Jude Fay (MIAHIP, MIACP, FCA) writes and speaks about the challenges facing therapists who want to earn a living in private practice. She is the author of This business of therapy: A practical guide to starting, developing and sustaining a therapy practice.
Her website is https://thisbusinessoftherapy.com.
Pauline: Jude, I’d like to start off by thanking you for agreeing to talk to me about your work. Orla Kiely said the best decision she made in her business was to marry her husband who was an accountant (Irish Times, 2015). A similar marriage of creative passion and practical business skills can be seen in your work. You have an accountancy background. Would you tell us how you got interested in therapy?
Jude: I have had an interest in personal development since taking an assertiveness training course in my twenties. A friend told me at the time that I didn’t need an assertiveness course; I think she was saying I was aggressive, and she was probably right! I went on to train as a trainer in assertiveness and sexuality, and as part of that training I was introduced to co-counselling, which I was involved in for some years. In my early thirties, I went into personal therapy for the first time, as a result of a personal crisis. The experience made a huge impression on me and taught me a lot about myself. I have continued that personal development journey in different ways right up to the present.
In my forties, I decided that I had exhausted the possibilities of accountancy and spent about 18 months exploring alternative options. I think when I chose to train as a therapist, there were a number of factors influencing my choice. I was interested in what shapes and influences how I turn up in the world, and I was attracted to the warmth and kindness of those therapists I knew. I think too, although I would not have been able to articulate it at that time, there was some sense of guilt about things I had done (or not done) in the past, and the negative impact I had had in certain situations. I think I was trying to atone in some way for my mistakes, and therapy seemed like a good way to do that. I was also reassessing my choice of accountancy as a career in the first place, so there was probably some sense of rejecting everything that went with that, and rebounding onto something quite different!
Pauline: I’m intrigued by the idea of atonement for past actions, and your idea that therapy might be a good way to do that.
Jude: Well, as I often find when my motivations and thoughts finally make their way to the surface and I get a good look at them, they don’t serve me so well! The concept of atonement was very much rooted in my view of myself as a ‘bad person’. I’m glad that’s changing!
Pauline: In a previous Conversation, Martin Pollecoff, the Chair of UKCP, said there was often confusion about therapy being a profession or a vocation (Dolan, 2017). In your book, This business of therapy (2016), you state that your philosophy is that helping clients does not need to be inconsistent with earning a living. What’s your sense of how individual therapists work with the difference?
Jude: The dictionary definitions of ‘vocation’ and ‘profession’ seem to me to overlap. But the existence of the question suggests to me that we are trying to resolve some deeper issue, perhaps relating to our knowing sense of ourselves. I believe that our work includes aspects of both profession and vocation. I often ask therapists what brought them into the work, and what is it they want from their practices. The answers usually include both vocational and professional reasons. I have spoken to the occasional person for whom a monetary reward for the work is completely irrelevant, but they are rare.
In working with therapists, in workshops or one-to-one, I find relief is often expressed that these issues are being named, that the dilemmas are being acknowledged. Often, there can be a sense of shame, that everyone else seems to have these issues sorted out, which is then lessened when someone starts to talk about it. Then they realise that everyone else is also struggling. Maybe not with the exact same issue, but with different aspects of the issue.
A judgement seems to be present that diminishes the worth of the help given because it is paid for. As Ger Murphy says in his preface to my book, “Trainees and therapists can have a negative attitude to business and to the issue of making a good living from the work, as if to do so was to sully the work in some way” (Fay, 2016: iv). Individual therapists express it in different ways, and in relation to different issues, but one common underlying piece seems to be a question of ‘Whose needs take priority?’ and an unspoken pressure to give the priority to the needs of the client. It arises in boundary issues around time and money, and in self-care issues. As in all relationships, the art is in the dance; knowing when to choose to prioritise yourself, and when to choose the relationship or the other.
Therapists are usually kind and caring people, with warm hearts and a desire to help others, but we can struggle to receive. Sometimes it’s appropriate to offer our help to ourselves first. My work is often concerned with offering a view that perhaps it’s not a question of their needs or mine, but that both needs have worth and validity. I have faith that when we do choose ourselves, difficult as that might be, we are modelling something important for our clients too. So, I find the challenge for the self-employed therapist is trying to integrate these polarities: the one concerned with worthiness and deserving of what we do, the other with making a living.
Another aspect of the profession/vocation question that interests me is where we position ourselves in relation to being paid for the work. Is there a touch of grandiosity in giving for no or little reward? And if that were reflecting some Shadow aspect of ourselves, what might that be? I know in myself a sense of shame about my needs, and that I would find it hard to acknowledge to a client who doesn’t pay their fee that I was relying on their money coming in that day. I wonder if it is easier to be seen as generous, than to acknowledge our vulnerability and risk being thought of as only in it for the money?
Pauline: Eugene Gendlin (1990) talks about his vulnerability in the following quote:
There are no qualifications for the kind of person I must be. What is wanted for the big therapy process, the big development process is a person who will be present. And so I have gradually become convinced that even I can be that. They will see the slightly shy, slightly withdrawing, insecure existence that I am. I have learnt that that is O.K. I do not need to be emotionally secure and firmly present. I just need to be present.
Jude: That’s a very interesting quote from Gendlin. It sets my mind off in a number of directions! I recently attended a talk at which therapists were invited to give some free hours to a charitable organisation. Curiously, the person giving the talk didn’t seem to appreciate the irony of expecting therapists to work for nothing, while other caregivers within the organisation were paid, such as social workers and chaplains. Many newly qualified therapists are giving their work for free as they work towards accreditation, even if a fee is being charged to the client. Some feel exploited by this practice, and that they have no choice but to go along with it. The phenomenon is indicative of our times and raises a very important question about exercising our power to choose. How we see the world influences the extent to which we feel we have any choice.
The power to choose is a key element of stepping into our authority as a self-employed practitioner. We live in a world of excessive choice, which can be overwhelming. Failing to make a choice can be the result of overwhelm. It is itself a choice, but it is often not the best choice for us to make. Refusing to choose takes away the pressure to choose wisely, and relieves us from the process of weighing the pros and cons to arrive at an answer we can live with, but we leave a lot to random chance if we allow the world to decide for us. When we work for someone else, we can allow our employer to choose for us. In the world of self-employment, however, we need to make choices in order to create a sustainable business.
Pauline: I have some experience in the craft sector, and know that passion and creativity don’t guarantee making a living.
Jude: It is true that passion and creativity don’t guarantee making a living. And it is also true that a combination of creativity, passion and some sound business skills can make a living in a way that fits with our values and ethics. There are plenty of examples around. Creativity and passion do not need to be synonymous with being a struggling artist starving in a garret! I think the challenge is to let go of the attachment to struggle and its link to worth. One of the key skills in being self-employed (as well as being kind to ourselves!) is to shift our focus from ‘Why we can’t…’ to ‘How we can…’. If we do want to provide our services for nothing, we can find a way to earn the income we need through other channels. However, we can only do this if we are willing to allow in the idea that it is okay to have earning a living as an objective.
We need to be open to learning, from business, how we can bring in an income without letting go of our creativity, and dare I say it, our freedom. The journey to this openness is internal work and asks of us that we meet the places within ourselves where we are conflicted about money. We have all ingested over our lifetimes a bewildering collection of values and beliefs which may or may not be serving us. These are often contradictory, and unless we have taken them out for an airing, they are outside our awareness. They have the depth and momentum of an oath and will come loudly into our experience when we attempt to act in a way that might be contrary to them.
To take just one small example from my own Catholic upbringing: in the Bible, there are many messages about money, including, ‘Blessed are the poor’. I absorbed this to mean that offering my services to someone who has no money is more virtuous and worthy than working for somebody who can pay me. But my having less does not mean that others will necessarily have more. An alternative and more supportive way of looking at it might be that, if I offer my services mostly to those who can afford to pay me, I can then pass on some of my prosperity to those who have less. However, until I bring into awareness the underlying message and its meaning for me, I have no hope of changing my reactions.
As long as we see therapy and business as being mutually exclusive, then we can’t allow ourselves to learn from the business world skills that might enable us to have a practice that is in alignment with our own values. If we look at the word ‘business’ and hear Donald Trump or Rupert Murdoch, then it is difficult to find what the business world could offer us in terms of making a practice that fits for us. The first step is to identify our own introjections and projections about entrepreneurship and money, which then leaves us freer to see what our choices really are.
Pauline: I’m wondering if you would talk about the shame you observe in therapists who blame themselves for not being able to make enough money to provide them with a good income, and enough to provide a good pension?
Jude: I am known for saying that therapy school doesn’t teach you how to make a living from the work. Most of us were drawn to the work for the sake of the work itself. Of the many therapists I have spoken to over the years, few gave much thought in training to the question of how they would work once qualified. At my workshops, many participants have said they never thought they would have to be self-employed. On qualifying, they were shocked to learn how few salaried positions there are available to therapists, and of those that are available, the often unacceptable conditions attaching to them. Or, if they have thought about self- employment, they didn’t really appreciate the consequences of that route. The self-blame starts almost immediately, ‘I should have checked this out sooner…’ or ‘I should have known…’.
Then, there is the presumption that because therapy school doesn’t teach them how to make a living, that maybe it’s simple or self-evident to everyone but them, and again the blame comes in… ‘I should know how to do this…’. If a newly qualified therapist asks their therapist or supervisor who has been qualified for years how it works for them, and they are told that clients just come by themselves, or there’s no need to do marketing, again the self-blame comes in when it doesn’t turn out that way.
Or they hear, directly or indirectly, that needing to earn a living from the work is wrong, or materialistic, or non-spiritual, and they are ashamed to ask for help. If they get past the early hurdles and start to bring in money, but get stuck at what I call the ‘not enough’ or ‘just about enough’ stages, they assume that they have done something wrong, and criticise and shame themselves because they are struggling. They may compare themselves unfavourably with a colleague or competitor who is doing well without knowing the full circumstances, and again, shame themselves.
If someone has always worked for someone else, they will have no concept of what is involved in being self-employed. It no more comes naturally to therapists than it does to any other occupation or profession. The muscles that we need to flex to be a therapist overlap but are not identical to the muscles we need to flex to be self-employed. For example, the empathy and sensitivity that are assets in the therapy room may be a liability when handling money issues.
Why do we put this expectation on ourselves, that we should know how to be self-employed and be able to do it with no training? It involves learning information, learning and practising business skills, and doing the internal work to grow into the role. That takes time and support – a lot of support. We take totally for granted supports that are all around us when we work for someone else (such as certainty about our income and a boss to escalate problems to, to name just two) and we ignore the need for that support when we set out to work for ourselves.
A newly qualified therapist may have never had to make a tax return, or write up books of accounts. They may have never had to work out what income they need to earn and how to translate that into a fee structure. They may have no notion of how to make a business plan or market their services. And although the bookshops are full of help for small businesses, most therapists don’t think of themselves as business people. Those that do look for information often find the material is not easily adaptable to their small private practice. We create unrealistic expectations of ourselves and our practices and set ourselves up to fail. The result? Overwhelm and more shame.
The challenge of being a self-employed therapist is to integrate and move between the skills of being a therapist and the skills of being a self-employed business owner as appropriate. They are not contradictory but complementary.
Pauline: What can we do as a community?
Jude: Everyone has a part to play in this. Silence and isolation add to shame, where talking can reduce it. We can all explore our own values and beliefs, and our own introjections and projections around money and business. We can also facilitate conversations with others about these matters. Students and newly qualified therapists can ask for and seek out information from tutors and supervisors. Therapists and supervisors can support students and newly qualified therapists by drawing attention to where these matters might be in the therapy or supervision work. Regional groups can provide a space in which these topics may be openly discussed to normalise the issues. Professional bodies and therapy organisations can host workshops to support newly qualified therapists in the transition to self-employment or to explore issues of lack of profitability.
And the work can start right here. As you read this piece, notice your internal response. Are you interested in what I’m saying, or do you want to argue with me or push it away? Whatever you feel about this issue is a good place to start. What do you know of it?
Pauline: I really enjoyed hearing your perspective, Jude. The larger conversation covers value and worth in all their different guises. I really enjoyed talking to you.
Jude: I have loved the conversation. Answering your questions helps me to have a better appreciation of the issues, and also of my understanding of them.
Pauline Dolan is in private practice @ Ballincollig Healing Centre.
Dolan, P. (2017). Martin Pollecoff in conversation with Pauline Dolan. Inside Out, 82, 44-49.
Fay, J. (2016). This business of therapy: A practical guide to starting, developing and sustaining a therapy practice. Charleston, SC: CreateSpace Independent Publishing Platform.
Gendlin, E.T. (1990). The small steps of the therapy process: How they come and how to help them come. In G. Lietaer, J. Rombauts, & R. Van Balen (Eds.), Client-centered and experiential psychotherapy in the nineties (pp. 205-224). Leuven: Leuven University Press. Retrieved 16 January 2018 from http://www.focusing.org/gendlin/docs/gol_2110.html
Irish Times. (2015, June 12). Prints charming: The secret of Orla Kiely’s success. The Irish Times. Retrieved 16 January 2018 from https://www.irishtimes.com/life-and-style/people/ prints-charming-the-secret-of-orla-kiely-s-success-1.2243249