Is It Time to Rethink the Medical Model in Therapy?

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Is It Time to Rethink the Medical Model in Therapy?

Hello, amazing therapists! With the rise of AI in therapy, it’s time for a heart-to-heart about a crucial pivot that I believe many of us need to make, not only in our careers, but also across the therapy industry. Specifically, it’s time to explore why moving away from the traditional medical model could be the key to a more successful and satisfying private practice. 

If you’d prefer to listen, I’ve also recorded an episode of Love, Happiness and Success for Therapists on why moving away from the medical model may be a smart move. You can listen on this page, Apple podcasts, Spotify, YouTube, or wherever you get your podcasts. 

Without further ado, here’s why you should be rethinking the medical model in your therapy career:

The Limitations of Relying on Insurance Companies

If your private practice is in the back pocket of health insurance companies, it could be a real barrier if your passion is NOT the diagnosis and treatment of mental health conditions. 

Being tethered to insurance companies for client payments means you’re often confined to working with clients seeking behavioral healthcare and medically necessary treatment. This is fantastic if your passion lies in clinical mental health for specific psychiatric conditions — a much-needed specialty. 

However, if your heart is drawn to areas like self-improvement, personal growth, or couples counseling, you’ll find that health insurance won’t cover these services. In fact, many of these clients would be much better served by working with a therapist who practices coaching, which is never covered by insurance. Relying solely on insurance can lead to feeling unfulfilled and disappointed in your work.

The Administrative Burden

The paperwork involved in health insurance models significantly reduces your effective hourly rate. Consider this: if you’re spending 1-2 hours on documentation for every billable hour at an in-network rate of $60 to $110, your actual earnings could be alarmingly low. This realization can be a wake-up call to reassess your therapy career path

If your mindset is currently, “but health insurance pays the bills,” you might consider reminding yourself that by pursuing a different economic model you may have fewer clients overall, but you might also be working literally half as many hours for the same amount of money, which is a great way to enjoy a comfortable living while avoiding occupational hazards like therapist burnout. It’s important to remember that your time is valuable, too!

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The Rise of AI in Therapy

We can’t have a serious conversation about the medical model in 2024 without talking about the fact that The Robots are coming for our jobs, too. AI-based therapy is making strides in treating mental health disorders, offering cost-effective and accessible solutions. Research is showing that in some instances, AI delivered interventions and assessments are as effective and have the potential to be even more effective than those delivered by humans. This is likely to increase as this technology advances.

But in the meantime, this shift is creating economic pressures on therapists who are sticking to traditional models, and this is only going to intensify as health insurance companies continue exploiting the potential AI offers them to slash their costs and increase their profits by avoiding paying for in person, 1:1 psychotherapy — especially for patients with mild to moderate mental health conditions. It’s essential to recognize these changes and adapt accordingly.

Embracing Coaching and Personal Development

So, what do we do instead? I personally believe that the path forward for therapists wanting to work with high-functioning clients focused on positive change, personal growth, and better relationships, lies in stepping outside the medical model altogether. 

While being very well-versed and competent in the diagnosis and treatment of mental health conditions is a basic competency for every therapist, I feel that we would serve many of our clients much more effectively by investing time and energy into learning how to help healthy, high functioning people grow and achieve their most precious and important personal and professional goals. Thankfully there is a well established, research based system for how to do exactly that: Coaching Psychology. 

Psychotherapy is for the diagnosis and treatment of mental illnesses. Coaching is about growth and goals. If you want to do successful work with healthy clients seeking growth and goal attainment, it’s a mistake (and may even be unethical) to subject them to psychotherapy that is not going to be helpful for them. 

Here’s how coaching can help you become a more effective therapist: 

  1. Beyond Passive Therapy: In coaching, there’s an active, solution-focused approach. This is about guiding clients to make positive changes and grow, which is incredibly fulfilling.
  2. Insurance Independence: Coaching allows you to step away from insurance dependencies, giving you the freedom to set your rates and reduce paperwork significantly.
  3. High Demand for Personal Growth: As people increasingly seek personal development, the demand for skilled coaches is soaring.

Growing Self’s Coaching Certification Program

Exciting news for those inspired to take this path! Growing Self will offer a coaching certification program tailored just for therapists. This program will equip you with the tools and skills to excel in coaching. And guess what? Listeners of the Love, Happiness and Success for Therapists podcast – and their friends – will get a 10% discount!

By becoming certified, you’re not just adding a skill that helps you grow as a therapist; you’re joining a movement. You’ll be part of a community dedicated to making a real difference in people’s lives, outside the constraints of the medical model.

Join the waitlist to get more info, and apply to enroll!

The time has never been better to reevaluate your career path. Are you ready to step into a space where you can work with clients on personal growth and relationship enhancement without the bureaucratic hurdles of insurance? If so, coaching might just be your calling. (And if you want to be a part of a group private practice where we’re actively making this shift, you can explore career opportunities at my practice, Growing Self). 

Remember, your time, skills, and passion as a therapist are incredibly valuable. By shifting your focus and embracing coaching, you open doors to a career that’s not only financially rewarding, but deeply fulfilling. I’m wishing you all the luck along the way!

With love, 

Dr. Lisa Marie Bobby 

P.S. — Are you at risk of therapist burnout? Take my free quiz and find out!

Citation:

Li, H., Zhang, R., Lee, Y.-C., Kraut, R. E., & Mohr, D. C. (2023). Systematic review and meta-analysis of AI-based conversational agents for promoting mental health and well-being. *npj Digital Medicine, 6*(236). https://doi.org/10.1038/s41746-023-00979-5

  • 00:00 The Rise of AI in Therapy
  • 03:24 The Impact on Therapists
  • 07:38 The Role of Insurance Companies
  • 09:53 The Power of New Technologies
  • 14:00 The Ethical Dilemma of Insurance Billing
  • 16:23 Pivoting Away from the Medical Model
  • 18:14 The Advantages of Coaching
  • 22:53 The Future of Coaching


Lisa Marie Bobby: My therapist friends, if you are primarily focused on clinical mental health, meaning the diagnosis and treatment of mental health conditions. Here’s something to consider. Insurance companies are increasingly turning to AI assisted therapy to replace One on one psychotherapy with a human, especially for mild mental health conditions.

What does that mean for you? It means that you may need to adapt your skills to future proof your career, including shifting away from the medical model and towards more growth oriented services. Like coaching can be a really smart move in the age of AI. And that is what we’re talking about on today’s episode of love, happiness, and success for therapists.

We’re going to be talking about how to embrace. The future of therapy by moving past the medical model, which is maybe not going to have the same kind of future that we hoped it would even, even a year ago. Five years ago, things are changing fast and we also need to be adaptable. So by the end of today’s episode, I hope you just think about some new ideas and new perspectives that help you understand where our profession is heading and how you can be course correcting intentionally in order to set yourself up for long term professional success.

Satisfaction and success, especially in this new world that we’re now living in with the rise of AI in therapy. I think this is a big pivot point for a lot of us. And this is something that I’ve been thinking a lot about. If this is your first time listening, I’m Dr. Lisa Marie Bobby. I’m the founder of Growing Self Counseling and Coaching.

Um, it’s a group private practice and have, I’ve been doing this for a long time. We have, gosh, 60 ish, Therapists on our team doing amazing work and, um, because I am really responsible for the well being of all of these clinicians who are relying on me to provide them with care and support for, for their professional well being, I’m always thinking about, you know, what is on the horizon and how can it impact us and, and how can our collective, um, Pivot, you know, in response to those things.

So I’ve been trying to be active, you know, in making good long term decisions. And more and more, I’ve been talking to my clinical supervisees, but also my colleagues about the future that I see really coming online related to therapy and the medical model and. What’s going to happen next? And of course, I can’t predict the future.

I do not have a crystal ball. I don’t know exactly what’s going to happen, but I think that it is possible to at least to a degree, see around corners a little bit, see the writing on the wall and, um, What is just emerging more and more for me is that therapists who are very tightly welded to the medical model and focusing on mental health treatment, like through insurance company payments are going to need to make a decision they are going to need to focus on.

More, um, intensive and, um, like presenting issues that have higher levels of acuity that are really complex enough and challenging enough that they would overwhelm of. At least current AI capabilities, they really will need a one on one highly qualified, highly skilled, highly trained, licensed psychologist or other mental health professional in order to manage this and provide a very high level of treatment.

So that that is door number 1, certainly to become more specialized and more focused. And door number two, I think involves reconsidering whether or not the medical model is a good idea for you at all, especially if you don’t want to do more intensive stuff that would overwhelm the emerging competencies of AI, because the, what I see happening already is that the sort of.

easier. I don’t know if any of it is easy, but the less complex, more straightforward garden variety type work, mild to moderate anxiety, depression, adjustment disorders, etcetera. You know, insurance companies see the fact that we have a Supply side problem when it comes to obtain treatment through their insurance, then there are therapists frequently that are able to provide those services.

There can be waiting lists. There can be, um. Difficulty connecting with an insurance panel provider and compared to the, you know, balance sheet of a health insurance company, even if like so many therapists, you have already negotiated a very low, um, in network rate from a health insurance company, which could be, I don’t know, 70, 80, 80, maybe in some places, 90 bucks, if you’re lucky a session, um, that’s still a lot more money paid to you then to a, I mean, a lot of health insurance companies are actually channeling the, the simpler stuff to coaches rather than therapists for treatment, believe it or not.

Um, but. Also directing clients to, okay, well, you know, we could connect you with a therapist and network, but first log into our app and work through this cognitive behavioral thing. And you can talk to our AI chat bot named Larry, who can help you, you know, feel less stressed and improve your sleep. I mean, that’s through health insurance companies.

Additionally, there are now so many. Apps, you know, pay seven bucks a month to get access to, to something that resembles um, basic non directive talk therapy. So there’s that piece too, right? Um, the robots are definitely coming for us. And I think, you know, I’ve talked with some therapists who are like, Oh, but it’s not the same.

It’s a robot. It’s so impersonal. It’s so cold. And you know what I keep coming back to, like 10 years ago. Maybe 12 years ago at this point, I was literally the only clinician that I knew that was offering services through, um, video conferencing through zoom. And I would talk to people about this and they’re like, but it’s like talking to a computer.

What are you doing? That’s crazy. And I think now in this day and age, like, Most services are conducted online. Even, you know, people that I can and do see in my physical office in Denver. We look out the window together. They’re like, I can see my house. It’s right there. They still prefer to come and meet with me through online video sessions.

rather than driving, you know, three miles and parking and walking up all the stairs and coming and sitting in my office with me just because it’s that much easier, right? It turns a 45 minute appointment where you log on, you log off. Um, you know, that that’s at least a two hour tour. By the time you find your shoes, get in your car, come all the way to my office, park, walk up, walk down, go back to the car.

Like, you know, so anyway, my point being is that Um, I think that we can underestimate the power of new technologies and really understand how deeply they will take hold. And I think also, if we’re honest, there’s a part of, uh, therapy that feels just very personal. It feels very human, right? And how, how can, how can, AI recreate that magic, right?

How could somebody feel as attached to a chatbot as they do to me? Like, maybe it’s a little bit offensive, isn’t it? And, you know, kids in Japan are already like trying to marry their chatbots, right? And so like, there’s, there’s a thing, humans get attached to all kinds of stuff, like marrying their pillows, like having passionate love affairs with video games.

And so it’s just, you know, having respect. that is being met, having respect for the fact that it’s a lot more cheap. It’s a lot more accessible than we are. And there’s also going to be these economic forces pushing people towards this to a greater and greater degree. So the other. Piece to consider as you’re thinking about where you want to focus, um, in terms of your own professional trajectory.

So there’s definitely the rise of AI and we’ll talk more about this on other podcasts, but you know, I think that there are additionally, if, if you are in the back pocket of insurance companies, meaning that you are relying on health insurance for payment for your sessions, this can be a huge.

Professional barrier, if your passion and what you really like doing and what you feel that you’re calling is and what you feel that your ultimate services is not the diagnosis and treatment of mental health conditions. Because being tethered to insurance companies for client payments means that you are, by definition, going to be working with clients who are seeking behavioral health care because health insurance only pays for medically necessary treatment.

And again, it’s fantastic if your passion is clinical mental health or psychiatric conditions. I mean, what else? We need this, but if you like to work with clients on life transitions, personal growth, self improvement, um, even, even grief and laughs, certainly any kind of relational work, couples counseling, like for the purpose of relational improvement, premarital counseling, uh, career exploration or career development, health insurance doesn’t pay for that because people aren’t coming in seeking treatment for a diagnosis.

They’re coming in because they would like to have better outcomes in their relationships or, you know, help in creating clarity in their career. Some clinicians will try to thread this needle by committing low grade. Insurance fraud saying, I know that you’re here for premarital counseling, and that’s what we’re doing.

But in order to get insurance to pay for it, I have to diagnose one of you with something. So I’m going to say that you have. An adjustment disorder, and this is a therapy for the treatment of adjustment disorder with a partner present and then submitting essentially of a falsified insurance claim on, you know, so that you can receive payment from an insurance company.

Um, it’s not uncommon people do it, but it’s really ethically. Like not okay. I mean, it’s not even dubious. You are saying that you’re providing treatment for something that isn’t you’re doing. And, and also, I mean, the fact that if we are submitting documentation that we’re providing treatment, we’re providing services, we’re treating diagnoses, our case notes also have to be.

In alignment with that. So in this session, we were talking about Mary’s adjustment disorder and this is the purpose of our time together today. Your treatment plan needs to reflect that. And again, if that’s what you’re doing, that’s great. Do that. But if you’re not, Doing that, if you are talking with a couple about communication skills, and let’s talk about how you each feel about setting boundaries with in laws.

I mean, premarital counseling, but you’re falsifying a treatment plan, a case notes and an insurance document. Like, What, you know, so there’s a lot of ethical dubiousness and, and I really worry about clinicians who have built their practices around this. They are relying solely on insurance, because if they’re going to stay ethical, it means that they are providing mental health services.

They’re doing behavioral health care, or they are in a position where they’re, um, you know, uh, Misrepresenting the work that they’re doing in order to get paid because they would like to do more premarital counseling or they feel more fulfilled by these other types of work. So, it’s tough if you have broken free from the medical model, and people are just paying directly for services.

You can do all the premarital counseling. You want people can have premarital counseling. They can pay for it. They can benefit from it. But it takes it takes away that ethical conundrum. Certainly. For There is also a very significant administrative burden if you are dealing with insurance companies, um, which, which really effectively reduces your hourly rate.

I mean, consider if you are spending 1 to 2 hours. On documentation and submitting see, you know, uh, what are the CMS 1500 paperwork through an online system that kicks back every other one and you have to correct it and resubmit this and you’re getting things in the mail and having to get on the phone.

I mean, easily it can be 1 to 2 hours for every billable. client session at the in network rate, which is already really quite low. I mean, I’ve seen 60 a session, like 110, but if you divide 60 an hour by three hours, if that’s how long it takes you to get, you know, the, the client. The check back, um, in terms of the work that you have to put in, I mean, that’s 20 an hour.

And I think sometimes for clinicians to do that math and figure out how much they’re actually earning an hour, given the work that it involves, that can be another pretty significant realization and wake up call that makes people reassess their career path. Um, But again, I mean, if you have this, this mindset around, but health insurance pays the bills, like who’s going to pay me to provide therapy, if it isn’t health insurance, you might consider just reminding yourself that pursuing a different model, like business model, can lead to Be a possibility for you.

So if you have more self pay clients, you may have less clients overall, but you also might literally be working half as many hours for the same amount of money. If you have full fee clients, you don’t have to do all the paperwork. I mean, so maybe you have. 10 or 15 clients a week instead of 25 or 30, but it could really be better for you, better for them.

You’re doing the work that you love and, you know, remembering that your time is valuable as well. So, um, there are a number of reasons for Pulling away from the medical model, you know, I, I do think that a lot of therapists are, are going to go off a cliff if, you know, AI essentially replaces them for a lot of what they’ve been doing.

So again, path number one is specialization to increased, uh, acuity services. That’s a thing, but you know, the other pieces of this, I think there are a lot of reasons to pivot away from being bound to insurance companies. If, if, um, You know, either that’s really not what you want to do, or you’re doing that mild to moderate kind of basic counseling stuff.

If you want to work with higher functioning clients who are focused on positive change, personal growth, better relationships, having more self pay clients, it is. may behoove you to get more invested, more involved, and potentially even certified in coaching psychology because there is a very well established research based system for how to do highly effective work with clients who want your help in achieving better outcomes that is not therapy.

At all. And at the end of the day, psychotherapy is behavioral health care. It is for the diagnosis and treatment of mental illnesses. Whereas coaching is a whole different system. I mean, they’re related, but they’re very different. And coaching is all about helping people grow and achieve their goals.

goals. Um, in my experience with working with healthy clients or seeking growth and goal attainment, it can often be a mistake and actually detrimental to them to, um, provide more of a traditional therapy kind of experience because talk therapy, again, It’s not necessarily for growth and goals. It’s for mental health treatment.

And if somebody doesn’t need that, and they need to grow and you’re kind of spinning your reels, wanting to talk about their parents divorce. And they’re like, yeah, but you know, I really want this to be different in my life. You’re going to feel stuck. And they’re going to feel stuck and, you know, some might think that you are practicing outside the scope of your practice when it comes to really being of service to high functioning clients who are really seeking to make changes, like active changes in their lives.

I often, you know, when I’m meeting with a new client, one of my first questions is, is this person needing psychotherapy or would they benefit more from coaching? And certainly I can provide psychotherapy if that’s what people want and need. But. If somebody is trying to create different outcomes, coaching is usually the way, because with coaching, there’s this active solution focused approach.

Um, it’s really around being in the role of a process guide, you know, helping people identify goals, outcomes, identify obstacles, and then working with them to help them. Learn how to do things a little bit different. Like, you know, a golf coach can be like, don’t hold it that way. Try this instead, you know, and obviously like making space for clients to, um, you know, uh, ultimately be the creators of this process.

But there is definitely a teaching component to coaching. Um, and the clients often really benefit from this. So there are a lot of advantages to our clients from. Embracing coaching. Additionally, I think that there can also be advantages to us. I mean, I don’t know about you, but I feel like my coaching clients are a lot of fun, you know, cute little couples coming in for premarital counseling, or really coming in with a specific thing that isn’t like a psychotherapy thing.

Like I don’t, Think I love my job anymore, but I’m feeling so torn and I don’t know what to do instead. Like that person doesn’t need treatment. They need help, like getting clear, moving forward. I love doing that kind of work. So for me, it’s personally very fulfilling work. I love my clients, but also certainly, you know, being able to build a practice that is completely independent of insurance companies.

I mean, coaching is not. Insurance isn’t going to pay for that unless, you know, it’s a hired gun coach who’s like working for the insurance company to talk about how to ameliorate the depressive symptoms of one of the clients who two years ago would have been one of your clients but who is now being shunted to a coach to do that instead.

So I also have strong feelings about coaches who do not have qualifications in psychotherapy effectively. providing psychotherapy, um, without licensure, without that, that designation. We’ll talk about that more on another episode of the podcast. We’ll talk about, uh, PTSD coaches and you can hear me rant for, yeah, get on my soapbox.

Um, but anyway, there are so many different benefits to coaching and also I think to, you know, clients, um, especially well informed, high functioning clients are increasingly understanding the differences between modalities and are really, I think, reaching out, seeking more of a personal development. Or improvement experience, as opposed to seeking help and seeking treatment.

So I think they’re going to want to work with you. Um, if you can help them in that way. So I see a very strong future for coaching that I feel really excited about. And, you know, I’m doing growing self counseling and coachings. I’m a licensed psychologist. I’m a licensed marriage family therapist, but I am also a certified coach.

And I have been for gosh, probably over 10 years now. Um, and because I. Love coaching so much. I, um, often work with clinicians in our practice and teach them the art, the science, the psychology of coaching. Um, a couple of years ago, decided that I’m going to develop a coach certification program through growing self to be able to help more therapists make this really important pivot for themselves, for their clients, for their careers, for their So it’s something that I’ve been kind of mulling over for a long time, but especially now, with the rise of the robots, and that I foresee things get going to be increasingly difficult for clinicians who are.

I’m going to stick with the medical model, a kind of that mid range level, it’s, it’s going to get hard. And so it felt more and more important for me to be able to put something in front of therapists that can provide them with a, a roadmap forward. So to become certified as a coach, to learn how it works, to understand the differences between therapy and coaching and how to practice coaching ethically.

As a licensed therapist, um, coaching can be very, very different from therapy. And also there are a lot of transferable skills. So it’s not like you have to start from the very beginning. Um, and my coaching program is designed. For licensed therapists. So not for civilians who want to be a coach. This is only for licensed therapist and it helps you attain the BCC credential, which is a national credential.

It’s you may have heard of like I C. F. The BCC is like ICF except for therapists only people who do not have a master’s degree in licensure and therapy cannot attain the BCC credential. So it’s, it’s special and it’s important. And that’s why I built my coaching program around it. And I’m excited to tell you about this, introduce you to it.

And if you would like to check it out, I hope you come to my website comes to growingself. com forward slash therapist. You’ll see a link to learn more about my coaching certification program and you as a love, happiness and success for therapist listener, get a promo code. Use the promo code L H S M. T. F.

No, F. T. Love, happiness and success for therapists. L. H. S. F. T. as your promo code and you’ll get 10 percent from me to you because, um, I want to make this happen. I am so passionate about therapists. Providing coaching, I think it’s really important. Most therapists don’t know how to do this. Most coaches don’t have our background, and that can get sketchy in its own way.

So we need to reclaim coaching as a profession and credentialing programs, evidence based research backed. Coaching credentialing programs like this one that are by therapists for therapists, in my opinion, are the path forward. So for me to you, I hope you check it out. Okay. That’s enough for our time together today.

Thank you for listening as always. And I’ll be back in touch soon with another episode. All right. Take care.

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