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A support group for failed therapists?

The first thing Truffo told me when I reached her in her Orange County office was that I shouldn't feel bad about my empty hours; nowadays, she said, even established veterans were struggling. Yes, the economy was bad, but the real issue was that psychotherapy had an image problem.

The one thing I enjoyed most was the wide array of cases I saw, I explained to Roth, and if I specialized, I'd be doing too much of the same thing all day. She suggested that if I wasn't ready to commit to a niche, I could add life-coaching services to appeal to "today's consumer looking for quick solutions rather than long-term insight." When I balked -- I couldn't picture "Lori Gottlieb, life coach" -- she assured me that many therapists who prefer deeper, broader work also offer coaching as an adjunct to their practices.

She told me about a therapist named Sandra Bryson. In 2009, Bryson called for help after her successful Oakland-based practice of 25 years lost patients when she stopped taking insurance. According to Truffo, Bryson shared a problem common to therapists: "a blah-sounding message and no angle." Bryson had always done well as a generalist -- treating anything from depression to grief to marital issues -- but Truffo urged her to find a specialty, one that "captured the zeitgeist but didn't feel played out." Bryson mentioned that she liked helping parents and had an affinity for technology, and voilĂ  -- suddenly she had a brand. Not as a clinician addressing typical parenting issues like boundary-setting, which Truffo called "generic and old-school," but as an expert who helps modern families navigate digital media. She also became a sought-after speaker on so-called hot issues like screen time, cyberbullying and sexting, and Bryson told me her practice, which is based on "mostly deep work," had become "more advice-driven." Now her schedule is full, and her income has increased about 15 percent a year.

"Nobody wants to buy therapy anymore," Truffo told me. "They want to buy a solution to a problem." This is something Truffo discovered in her own former private practice of 18 years, during which she saw a shift from people who were unhappy and wanted to understand themselves better to people who would come in "because they wanted someone else or something else to change," she said. "I'd see fewer and fewer people coming in and saying, 'I want to change.' "

From a branding perspective, the fix was simple. At professional-networking events or in newsletters, her pitch went from "I treat people with depression and anxiety" to "Are you having trouble with the difficult people in your life?" Of course, therapy isn't about changing someone else, but that wasn't the point. If she could get people in treatment and help them feel better, she explained, why did it matter how she spun her pitch? Her goals seemed valid, but the idea of pitches and branding still made me uncomfortable.

call Alison Roth, who started the firm ShrinkWr@p (tag line: "Web sites even Freud would envy"). During my free consultation, I told Roth that I wanted a simple, professional-looking Web site, but she told me that wouldn't be enough. She said the same thing as Truffo: If I wanted clients, then I needed a brand.

I'd recently seen a satirical YouTube video sent around by my colleagues, in which a psychologist urges her mentee to become a life coach instead of going to graduate school. I used to find it funny, but now I saw its truth. Coaching was indeed more profitable (the coaches I knew charged more than most therapists) and less arduous than therapy. The more coaching calls I got, the more I started to worry that I was falling prey to the same consumer-friendly forces -- there are even iPhone apps for depression and anxiety -- that were making coaching such a popular alternative to my own field.

One day right before Christmas, I got a call from a man in his early 30s about coming in for therapy. He explained that he wanted to figure out whether to marry his girlfriend, and he hoped we could "resolve this" quickly because Valentine's Day was coming up and he knew he either had to produce a ring or she'd bail. I explained that I could help him with clarity but couldn't guarantee his timeline. The day before our appointment, he called again and told me he found a relationship coach to help sort things out. She gave him a four-session-package guarantee.

-- Lori Gottlieb is the author, most recently, of ''Marry Him: The Case for Settling for Mr. Good Enough.''


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