Cover Story

For Jana Martin, PhD, it began in September. Two of her long-term private pay clients said they could no longer afford to see her. Then two more clients asked if they could come less often to save money. The Long Beach, Calif., psychologist also found that her treatment was increasingly focused on people's financial anxieties.

But most astonishing of all, she says, was that in one two-week period she received referrals from six physicians, including two she had never heard of before.

"While I tend to get referrals, it was unusual to get so many in such a short period of time," says Martin, 2008 president of APA's Div. 42 (Psychologists in Independent Practice). "I credit the physicians for understanding that some of the physical symptoms they are seeing now have psychological roots and are related to the economy. I also think this reflects the success of public education efforts by psychologists."

Martin's experience is being echoed in practices across the country. In interviews with the Monitor, practitioners are reporting that—at least as of early December—more Americans are seeking psychologists' services to address their fears related to the turbulent economy. According to APA's 2008 Stress in America survey, eight out of 10 Americans reported in September that the economy is a significant cause of stress, up from 66 percent in April.

"Money and work are the big stressors," confirms Shannon Jones, PhD, of Gig Harbor, Wash., a member of APA's Committee on Rural Health. "Many people are worried about losing their jobs. A few who have lost their jobs are not finding new ones."

The same has held true for St. Paul, Minn., psychologist Marge Charmoli, PhD, who says her clients' concerns about the economy are adding to "whatever stresses and concerns brought them to seek out psychotherapy."

In Wilmette, Ill., Nancy Molitor, PhD, says her patient load is up 20 percent.

"In 20 years of practice, I've never seen anything like it," she says.

Like other psychologists, Molitor is witnessing the ways in which the economic turmoil is playing out across the lifespan. One of her senior clients fears leaving her children without an inheritance. Middle-aged clients are anxious about paying for their kids' college. Couples she hasn't seen for years are back in therapy dealing with trust issues stirred up by financial woes; some in the midst of divorce are finding they can no longer afford to live separately. College students are worried about securing loans and finding jobs.

"Children, too, are affected by the stress, anxiety and real problems that their families are experiencing," says Rosalind Dorlen, PsyD, an independent practitioner in Summit, N.J., a community hit hard by Wall Street layoffs.

Several psychologists compare the anxiety they are seeing with post-9/11 levels. "The agitation is more acute than I've ever seen," says Molitor. "I spend more time calming people down, getting them medical referrals and making sure couples are safe at home."

Meanwhile, like Jana Martin, psychologists are also reporting that some of their more established clients no longer have the money for therapy. APA President James H. Bray, PhD, says he's seeing that in his own public and private practices in Texas.

Practitioner Sandy Rose, PhD, of Dover, N.H., another member of APA's Committee on Rural Health, has noticed the same in her area. "More people are calling requesting sliding-scale fees and more people are calling with Medicaid as their payer," she says.

Recession proofing

What if the economy worsens? Brad Klontz, PhD, of Kapaa, Hawaii, a practitioner and president of the Hawaii Psychological Association, echoes the concerns of many psychologists: "While I am seeing more referrals now," he says, "I anticipate that the increasing number of Americans who are losing their jobs and, as a result, losing their health-care benefits, will lead to worsening access to care issues for Americans in the coming months."

Several psychologists said they will continue to help people, even if clients can't come to their offices. One way is through offering workshops. "Talk to people about the effects of the crisis and help them think through how they can nurture themselves and meet their underlying needs without breaking the bank," says New York City practitioner April Benson, PhD, who specializes in treating patients who shop too much.

Martin reaches out to potential audiences by sending letters to churches, temples, local businesses and parent-teacher associations, telling them that it's likely that their communities are experiencing stress due to the economy and that she can help.

"PTAs are a particularly great resource and have the potential to reach a lot of people," says Martin.

She created a Web page on her local public school's site that offers information from APA on how to cope during stressful economic times and how to talk with children about the issue. (The materials are available at the APA Help Center. APA members can also request a public education campaign toolkit by email.)

Other psychologists might want to teach a class, says Bray. "With college enrollment up, psychologists can reach out to community colleges and teach," he says. "Not only does it provide a great public service, it will build your practice for the future."

Martin also chats with physicians, dentists and other health-care professionals to ask what they may be seeing among their patients these days and tells them about how she can help. Four years ago, she offered a series at her local VA and to this day gets calls stemming from her time there.

"You never know when something you do will plant the seed and, when someone needs help, they'll remember you," she says.

Also, talk to the person who does your taxes, recommends says Jonathan Rich, PhD, a practitioner in Irvine, Calif. He or she may also know of people who need your help.

"We can promote ourselves without being obnoxious," Martin says. "We're all professionals, we all receive services from one another, and there is a way to show others that we can add value to the services they offer."

A silver lining?

How will psychologists stay strong, even if their practices dwindle dramatically?

On the national level, APA's Bray is hosting a summit this spring to explore emerging practice opportunities. The APA Presidential Summit on the Future of Psychology Practice in San Antonio, May 14–17, will "enable us to think about new models that will enable psychology practice to thrive," says Bray.

On a personal level, Bray recommends that psychologists follow their own advice. "The first thing we need to do is use our own skills as psychologists to take care of ourselves," he says.

For James Gottfurcht, PhD, of Los Angeles, that means embracing the healthy habits that work for his clients: yoga, meditation, deep breathing, exercise, being in nature, hot baths. "All of these things quell the body on a physiological level," he says. "Pick one that works for you."

At the same time, he says, substitute those beneficial behaviors for such unhealthy ones as repeatedly checking your retirement portfolio. "There's no rational reason to look at an anxiety-provoking stimulus so much," he says.

Others say they are exploring their interests outside the clinical realm.

"Psychologists have a lot of skills," points out Rich. In addition to his clinical practice, Rich creates tests and analyzes data. "Find something you enjoy doing and pursue it," he says.

For April Benson, that's volunteering at a school near her practice. But for others, she says, it could be taking that dance class you've always wanted to take.

Talking with friends and colleagues is key to Molitor's stress reduction. "When you work alone and listen to anxious patients all day, it's helpful to get together with a friend," she says. "Networking also builds up ideas and you can feed off each other."

And, perhaps most important, psychologists are looking for the potential upside of this economic downturn.

"I am convinced that my patients—as well as all of us—will begin to embrace a new way of life," says Dorlen. "Perhaps out of all this turmoil people will realize that there will be opportunities for creative growth, economically as well as psychologically and spiritually."

Instead of putting in 50-hour work weeks, maybe psychologists will find they can work less and spend more time with their children, adds Molitor. Instead of enrolling the kids in five afterschool activities, maybe they'll pick just two, and there will be more time together around the dinner table.

"Maybe families will be together more and realize what is going on in each other's lives," says Molitor. "That's a wonderful silver lining."