The Good, The Bad, and the Ugly: My Top 5 Predictions for 2020
If you’ve been a therapist for ANY amount of time, you’ll know that being a mental health therapist in today’s world is a mixed bag.
Yes, you get to help people live a better life and effect change for generations to come, but it often seems that we do this IN SPITE of the other parts of our job, not because of it.
To help you prepare for what\’s ahead as we slide into the next year (and decade!), I\’m giving you my top 5 predictions for 2020 as related what we do as mental health therapists.
Don\’t worry – it\’s not all dire, AND I give you an answer at the end of the article so keep reading 🙂
Prediction #1- Our society will become even more open about mental health issues
Before I get into the predictions and outlook for therapists in 2020 and beyond, I first want to first acknowledge that we, as a general society, are becoming more understanding of mental health issues and the need for therapy.
I see so many young adults in my office on a regular basis who will openly talk about their therapy to friends and even have discussions about their therapy session at school!
Now, I’m not THAT old but just 20 years ago, that would have NEVER happened, but now therapy is more part of our general zeitgeist than ever before.
If you have a second (or even if you don’t but you work with teens and young adults), you need to get on TikTok and do a general search for mental health. You’ll see some HILARIOUS, informed, and normalizing videos about therapy. The hope is that as this generation gets older and runs our society, our culture will have a more informed, healthy view of mental health and the issues that arise from unresolved trauma.
To back up what I’m saying, check out the article written by Barna in 2018 titled Americans Feel Good About Counseling. According to the research cited, approximately 42% of Americans have seen a counselor at some point in their lives. As expected, the most open to therapy cohorts are the Millennial\’s and Gen X’ers. As a side note, I suspect that if included, the Gen Z group would have the best numbers for responsiveness to therapy.
Prediction #2 – Clients will see the need for and request trauma-related treatment
Some of the other key points important to note for mental health therapists is that the top two reasons for entering therapy were doctors referral (not surprising given the elements of the Milgram study still hanging around) AND past trauma.
It is important to note that of those who were self-referred, past trauma is what brought them in for therapy. Again, this signals a continuing shift in the recognition that our past affects who we are today and by healing our past we can improve our future. It is worth noting that this behavior by actual clients is in direct contrast to what our psychological community still refuses to actively acknowledge, i.e. the denial of complex PTSD and Developmental Trauma Disorder diagnosis in the DSM-5.
I predict that the combination of clients’ continual emphasis on and presentation of trauma-related symptoms will force those in the research and authoritative roles to provide more funding and training for clinicians working on the front lines with those whose lives are most affected by the aftershock and blast radius of unresolved and untreated trauma.
The good news is that more and more insurance companies are recognizing the need for trauma-informed treatment, but this could be brought even more to the forefront by large organizing bodies, such as the APA, providing even more education about how trauma is at the root of many mental health disorders and addictions.
One other important finding from the Barna study was that affordability and expertise were the top two considerations for potential clients when choosing a therapist. More on this in the second part of this article, but again, we need to recognize that trauma + therapist expertise are driving factors for MANY clients.
To summarize, the good news for we therapists is that people are more accepting and aware of the need for therapy, especially around past trauma. This makes our jobs easier as a whole and also provides a better outlook for job prospects for the therapeutic community. It also means that we need to have trauma-informed practices in our therapy spaces, which leads to the next prediction for therapists in 2020.
Prediction #3
Having a specialty related to trauma-informed practices will soon be a must to be a practicing therapist.
No longer do we live in the days where one can just graduate from school, get licensed and be a successful therapist. Not that this isn’t available (I see employed therapists who go this route all the time), but those who do the bare-minimum will become, and are becoming, at risk for being left behind.
Here in Arkansas, we have experienced a huge shakeup in the mental health community with major changes in Medicaid. These changes resulted in many agencies going out of business, therapists losing their jobs and/or therapists taking major pay cuts for doing the same amount of work.
Those therapists who have, in the past, been able to just graduate and bill now are seeing themselves as left-behind in the job market, often pushed out by therapists who have taken initiative and received further training. While therapy jobs may be still available, the higher-paying, rewarding options for clinicians are coveted even more than before.
I do not think that therapy boards will require clinicians to have a specialty; however, I do believe that therapists will be ‘required’ in a different way to have specializations, in that they will have to do so to remain employed by the continued client-led and client-driven mental health requests. If I am a person who is having to pay out of pocket for my mental health-care, I’m going to seek a therapist who not just has a license, but one who has proven to know how to heal my trauma-related issues, which are often not able to be healed with simple CBT techniques (for more on what DOES heal trauma, get a spot at my upcoming FREE training Jan 26 happen in the FREE Facebook group HERE).
To emphasize this point further, research by Milliman with the National Alliance on Mental Health, found that clients were much more likely to pay out of pocket for mental health services as opposed to medical services.
Again, this fact reinforces that clients will continue to be much more selective with what they are paying out of pocket for mental health services.
Prediction #4
Insurance companies will only pay for those therapists who are able to differentiate themselves with what they do to help clients, especially as related to trauma.
In spite of the gains made to destigmatize mental health and therapy services, a gap remains between what insurance companies say they will pay for and what actually is covered by those seeking services.
For example, the Mental Health Parity and Addiction Equity Act of 2008 has now been in existence for over 10 years and was designed to ensure that those covered had as much access to mental health services as medical. However, over the past several years insurance companies have found ways around paying for services for those insured.
There will eventually be a backlash when the public cries enough is enough (in a similar fashion to the cascading effect of the #metoo movement).
Do I think this will happen in 2020?
Nope.
Insurance companies will remain concerned about the bottom line and those affected will continue to be silent or in such a disenfranchised state that the slippery system put in place by insurance companies to put profits first will still be the norm.
Don’t believe me? Bloomberg Businessweek wrote an entire feature in 2019 about how these shady practices are affecting real people and are often linked to lack of help with addiction and even suicide.
Given that insurance companies will continue to dictate a large portion of how the mental health system works, it is imperative that we, in 2020, work within the guidelines as set by the insurance companies.
Many insurance companies only take a select number of therapists to be in-network on their panel. When you are able to state why your services are different and how you can help people get better faster or more effectively, insurance companies are more likely to consider you for approval for their panels. For more info about this, check out this link from Therapy Notes
Prediction #5
Politics will continue to affect policy.
This is a historical fact. How the government allocates funds affects our jobs as therapists but also those who we serve, who are often among the most at-risk populations.
If we do continue with a Republican-run White House and Senate, this will likely result in even more cut-backs for mental health services in general, resulting in those seeking therapy to pay out of pocket for expenses.
This will cause an eventual increase in a client-led market (as opposed to insurance-led) and will make it mandatory that therapists wishing to stay in business will be required to outline how they help clients heal from past trauma. 2020 will be an ideal time for therapists to hone not just their craft but their ability to communicate the need for their unique skills.
Historically, Republicans and a Republican-run government have not been huge supporters of furthering the ‘soft sciences’ such as psychology, mental health and the associated research. In fact, the proposed budget from President Trump for National Institute of Mental Health (NIMH) research represents a funding decrease of $239.9 million down from 2019.
Of course, the NIMH research is not directly tied to insurance policies and payment, but it is a clear indicator of the priorities of our current Republican administration. Again, I’m not giving an opinion on Republican vs Democratic administration, I am merely making an observation and then a prediction based on historical (and current) data.
If the trend continues, insurance companies will be allowed to continue to scale back services for mental health services and those in need of services will have the responsibility/opportunity to seek out mental health treatment out of pocket. Of course, this will result in a downward spiral for those not able to pay for mental health treatment (which is a whole other article,) but it remains that we, as clinicians, must be aware of how these changes affect our ability to remain in business, whether in an agency or private practice.
Now, for what YOU can do about this – get yourself trained!
Do NOT be content to sit back and let things happen.
A responsible therapist not only shows up for her clients but also knows the latest in trauma-related research and best practices.
Bettering yourself as a therapist will not be an option in the years to come if you are going to remain viable as a therapist.
Good news – this does not have to be expensive, scary, or even uncomfortable. I have an upcoming FREE online training happening January 26, 2020 where I walk you through the WHY behind how sandtray can be trauma-informed and WHY it works so well with trauma for all ages.
No need to sign up – you just show up through our FREE Facebook group – BUT you do have to be a member of the group to get the FREE live training happening Jan 26!