Why Therapy Has A Branding Problem
The fact that the word of 2022 was “gaslighting” highlights the pervasive shift in how we societally talk about mental health. As the New York Times mentioned, therapy has drastically shifted from a taboo topic to a society must-have. As a therapist, I’m excited about self-care, mental health, and relational dynamics becoming a facet of our everyday conversations. What I worry about is that with the increased frequency and accessibility to information comes a plethora of misinformation and miseducation. The reality is the mental health field has been catapulted into the spotlight, yet we have no driving force taking advantage of this opportunity. Therapy has a branding problem - point blank.
While “attachment styles” and “reframing thoughts” are becoming noteworthy buzzwords, there’s still an underlying connotation that people don’t understand what we do, how therapy works, or how to access it. Those that do have a basic understanding of therapy and want help, struggle to actually get it. I know how painstakingly difficult and annoying it can be to find a qualified professional. I’ve not only gone through the process myself, but I’ve been tasked with being a therapist matchmaker for family and friends. If it’s difficult for me, somebody who is in the field, knows the lingo, and understands what to look for, it has to be that much harder for a regular consumer.
Over half of adults with mental illness, around 27 million people, do not receive mental health treatment. The percentage of adults with a mental illness who report an unmet need for treatment has increased every year. Yet, the number of mental health professionals in the field has also increased. Need is increasing and the number of available therapists is increasing, so what’s the deal?
Hi It’s Me - We’re The Problem
People Don’t Think We Can Help
Over the last few years, there’s been an uptick in celebrities talking about their mental health and the positive impacts of therapy including Selena Gomez, Demi Lovato, Kevin Love, Michael Phelps, and Simone Biles. We’re making significant strides in normalizing the conversation, but there’s still an underlying societal distrust in the effectiveness of therapy. In a 2018 study, researchers found that college students show low rates of help-seeking behavior although they are an at-risk population for mental distress. Specifically, studies show that only 8 - 38% of students experiencing a clinically significant mental health problem sought help. Considering that millennials have laid claim to normalizing therapy and most colleges offer low or no-cost treatment options, it would seem accessibility isn’t always the scapegoat. Stigma and miseducation surrounding mental illness still exist and drastically decrease help-seeking behaviors.
I told someone the other day that I was on my way to therapy and they asked what for. Therapy is still perceived as a reactive measure. You go to therapy when you’re in distress, pain, or crisis. While all of those things can be true, there’s also a huge benefit in going to therapy for the sake of working out your brain. Your emotions, your behaviors, and your relationships take time, energy, and effort to maintain. Therapy is a valid and effective tool for doing just that.
People Who Do Want Help, Can’t Find it
Cognitive behavioral therapy (CBT), psychodynamic therapy, and acceptance commitment therapy (ACT) are all common examples of the various dozens of therapeutic approaches and modalities that are available. While we’re trained clinically and academically, we receive zero education, guidance, or training on how to properly market ourselves to consumers. In a quick-fix society, we expect people to spend time deciphering useless jargon and credentials, translate their symptoms, and discern what course of treatment is the best fit. Rationally, our anticipation is that those who are overwhelmed and struggling to function in their day-to-day lives will persist through the antiquated search directories and endless complications to get help.
Let’s say I’ve seen enough TikToks, Instagram posts, and articles that I’ve finally decided to give it a try and start the process of finding a therapist. I’m instantly confused by the onslaught of different acronyms: LMHC, LPC, LCPC, LCSW, LSW, MFT, etc. Since the profession is not federally regulated, each state has individual educational and licensure requirements. We don’t only overcomplicate describing our approach, we make it impossible to identify if we know what we’re doing as well.
So I’ve decided to take a guess at what kind of professional I need: social worker, therapist, psychiatrist, psychologist. I search for hours to find someone that takes my insurance, has availability, and seems like they’d generally be a good fit. I get thwarted by waiting lists, hefty costs, and no responses.
Accessibility
Let’s break down the issue of accessibility. Most Master’s degrees in Mental Health require a two to three-year commitment. On average, these programs cost anywhere from $19,000-$40,000+ a year. During this program, you are required to complete a certain number of hours of clinical training in which you see clients for free. Once you graduate, the average salary for a licensed therapist is around $69,000 a year. For a therapist, this typically looks like seeing 25-35 clients per week. I’m horrible at math, but from the numbers above - I think you can glean that free labor + student loans + unsustainable workload = burnout.
The shift in therapists turning to self-pay is not out of malice or ill intention. It’s due to a desire to get paid our actual value, to prioritize providing high-quality care to our clients vs. high quantity, and to be able to focus on clinical work over administrative tasks. For many, hours are wasted fighting with insurance companies trying to process a claim of $30 for an hour-long session. Those that don’t turn to private practice or self-pay end up feeling so burnt out that they may even leave the field after a few years. The turnover rate in behavioral mental health organizations ranges from 30-60%. Ironic that in the field that touts the importance of self-care and boundaries we’re stuck in a system that categorically denies us that right if we want to survive.
What Needs to Change?
Federal Regulation: There should be a central educational and licensure requirement across the US, giving better access to those in rural or underserved populations to gain access to therapy via telehealth. Additionally, this allows therapists to better access their network across a variety of locations and uphold standards of care when clients move.
Better Compensation By Insurance: Our healthcare system needs to finally acknowledge that mental health is health. As such, they need to compensate therapists appropriately for their time, competence, and education. They also need to make it substantially easier to administratively deal with insurance claims.
Branding 101: As a field, we need to collectively work to communicate more simply and more frequently about what we do, who we help, and why it works. This starts with an improvement in counselor education but has to be implemented across the board from new to seasoned professionals.
Tech Companies: When we want food, we order from one of our apps to get delivery. When we want to connect, we open social media apps. It’s understandable that we want our therapy delivered in a similar format. The reality is that’s not how most of the work gets done. While BetterHelp, Talkspace, and Cerebral are working to fix the accessibility issue, making therapy “on-demand” only increases the risk of burnout and the likelihood of low-quality care.
Revolutionize: As Jonah Hill’s recent Netflix documentary suggests, therapy is about the relationship between therapist and client. Real work happens when you refocus on the feelings, energy, and transference in the room. Skills and coping strategies can help, but anxiety, grief, and loss are all part of our lives and will continue to be. Furthermore, when clients look for therapists, they want somebody they can relate to. The importance of the relationship gets lost in the search process due to outdated ethical codes. For example, I’m not allowed to ask for client feedback to be shared on a Yelp page or my website due to ethical concerns. Yet, all a consumer wants to know is that I’m trustworthy, know what I’m doing, and have the capacity to relate to them. The best way to build that credibility is to hear from someone who’s gone through the process, yet we don’t allow that to happen.
My point in saying all this is that chunking the issue down to accessibility is an oversimplification. Systemic changes need to occur to ensure better quality care, greater access, and more preventative rather than reactive education and information surrounding mental health and therapy.
