey of 26,000 Americans over age 50 from 2006 to 2008. A separate survey conducted by mortgage counselors and reported to the university contended that 70 percent of their clients were suffering from depression, and a third had threatened to harm themselves.

Although the survey focused on people over age 50, younger people face the same impacts, researchers said.

In the January issue of Psychotherapy Finances, we explored the subject of non-compete clauses and how they affect therapists. These are contracts businesses (a group practice, for example) ask employees to sign, restricting where they can set up shop if they strike out on their own.

“The contract will say explicitly that for X amount of time, the practitioner is not allowed to contact any of the clients or try to get them to leave that practice for another practice,” said David Ballard, assistant executive director for marketing and business development with the American Psychological Association. “Client lists are proprietary and the therapist is prohibited from copying them.”

One therapist we featured signed an agreement that said if she set up a solo practice after leaving a group, she had to call herself a coach rather than a therapist.

Non-competes pop up in all areas of the economy. They bar employees from going to rival companies for as long as two years.

Now, an intriguing new study reveals that these agreements are actually driving technology professionals out of the field. Rather than try to maneuver around the contract requirements, they opt to shift gears in their career.

In a survey of 1,029 engineers by an assistant professior at the Massachusetts Institute of Technology, a third of them said they left their industry rather than deal with a non-compete clause.

The paper, “The Firm Strikes Back: Non-compete Agreements and the Mobility of Technical Professionals,” appeared in this month’s edition of the American Sociological Review.

But what applies to all professions is this finding: “Firms strategically manage the process of getting workers to sign such contracts, waiting for workers’ bargaining position to weaken.”

We’ve heard from attorneys and clinicians about therapists who were asked to sign a non-compete after they had already come onboard. That basically undercuts any bargaining position they may have had.

If you do maintain some bargaining power, experts say it’s often possible to soften the language. One way is to try to reduce the size of the geographical area that’s restricted. You can also try to minimize the timeframe involved, from two years to as little as six months.

- John Nelander, Contributing Editor

People often get the political bug around this time of the year, and that includes therapists.

Clinicians are not strangers to politics, especially those who are active in trying to manage scope of practice issues through lobbying efforts at the state and federal level. But occasionally therapists get involved in a broader way, and that’s what clinical social worker Jeffrey Kerekes has done.

He’s running for mayor of New Haven, CT.

We featured Kerekes about five years ago in Psychotherapy Finances for an innovative practice that featured house calls, and a marketing effort that included Podcasts. It’s an online interview format, with Kerekes chatting about depression, the secrets to happiness, relationship issues and other topics with colleagues.

“I’m having somewhere between five to seven hundred people per show,” he told us at the time. (Now, they have been downloaded “several hundred thousand times,” he says.)

“One of my goals is to get clients, but another one is education. Psychotherapists aren’t in the media that often. This is an opportunity to provide some information for clients.”

He also works over distances via Skype and Instant Messenger.

Kerekes was using Google AdWords to get clients to click through to his website, which you can visit by clicking here.

Nov. 8 is Election Day in New Haven. Kerekes came in second in the Democratic Primary on Sept. 13, losing to nine-term incumbent Mayor John DeStefano Jr. who received 5,716 votes to Kerekes’ 2,895. That’s 44% to 22%, but two other Democratic challengers grabbed 17% and 16%, so Kerekes opted to stay in the race as an independent.

Kerekes won three wards outright.

“Fifty-six percent of Democrats rejected John DeStefano,” Kerekes said at the re-launch of his campaign following the primary loss. He’s been tagged an “anti-establishment budget watchdog” by the local newspaper (The New Haven Register) and has landed two important endorsements from the African American community.

Since there’s no Republican candidate, Kerekes goes head-to-head with DeStefano Jr. on Election Day. What happens to his practice if he wins?

He tells us that, since launching his candidacy for mayor, he’s been continuing to work with existing clients. “But I stopped accepting new clients in June,” he says, “to be fair to new clients in case I would only be available until November.”

- John Nelander, Contributing Editor