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Principles ofPsychotherapy
Marketing:
The Pink Spoon Method
psychotherapynetworker.org
CLINICAL GUIDE
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Ijust received an email from Ann, a psychotherapist in
Washington State: Casey, for the rst time in my 15-year
practice, Im starting to get really scared. At rst, a few
clients decided to take a break and stopped coming. Then
a few more moved from weekly sessions to every other week.
Ive just balanced my books and realized that Im making
only half of what I did this time last year. What can I do to
get my caseload back to where it was before?
Last week, I had a call from Charlotte, a psychologist in
northern California. She, too, said her caseload was downalmost 50 percent: Im still getting calls asking if Im taking
clients, she told me, but these calls are few and far between.
When I do get new clients, they come once or twice and then
realize they cant afford it. Im starting to negotiate and lower
my fees. I need to make at least enough to pay my rent. What
can I do to get more clients who can afford therapy?
The note of desperation in these e-mails is hard to miss.
Ann and Charlotte arent alone. I speak with private practi-
tioners all over the world, and the mood out there is somber.
The resounding chorus from private practitioners everywhere
is the same: This economy is killing me! I need more clients
How do I nd them and get them in the door?
Over the years, business coaches (including me) have
produced an avalanche of books, articles, courses, and work-
shops on how to build a bigger private practice and recession-
proof it. The goal of their advice is always the same: teach-
ing therapists traditionally allergic to doing anything that
smacks of selling themselvesthe marketing skills thatll
draw more private-pay clients to their waiting rooms. The
question to which therapists tirelessly address themselves and
their efforts is and always has been: What can we do to ll
more private-session hours?
Whats the Real Question?
Now Im wondering if this isnt the wrong question. In theeconomic tsunami threatening to overwhelm us, it begins to
seem that the right question isnt How do I get more indi-vidual clients? That just boils down to How do I do more
of the same? Perhaps the real questionshould be How do I
do meaningful clinical work and sustain a good income over
the short and long term, regardless of the economy? Notice
that this question makes no mention of attracting individual,
private-pay clients.
It now seems to me that the way we automatically think of
building and maintaining a therapy practice may no longer
be an economically viable way of sustaining ourselves. For
the past hundred years, psychotherapy has operated generally
as the private meeting of one patient with one well-trained
mental health expert for roughly one hour of presumably
helpful conversation. Despite our attachment to this model,
it isnt the most efcient or creative way of helping people or
of making money. Many therapists would like to help more
people than they can responsibly jam into an 8-, 10-, or even12-hour workday. Or theyd like to be able to do something
for all the people needing help who cant afford one-to-one
therapy by the hour. Then theres the money crunch: even if
therapists raise their hourly fees, their total income wont rise
by much. In fact, trading hours for dollars means we have
jobs, rather than independent businessesjobs that dont pro-vide retirement plans, sick pay, or paid vacation days. Since
our income reects the number of in-person sessions we pro-
vide, a recession that constricts peoples sense that they can
afford therapy can send our nances hurtling right off a cliff.
The New ZeitgeistThe economic downturn aside, the biggest problem with theold fee-for-service therapy model is that it isnt in sync with
social and cultural shifts in how increasing numbers of people
think about therapy and therapists. those seeking psychologi-
cal help today dont think of themselves as patients, or even
clients, as much as they consider themselves consumersor cus-tomers. They want to be served what they want, on their terms.When they have emotional or relationship problems, they
look for a quick, effective solution, which will help them get
through a tough time. Theyre less interested in an intense,
open-ended relationship with a highly trained stranger than
with a practical, appealing, and reasonably pricedproduct, one
thatll provide some short-term relief and maybe a littlelong-term wisdom.
One reason for the increasing impatience with standard
therapy (besides cost, of course) is our Internet-reinforced
demand for instant gratication. Last year, my mother-law
became ill, and we needed help dealing with her dementia.
Id spent 10 years working with the geriatric psychiatric
population, but when it was my familys problem, I wantedinformation quickly. Therapy might have helped us through
Principles of Psychotherapy Marketing:The Pink Spoon Method
BY CASEY TRUFFO
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the crisis, but it would have taken a lot longer than the hour
I spent searching the web to nd helpful resources, including
free checklists and articles, as well as downloadable material
I could purchase online.
Today anybody facing nearly any life challenge can do
the same thinggo online and within a day, an hour, or even
minutes nd that particularly helpful special report, audio
recording, or book, and have it delivered instantly to their
e-mail inbox. They can be reading or listening to solutionsin the time it would have taken them to leave a message for
a therapist. This means that therapists are competing with a
ood of authors, coaches, lecturers, and other experts (and
with enterprising quacks), all of whom offer various forms
of self-help.
Another social transformation of our era is the almost
universal time crunch; none of us ever has nearly enough
of it. Taking a couple of hours from a busy day to go to a
therapist for a personal session feels to many like a grossly
inefcient use of time. Its much more convenient to hire a
life coach or relationship coach, open to spur-of-the-moment
telephone and electronic sessions.
What to Do?Some psychotherapists, seeing the writing on the wall, are
responding by updating how they do one-to-one therapy to
bring themselves more in line with what people want. Theyre
adding e-therapy, web chats, text or e-mail consultations.
Theyre offering phone sessions in hour-long and abbrevi-
ated formats15-minute laser sessions, for example, to
help clients get back on track after a disturbing interaction at
home or at work.
The problem with these solutions is the method of deliv-
ery. While meeting the need to be more exible, it still means
that therapists can provide service to relatively few peopleat a time, which still limits their income and intensies the
struggle to get more clients in the door.
We need to get off the one-person for-one-hour-for-one-
fee track and think more broadly about what we can offer
the world and how to communicate it to asmany people as
possible. We need to share our wisdom and knowledge in
ways that serve the community while leveraging our time and
energy. We need to devise a model that supports us when the
economy is booming and doesnt desert us when the economy
is tanking.
Some years ago, I, too, was at a point where I was tired
of hustling to get more clients into my practice, which was
feeling more like a job than a vocation. This hit home oneDecember when I felt burned out and needed time off to rest
and reenergize. I began to think about the odd contradic-
tion of our profession: were a helping profession, yet when
we need to help ourselves, we do so at the expense of our
income. I knew there had to be a better way. Then I discov -
ered a business model that had been used successfully in other
elds, most notably in the coaching profession: the Multiple
Streams of Income model. I found it useful and decided to
modify it for therapists.
Simply put, this model helps clinicians augment their in-
person practice with information productsbooks, CDs,
audiotapes, e-books, and e-coursescreated once and then
sold repeatedly. The products may be physical, but the power
of the model comes from using the Internet to sell and deliver
them. Using this model meets consumer demand for instant
gratication; lets therapists help people who cant afford
therapy; extends therapists reach beyond their local commu-nities; and offers dependable, additional income.
When implementing this model, some therapists choose
to reduce the number of one-to-one hours and limit their
in-person time to high-end workshops or retreats. Others
choose to stop all clinical work and spend more time creating
and selling products, or providing speaking and consulting
services. The beauty of this model is that it can be adapted
to each providers desires and personality.
Getting Startedthe Lure of the PinkSpoonThe model makes sense, but will it work? Can clinicians
compete in the oversaturated self-help market and still makea good living? People have been publishing self-help literature
for decades. How can we break into that market?
You dont do it by trying to get your idea published or pro-duced by a big company; few are likely to take on the projects
of an unknown psychotherapist. Not to worry! Technology
has made it easy for independent practitioners to create
downloadable written or audio products and compete with
the big companies quickly and inexpensively.
You dont have to start big; in fact, one of the charms of
this approach is that it doesnt require a huge commitment of
time and money.
First, before you do anything else, identify a nichethespecic clients, group, issues, areas of therapy, or specialty
that interests and excites you. Lets say you love working
with kids and are particularly concerned about school bully-
ingsomething you emphasize at your website. (You dohave
a website, dont you?) You then develop material that provides
information for people in your area of interest.
When a parent happens into your website, she sees your
offer of a free report on Why Some Kids Get Picked On by
Bullies. This parent doesnt know you, doesnt necessarily
feel the need to put her child in therapy, and isnt ready to
shell out lots of money for treatment; but since her child is
being picked on in school, shes drawn to your reportand
besides, its free.She signs up, leaving her e-mail and/or mailing address,
and gets the report. You, in turn, get the opportunity to con-
vert a chance visitor to a new customer or client by gradually
taking her through different levels of interest, commitment,
and expense.
This vital rst step is known as pink-spoon marketing,
referring to the free samples of ice cream that shops promot-
ing new avors provide in tiny pink spoons. Customers may
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like a free sample so much that they buy a cone to consume
on the spot or a half-gallon to take home. Similarly, once your
customer has her pink spoonful and you have her contact
information, you can follow up by sending her a newsletter.
Most important, you can introduce her to the rst of several
levels of products along an increasing price continuum.
Once someone has obtained, and liked, your free item,
its quite easy for her to decide to buy your 30-page e-book,
Teach Your Child to Stop Bullies in Their Tracks, for $17,or even your $40 one-hour teleseminar. Shes getting the help
she needs for her son without having to commit to ve in-
ofce sessions for $800 to $1,000. Its a bargain!
Now, having plunked down the money for the e-book
or taken the one-hour teleseminar, she may feel she knows,
likes, and trusts you well enough to wade even deeper into
the help you have to offer. At level three, shes moved past the
taste-testing phase and is ready to spend thinking money
(shell think about the purchase before making it) for a $100
CD/DVD set, a $125 half-day workshop, or a $175 six-week
e-course.
At the fourth level, $200 to $500, the customer will be
ready to spring for your big-ticket items, such as a workbook,six CDs, and follow-up calls. Shes reached what we call the
sweet spot, the point at which she feels connected to you
and your message and regards you as someone who can help
her. Or you could team up with a partner and create a full-
day workshop. One of you could work with the children and
one could work with the parents. This could be marketed
locally and on your website. Then you could take the hand-
outs and exercises and create a workbook. Add a lecture on a
CD and you have a product to sell online.
Finally, we reach the heights of level ve, at which you
offer your most valuable commodity: your time. Counseling,
coaching, consulting, speaking, and training are usually
offered at this level, and people are willing to spend $500 an
hour or even $2,000 to $5,000 a day or much more to work
with you one-to-one. Because youve taken the time to culti-vate a strong relationship through the funnel of products you
developed, there are multiple possibilities to offer.
In an almost underground manner, some therapists
around the world are implementing this Multiple Streams of
Income for Therapists model. Some are just getting started
and some have been doing it for years. Lets take a look at a
few of them.
Josue Maymi, a therapist in Houston, has been practicing
since 1993. He decided that hed like to create some small
booklets with advice on varioustopics, and has focused on theproblems of couples in relationships. Hes written a playful
yet insightful booklet, Ten Qualities You Want in a Friend, Lover,Employee & Business Partner and Twenty-One That You Dont Want,
which he sells on his website, www.menarestupidwomenare-
crazy.com. I have a lot more ideas for products, he said.
This is very exciting to see how I can sell information prod-
ucts on my website and help a lot of people that might not
even be in my area.
Esther Kane, a counselor in British Columbia, Canada,
offers books on relationships for women. She has a special
afnity for those with eating disorders and has created six
audio recordings that can be purchased and downloaded
on to her site: www.endyoureatingdisorder.com. For $19.95,
clients can purchase audio recordings on such topics as
Mindful Eating. These can be downloaded to an mp3
player and listened to anytime.
Belleruth Naparstek, a licensed social worker in Cleveland,is the author of Invisible Heroes: Survivors of Trauma & How They
Heal. In 1988, she had a robust practice, so she wasnt lookingfor a way to make more money; however, to meet the needs
of a client who was undergoing chemotherapy, she made a
guided-imagery tape. The tape was a hit. Not only did it help
the client, but a waiting-room nurse in the hospital began
requesting copies to use with other patients. Intrigued that
an audiotape could provide such results, Naparstek started
creating more tapes.
For years, she kept her practice while developing guided-
imagery tapes for people struggling with different diagnoses.
Then she decided to turn this process into a business. I
recognized that I was only going to help so many people withmy practice, but with these tapes, I could help a lot of people,
and I wouldnt even have to be there. Naparstek and a busi -ness partner persuaded Time Warner to publish the tapes,
and have since created www.healthjourneys.com, a portal
that posts research and practice articles, and offers scores of
tapes, CDs, videos, and software. The site has a growing list
of titles by other practitioners that promote not just guided
imagery, but meditation, yoga, qigong, acupressure, and a
host of other research-supported, mind-body methods.
I love the autonomy and creativity that this business pro -
vides me. But it isnt just that, Naparstek reports. Studies
at Duke University are now showing that for PTSD, guided
imagery, delivered via an audio download, leads to outcomes
that are as good as or better than interventions with cognitive
behavioral therapy, and better than supportive therapy. This
isnt just an alternative to regular therapy: its a portable,
scaleable, affordable, self-administered product that works.
And at a time when other businesses are struggling, ours
is doing well, because we provide an inexpensive group of
resources for stress.
While Belleruth Naparstek fell into the Multiple Streams
of Income for Therapists model, Bill OHanlon specically
chose it. He saw the power of Internet technology and recog-
nized that it could be a way to deliver content to people who
were searching for information. Excited about this medium,he loved the challenge of creating products and services that
would help people and be a passive-revenue stream for
him. This allows me to reach a much wider audience than I
could have in my clinical practice, he notes.
OHanlon, an author of more than 29 books, offers doz-
ens of free and for-fee information via websites, podcasts,
blogs, web-based courses, teleclasses, and audio and video
programs. At this point, I dont do any clinical work, he
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reports, only writing, speaking, a little phone coaching, and
lots of Internet-based stuff: e-books, online courses, digital
audio and video, et cetera. I love what I do, and work way less
than I used to, so I now have a life instead of just work with
a little life on the side.
When visiting his site, www.billohanlon.com, people
can get a variety of free items and purchase an array of
products as well. For example, a web visitor can buy A Lazy
Mans Guide to Success, a $15 e-book. Someone struggling withanxiety or feeling desperate can get Calm Beneath the Waves, a
$12 hypnotheapy audio download. He also offers an e-mail
membership program called Change: 101 Email Tips for
$10. Members receive a tip every four days to help them
get off the dime and make positive changes in their lives.
OHanlons in-person contact with clients takes the form of
speaking engagements and workshops.
Not everyone chooses to close his or her practice, as
Belleruth Naparstek and Bill OHanlon did. In 1983, the
husband-and-wife team of Ellyn Bader and Peter Pearson
opened The Couples Institute in Menlo Park, California.
Since then, theyve expanded and added additional therapists
to their institute, allowing them to serve more people. Butover the years, their experience with couples taught them that
people want to learn how to improve their relationships in
many ways besides sitting in a room with a therapist. Via their
website, www.couplesinstitute.com, Bader and Pearson now
offer books, audio recordings, and membership programs
for therapists and couples, but they continue to see couples
in their ofces in traditional one-to-one counseling sessions.
Providing additional, affordable resources for couples is a
win-win situation for the Couples Institute and the couples
it serves.
All these clinicians have been using the Multiple Streams
of Income for Therapists model for years. Their businesses
are highly successful today, but they all started with that rst
product, like Naparsteks initial audiotape. Our current social
and economic conditions are calling to us to provide alternate
solutions. Therapists are uniquely trained and qualied to
provide the educational materials that society wants today.
You dont have to be a Dr. Phil or John Gray to do it. It just
takes the courage to take the rst step: to look at a potential
market and think, What do I most want to share with them?
Sadly, many private practices wont survive this economic
turndown. The challenge for therapists is to respond to the
social and economic climate with a model that works: the
Multiple Streams of Income for Therapists. It allows us to
respond appropriately to important cultural changes and stayin business, making both money and meaning.
Building our practices on the basis of seeing one client per
hour worked well when the psychotherapy eld was growing,
but it has become a root-bound approach. We need to expand
our thinking and nd a bigger, more capacious modelone
encompassing new ways of thinking about how we work and
deliver our services to those who need them. Simply put, we
need a bigger pot.
Casey Truffo, MFT, is the CEO and founder of the
Therapist Leadership Institute and a marketing coach
and owner of www.beawealthytherapist.com, where
she offers free audios, articles, and teleclasses to help
therapists market their private practices and enhance
the lives, careers, and reputations. Contact: casey@
beawealthytherapist.com.