Psychotherapists Need a New Career Path for a Future in Healthcare
Psychotherapy has given rise to many derivative clinical services. For example, we now have digital therapeutics for self-help therapy and behavioral health coaching by non-professionals. Therapy itself is changing as professionals are asked to adapt to new demands within healthcare settings.
The people providing these evolving services must change as well. Behavioral healthcare executives monitor how industry developments affect their staff, and the most pervasive changes in decades are upon us. Our field is becoming part of a consolidating healthcare industry. Therapists may be deeply affected, and so we need a strategic plan focused on their careers.
Compensation for therapists often does not measure up to their skills and education. This can be rectified as many shift into medical settings. Pay equity should be built into a new career track—a series of progressive roles, from basic to advanced to supervisory—to pursue over a healthcare career. If we manage these career changes for therapists well, it could translate into better care for patients.
Healthcare consolidation could have many different outcomes for our field, and so let us consider the primary risks and opportunities before examining the underlying issues:
- Because we are in an era dominated by a focus on tools and techniques in both professional and non-professional services, we risk therapy being reduced to the use of therapeutic techniques, not the use of professional judgment.
- We have an opportunity for therapists to help many more people in primary care than in standard therapy practices if we leverage their clinical judgment and help them adapt to medical settings with non-traditional, brief visits.
The Emergence of Therapy Technicians
People are finding help outside traditional therapy today. Digital modules replicate aspects of therapy, and non-professional counselors offer light versions of it. These counselors and coaches might best be described as therapy technicians. A basic misconception about therapy facilitates their emergence.
People reduce therapy to the techniques used, even though research shows therapists personally drive results far more than their techniques. Few data points are so unappreciated and so unassailable. Nonetheless, these lower skilled technicians will likely flourish since the demand for help is intense.
Anyone can use the title “counselor” today, much to the chagrin of anyone persevering to earn a professional license. These technicians are a step below professionals in education and training, but they use technical therapeutic language in describing their work.
Beyond a lack of licensure, there is little quality oversight of this work. These technicians could replace therapists with impunity since they have no license to risk. The role of therapist is attractive to many people, especially absent the time and expense of licensure.
While technicians cannot bill insurance without a license, primary care practices employ behavioral coaches for therapy-like tasks. Physicians know behavioral issues are prevalent, and many welcome lower-cost technicians. Counselors may deny offering therapy, but they get sufficient marketing value by noting parallels to therapy. Also, these technicians gain legitimacy as physicians refer to them.
A New Track for Therapy Professionals
A good solution to our access problem is available with our existing professional workforce. We can leverage their skills in new ways. As our services are absorbed into healthcare, a percentage of therapists could move into primary care to provide brief interventions. Those currently working there provide either full therapy sessions or brief, technical consultations. Neither is optimal.
Many therapists unfortunately agree with key assumptions driving the growth of therapy technicians. Despite research to the contrary, many believe techniques produce clinical change. Consequently, some of today’s therapists in primary care work from a menu of diagnoses, techniques, and tools.
Physicians may appreciate this medicalized approach, but there is a better way. Therapists need the freedom to form therapeutic alliances, listen empathically, and use clinical judgment in brief, unstructured visits in primary care. Many have the skill and versatility to provide such services.
Payers, especially health plans, can be critical change agents in this. They should be eager to play a role given their chronic network deficiencies. The funding and promotion of new therapy careers is well within their capabilities. Our business and clinical leaders should engage health plans now and begin pilot projects.
Recognizing Professional Judgment
The easiest path for healthcare to take is to fund lower-cost solutions ranging from digital therapeutics to solo technicians to those working within team-based care models. Multidisciplinary teams may seem like groups of experts, but many use unlicensed coaches and counselors for behavioral services.
The best path is to rely on our professional workforce and elevate their clinical judgment to its proper significance. Technicians do not possess this. It is a product of professional education and experience. It should be trusted and well compensated in this new career path. The goal is to attract good people to challenging and respected new roles.
Let us empower therapy professionals and not constrain them with technical guidelines replete with recommended techniques and organized by clinical condition. They primarily need the space to use their abilities as they judge best.
Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.
The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.
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