How Client Behavior Will Change and How Therapists Can Adapt Their Practices to Covid-19
The coronavirus is like nothing we have seen in the past 100 years, and the way it changes consumer behavior is yet to be clearly seen. We know how consumer purchasing changes in recessions, but paired with community isolation we simply don’t have historical data for consumer behavior, with the last similar event being in 1918.
However, we can tell how lock downs in the U.S. will affect client behavior from our predecessors in Italy and Wuhan. Italy’s response to the crisis has led to a lock down in the worst hit part of the country, so it can be considered an accurate analogy to the American situation as it develops.
We can already tell from the foreign data that interpersonal relationships will be challenged. For example, in Wuhan for the first time in recent memory, “Those who made appointments for divorce are more than those who want to get married, ” as Dai Shijun told Tongchuan Evening News (The Star). Personal anxieties have been highlighted by the pandemic, with anxieties over job loss and grief being prominent. During these difficult times consumers will still have the need for therapy, even while overall client inquiries may be down.
Finding #1: Divorces rose following the quarantine in Wuhan. For individuals during lock downs, anxiety increased and a need for therapy remained.
In this article, I used past publications, current reports and Google search trends to describe the current situation and probable future circumstances for mental health clinicians in the United States.
Immediate Impacts – Job Loss and Increased Uncertainty
“When a large number of people lose their jobs in a short period, there tends to be an increase in demand for medical services in some areas, such as mental health.” (Collier)
“The current [in 2009] stress on mental health systems in the United States, where the recession struck earlier and was accompanied by a devastating mortgage crisis, might be a preview of what’s in store for Canadian mental health workers. US mental health professionals report growing traffic at emergency rooms, mental health clinics, therapists’ offices and on mental health hotlines. Some doctors report seeing more cases of alcohol abuse, drug overdoses, panic disorders, depression and stress-related physical problems, such as abdominal and chest pains.” (Collier)
We know that unemployment claims have been high in recent weeks as businesses that don’t allow remote work have laid off their workforce. This has most hurt hourly service industry employees (ex. restaurants and construction), while office/white collar work has been largely unaffected. Keeping this in mind, if your customer base is in this affected group, your practice is likely to take a hit (if so you have probably already seen this already). If this does describe your client base, skip to the recommendations section to see how to approach these times of crisis.
For other providers that have a higher income clientele, you will not likely see an immediate impact as your clients maintain their jobs, indeed stressors will still rise for these clients and the general population, thereby increasing demand for personal therapy services. In fact, those that remain employed will face issues that commonly result from recessions. According to Stan Yaren, a psychiatrist in Winnipeg, Manitoba, regarding the 2008 recession. “People still at work are still vulnerable. Their options and choices are narrowing. People may be staying in jobs that they otherwise would move out of. And the fear of the loss of a job is often as bad as an actual job loss.” (Collier)
Finding #2: Those maintaining jobs, experience equal or worse stress compared to those losing their jobs.
Furthermore, according to The Psychology of the Recession on the Workplace, Professor A.S. Antoniou states that “Job insecurity can lead to lower self- esteem, individual health and well- being, depression and suicide ideation because a job is so integrally related to a person’s self- concept. Further, since the welfare of one’s family depends on one’s livelihood, individuals may feel threatened both for themselves and their families should they lose their jobs. “ (Antoniou) [1]
An increase in the following conditions is expected during times of recession:
- Alcohol abuse
- Drug abuse and overdose
- Panic disorders
- Depression and anxiety
- Stress-related physical problems, such as abdominal and chest pains
- Lower self- esteem
- Lower individual health and well- being
- Increased suicide ideation
Finding #3: During an economic downturn, individuals have an increased need for support even if new client referrals are down temporarily.
This is confirmed by Diana Frasquilho in BMC Public Health “The evidence was consistent that economic recessions and mediators such as unemployment, income decline, and unmanageable debts are significantly associated with poor mental wellbeing, increased rates of common mental disorders, substance-related disorders, and suicidal behaviours.” (Frasquilho)
Therapists are needed during downturns more than ever in the general population in order to build new coping abilities for individuals to manage their situation. “The ability to deal with stressors effectively is particularly important in these difficult times, in order to avoid negative psychological and physical outcomes” (Antoniou) [1] During these times it is necessary for providers to communicate the value of their therapy and to be adaptable financially to their clients. More in Recommendations.
The Data From Italy
Data from Italy shows that the national emergency that they are facing has increased emotional intensity on a personal level. This mirrors the findings of relationship difficulties during and following Hurricane Hugo (Cohan).
Finding #4: In Italy, after lock down search results trended towards anxiety and therapy terms. It is important for practices to capture these search terms.
Long Term Impacts on General Therapy
Clients Adapt, and Practices That Seize the Opportunity Then Profit.
Clients adapt to change times and begin to consider their situation more in depth. “[A] Gallup survey on well- being that collected daily data from 1000 American participants reported a sharp decline in their life satisfaction, a sharp increase in worry and stress, and a decline in positive emotions between the autumn of 2008 and the spring of 2009. However, by the end of 2010, those measures had largely recovered even though the unemployment rate remained high. Thus, it seems that Americans are still happy. Such curvilinear relationships between recession and well- being can be explained by the environmental adaptation- level theory (Wohlwill, 1974).” (Antoniou) [1]
Tip #1: Think long term and be ready to seize opportunities that others may be fearful of.
As people adapt to their situation and become less petrified to act and make big decisions, their new commitments to therapy will compensate for their past delay to seek therapy during crisis. Stressful times breed strong memories, so if you can show your value to your clients at the time when they most need your support, you prove your value to them long term. Once things quiet down and demand for services returns to normal, those therapists that proved most able to weather the storm stand to benefit. This time also presents new opportunities to grow, as Warren Buffet says “Be greedy when others are fearful, and fearful when others are greedy.” As other therapy firms turtle and try to maintain business as usual out of fear, therapy firms (that have a good footing as-is) should seize the moment to develop new modes of thinking. In my final section I go over how that is possible for firms, but the opportunities are there if seized appropriately. See more in the Recommendations section.
Recession Breeds Conflict and Increases Relationship Intensity
The logic of how recession affects relationship behavior is a simple one. Increases in economic stress on a family unit leads to increased stress on the roles within the family which then reduces marriage quality. This concept has been backed by research, and termed “the family stress model”. According to Jeffrey Dew in the Journal of Financial Therapy “The model whereby negative economic events lead to economic pressure, then worse affective states, and finally declines in marital quality is termed the family stress model of economic pressure and marital distress, or simply the family stress model… researchers have validated the family stress model across countries and cultures”(Dew 2013)
Again, it is clear that relationships are sensitive to economic pressure. “We did find that individuals who reported that their financial situation had become worse over the past year had lower relationship happiness than those whose financial situation had stayed the same or improved. Further, individuals who experienced increased feelings of economic pressure reported lower levels of relationship happiness. This finding is similar to other studies (e.g., Conger et al., 1990), suggesting that negative financial events and economic pressure take their toll on relationship quality.”(Dew 2013)
The severity of the economic stress that couples face also has a compounding effect on relationship quality. “Financial stress was a strong predictor of lower marital happiness. Among men and women with no financial stress, 87 percent reported being happy or very happy in marriage. The number dropped to 84 percent among those who reported one major economic worry. But among those who had two or three financial worries, only 67 percent reported that they were happy in marriage.” (National Marriage Project at the University of Virginia)
National Emergency Increases Relationship Intensity
But this current crisis is more than a recession, it’s an international emergency. Luckily we have data on how couples respond to similar crises, where isolation is called for and couples feel helpless.
One notable study measured changes in marriage, birth, and divorce rates in affected areas following Hurricane Hugo in 1989. The results clearly showed that, “a life-threatening event motivated people to take significant action in their close relationships that altered their life course.” (Cohan) While divorces and marriages were stalled during the hurricane, they rose disproportionately following the incident.
Finding #4: A life-threatening event motivates couples to take significant action in their relationships that alters their life course.
Data From Italy and Wuhan
Immediate interest in marriage and divorce has been reduced by coronavirus (see Fig 1 and 2), but as we have seen in Wuhan, once lock down is lifted then interest surges. People seem to be in a stressed “lets get through this” mode and not considering ending the relationship or beginning to question its quality until after lock down. Searches for relevant terms seem to be stable, but less action is taken to acquire the needed therapy while in this stressed mindset. As lock downs lift, marriage therapy demand will increase.
Recommendations on How to Adapt and Recession-Proof Your Practice
In the immediate term, money issues will be felt in the therapist-client relationship. According to Freud “money matters are treated by civilized people in the same ways as sexual matters, with the same inconsistency, prudishness and hypocrisy” [2] This is true with clients as well, the relationship between the therapist and client is one influenced by money and the clients decision process. The best clinicians can do in this situation is to be adaptable.
As Dr. Zur writes in the independent practitioner,“It is of vital importance to respond to clients’ economic realities with understanding and empathy, as well as to not hesitate to bring up the issue of whether they can afford therapy or not. Flexibility is the key response when it comes to dealing with clients in crisis and this flexibility can be expressed through the negotiation of fees, methods of payment and frequency of sessions” (Zur, 2009)[3]. In short, be understanding and show flexibility.
Therapy Branding Recommendations
Tactic 1: Brand and Boutique Practice
This is something I work on all practices with, while in crisis or not. Being a boutique practice is about building your brand. Can you answer these questions to prospective clients convincingly?
- Why do I need therapy?
- Who are you, how can you help?
- Why should I choose you for my therapy over someone else?
All therapists can answer the first question just from basic clinical training, however very few are able to effectively answer questions 2 and 3 sufficiently. There are dozens of firms in any given area, and if you are a private pay practice you are already seen in the client’s eye as an expensive option, so what justifies that expense? What are your results? Why does your approach do the least harm and most good? This should be something that people can immediately determine from your brand identity, pictures, logo and website copy. Use any down time you have in the coming weeks to answer these questions to yourself and direct your future strategies, and remember to get creative! You may also Contact Me for help.
Tactic 2: Expand Vertically, Build Component Offerings.
Expand into adjacent markets for additional services.
Just as wealth building strategies require many sources of income, you should build out extra services with their own separate client markets. If your private pay therapy clients dry up, do you have another avenue to sustain your practice? Diversify your portfolio!
Social Work Today has some ideas on this topic: “The services that social workers add often revolve around what’s needed in a non-therapy setting; executive coaching, management consulting, expert witness, teaching, mediation, and training seem to be popular and profitable roles for therapists who retool their clinical skills.” (Social Work Today)
Among relationship therapists, during recession “Practitioners who help couples build their relationship quality may find it helpful to seek the advice of a financial practitioner who can help them understand the complexities of family finance so that they can better assist their clients and vice-versa.” (Dew 2013) Or you could begin offering services in-house, and recruit a financial advisor to work with your clients part time. Expanding to adjacent coaching markets like relationship coaching, executive coaching and especially life coaching (See my article, life coaching opportunities) are all areas to consider and in many markets across the country these are very open fields to succeed in.
Furthermore, while Jennifer Senior asks couples to go online for relationship advice, “To keep our relationships sane, we’ll all need to turn to virtual communities of outsiders, whether it’s through work or FaceTime or virtual dinner parties.” (senior) Marital therapists must step up and inject themselves into this conversation and present online options to provide expert guidance.
Digital Marketing Recommendations
Rely less on Google Maps/Walk-in traffic generators.
Search volume for “google maps” provides a good pulse for google maps use overall. Google is projecting the usage of the term to tank in the coming weeks. This inherently makes sense, because if you aren’t leaving your house, why would you be bringing up Google Maps? For many local businesses, their lead sources are heavily based on Google Map data. This is because most business owners have already done what does well in map rankings: claim your google my business profile, build that out and get reviews. In the meantime, SEO (search engine optimization) remains a black box. That may have worked in the past and will work with the return of normalcy, but “business as usual” will not be a successful strategy in the coming weeks.
Adapt to Online Immediately
As seen in Fig 4. Searches for online therapy have increased dramatically with the trends to isolate. People are looking for online alternatives to their in-person options. Firms that have been on top of this will do well in the coming weeks. Update your Google My Business and Psychology Today profiles immediately in order to stay ahead of the curve. In the long term, SEO is most effective at capturing this segment.
Provide Value to Your Community
Quality marketing is all about adding value to people’s lives. Either educating them about a new service that would improve their life or providing them a better quality alternative than the one they currently have. Right now people are anxious and confused looking to find answers to many of their questions. Get out and help however you can because people will remember how you acted during these times once business is normalized and demand is higher than before. Get out there and comfort your followers on social media, create content for how people can manage their coronavirus related anxiety, or be available to answer your clients questions and provide comfort directly. Essentially practice what you preach, remain calm and carry on.
Ad Spends Have Become Less Lucrative, SEO Presents More Opportunity.
As Wordstream has reported, clicks and conversions on Google Ad PPC are down significantly, converting customers here will prove difficult. This proves that consumers are less likely psychologically to commit to a “sell” because they aren’t sure what the future holds. Many practices are feeling this now. Clients are looking for an authority that knows what they are doing and they can trust, they need you to build authority with your marketing.
This is my only “sell” in this article. These PPC results make it clear to me that SEO is the investment for most firms for the future. Right now. While consumers are timid for the near term, it is time to invest in your long term strategy and build SEO. When people search for “anxiety therapist Chicago” if you aren’t showing up in the organic results that people trust, you are missing the biggest digital lead source (as ads and map aggregators have become less powerful), but it is too late to correct for that quickly for this crisis. While, in 6-12 months (when SEO results are fully realized) you can lead your field because currently other practices are afraid to invest for the post-lockdown environment. If you are interested in what that would look like or how to start this process, contact me for a free SEO audit.
Develop Closer Relationships With Your Referral Sources
If you are facing yourself having more time on your hands, reach out to your referral sources (if you don’t have any solid referral sources, then build them). Many are seeing less business now and have time to talk. If you practice mindfulness based therapies reach out to those providers. Send a message to the PCPs in your life that are on the front lines of this and show your appreciation. Add value to their lives as well and offer help however you are able.
Sources
[1] Antoniou, A.-S. G., & Cooper, C. L. (2013). The psychology of the recession on the workplace. Cheltenham: Edward Elgar.
[2] Freud, S. (1913/1958). On beginning the treatment. In J. Stratchey (Ed.), The standard edition of the complete psychological works of Sigmund Freud, Vol. 12 (pp. 121–144). London: Hogarth Press.
[3] Zur, O. (2009). The challenge of therapy in times of financial crisis and personal, national and global despair. Independent Practitioner, Winter, 20–22