One of the reasons therapists shift directions is, of course, necessity: Market forces lead some to pursue avenues they otherwise might not have taken.

If you're creative about it, though, externally driven changes can actually improve your practice, says David Hayes, PhD, a private practitioner in Columbus, Ohio, and an in-house psychologist at Bank One/JP Morgan Chase, a regional banking center there.

Hayes' strong grounding in psychodynamic theory-the focus of his doctoral program at Michigan State University-provided a solid foundation during his initial years as a psychologist. He did his postdoc at the Menninger Clinic in Topeka, Kan., where he learned the clinic's powerful testing-battery diagnosis system and worked long term with clients who had serious mental illnesses such as bipolar disorder, eating disorders, major depression and schizophrenia.

From there, he secured his first "real" job at Menninger's sister hospital in Columbus, Harding Hospital, where he continued his in-depth approach to treating serious mental illness, eventually becoming director of outpatient clinical services.

But when managed care struck in the late 1980s, it targeted first the hospital's inpatient services, then its outpatient ones. "It became very clear that the opportunity to do long-term treatment of that sort was just going to disappear in that setting," Hayes says.

In response, he stepped up his private practice, seeing some of the same patients he had seen at Harding, as well as high-functioning professionals. And he secured a half-time job at Bank One, where he conducts stress-management seminars and counsels employees, including senior managers.

While he still draws heavily on his psychodynamic training, Hayes' new clientele has pushed him to be a more active therapist.

"In business, there's a premium on being able to understand a problem quickly," he says. "If it's going to take two years, the client is going to be long gone."

But there's one aspect of his work Hayes knows will never change: his basic motivation as a psychologist to understand and help people as fully as possible.

"Being a psychotherapist has been an extraordinarily rich path," he says. "I've valued the chance to engage with people from all walks of life at a level that happens only rarely outside the psychotherapy consulting room."

--T. DeAngelis