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Notes -
I wanted to add something related but tangential to @self_made_human 's post on therapists.
The business model issue.
Without doxxing myself, I'm just going to say that I once had a person who ran / co-owned a therapy practice explain how his business ran. He and his partner would contract with independent providers who would contract with them, they guy and his partner would handle all of the overhead, paperwork, legal, marketing, etc. and take a percentage of patient fees.
He told me that the customers break down into three groups.
The first two are what you would probably expect.
The first group is more or less stable people who go through specifically difficult life circumstances and require the services of a therapist for some amount of time. People after a divorce, death in the family, traumatic event. In addition, you also have those with enduring mental health issues (major depression, bipolar etc.) that can function in society but probably need therapy and possible medication to do it. In many ways, these are the "best" patients in that the therapist gets to see them heal, grow, thrive etc. Very much a win-win.
The second group are folks with severe mental illness that have sought out therapy usually with the assistance of family and / or friends. Now, because the guy telling me about this was running a very much for-profit no-insurance practice, I will caveat that this is one perspective / reality. I can definitely see how this group's dynamics may be different at other kind of practices / state sponsored hospitals etc. Anyways, these folks have brutal situations and are doing what they can to manage. In addition to the severe mental illness, substance abuse and other self-destructive behaviors are super common. Some therapists really are dedicated and do what they can to help, but few and far between see these folks really turn it around. Maybe a few "stabilize" and can live with a lot of family support.
So, here's the first business question. Do you think Group 2 here can ... pay their bills? on time? Even with family support, the answer is "no."
But that first group! Surely they always pay. The answer is "yes" .... for a time. Remember, folks in that first group often "get their shit together" after 6 months, a year, two, three ... And even the ones that are getting therapy for decades are probably not doing it weekly after a while. They often slow down to once a month or even less frequently as check-ins.
So, from a cash flow perspective, you're in a rough spot; some percentage of your patients are so unreliable you can't really put much confidence in their recurring revenue. Another percentage pays, but does not pay with enough volume or long term durability to cover that other group. What to do?
Group Motherfuckin' 3.
Group 3 are the textbook, highly online, utterly insufferable "therapy culture" people. Soccer moms, yuppie young professionals who probably had awesome childhoods, confused and wistful early retirees, college professors (who may be banging those young professionals), and art history majors. Unfulfilled dads don't get therapy - they become very good at grilling meat and an expert in either WW2 or the Civil War (God Bless all ye taxpayers!). Group 3 is at least weekly in their visits. Many are more frequent. Most will go through periods of "needing" more intense therapy. They change prescriptions a lot for .... unknown reasons. If they catch a hint of lack of interest from the therapist, you can bet they will effect some sort of scene outside of therapy to re-energize their sessions (_"When we were in Cabo, I told Braden that I wanted to try polyamory. He just went golfing without saying a word! HOW CAN I LIVE LIKE THIS!") I'll be nice a little here; sometimes, Group 3 types just need a little professional reassurance and they do turn their shit around. Sometimes, even, they realize a lot of their problems are of their own making or that their perspective was just miscalibrated. Yet, the majority are absolutely using a therapist as a paid friend. Depending on where you live, lap dances from strippers are more cost effective.
Back to business - how do we square the circle of Group 1 and Group 2 not covering our costs or making us money?
Group Motherfuckin' 3. And boy do they Make. That. Money.
What to take away from this? As @self_made_human 's post pointed out - therapy works (if you work at it, I would add). But the problem is that so much of the therapy business and market is now geared towards "therapy culture" people that it's creating a really bad situation in which new providers either think that everyone they're going to meet is just an exasperated housewife or, even worse, that everyone they're going to meet is just an exasperated housewife who doesn't care if it's $275 / hr holy shit free money hack. When that second group comes face to face with their first hard case of a patient, it can be horribly destabilizing for both of them. The proliferation of the online telehealth therapists is the poster child for this.
What's the market solution? I don't have one and I don't want one. If we ever get to the point as a society where we really deeply subsidize mental health services, we're going to be broke overnight. Think about that - that's creating a free service for when you feel bad. Absolutely uncapped demand. And, as I hope this post as pointed out, the way it works in practice, you do have an effective voluntary (albeit semi-informed) wealth transfer tax. I will never not let rich people spend their money the way they see fit.
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