Concierge medicine, conceived in the 1990s, is a type of medical practice where patients pay an annual or monthly fixed fee or “retainer” to ensure more attention, contact, and thoroughness from their doctors. Another term that is used for a concierge medical practice is a “boutique practice.”
Regardless of the name, patients utilizing concierge therapy may be able to obtain quicker appointments and more personalized treatment. Recently, concierge psychology has become popular, and I have chosen to move to a concierge psychology practice. Practically, this means that I work with a limited number of patients (compared to 10 or 12 back-to-back appointments a day) and am able to give my full attention to all of my patients without the risk of burnout.
Here are a few examples of concierge patients.
Jane* has debilitating depression. She has worn out her support system (husband, friends, family) with negative perseverating thoughts. Our daily check-in (sometimes 15 minutes, other times 1 hour) helps her get through each day while waiting for her scheduled electroconvulsive therapy (ECT) at a local hospital to begin. After Jane completes ECT, which she found successful nearly two decades prior, she will require less contact with me to “get by” but for now, she relies on my carrying the hope that her depression will lift.
I met Margot* when I interviewed her for one of my therapy groups. When she mentioned in a group session that she woke up on a Sunday morning with her body bruised, her clothes ripped off, and no memory of the event, I was clearly concerned about her drinking and substance use, in addition to her mental health and judgement. I asked if we could meet individually. In the individual sessions that followed, I used motivational interviewing techniques that allowed her to determine that her drinking, while a pleasant escape for a moment, was harming her life and her future. Our month of check-ins (approximately four times a week) and appointments ultimately led to her decision to seek residential treatment. Margot never had addiction treatment before even though she had been in therapy for years. Her addiction was directly related to her inability to cope with life’s challenges due to parents who were both neglectful (didn’t parent) and also destructive (narcissistic addicts themselves). She had no reason to trust people, yet she came around. Our continued and frequent contact and connection was truly curative. This client has now been sober for 6 months; her first sober period since early adolescence.
Sally* is challenged by indecision. I see her for weekly appointments, but we also communicate almost daily via email because she gets stuck vacillating between different options on small tasks, impeding her in a number of roles, including motherhood and career. While I do not provide written answers or solutions, I do remind her of something easily forgotten when she is anxious: every time we say no to something, we are saying yes to something else, and every time we say yes to something, we are saying no to something else. Therefore, some feeling of loss in with every decision is normal and doesn’t mean her past or current decisions are wrong.
In the concierge model, psychologists aim to return calls and emails quickly (eg, within 2 hours), and their availability includes weekends and holidays (often 7 days a week). They offer same or next-day appointments virtually, by phone, or in-person when possible.
Concierge psychologists also provide direct access to an assistant or billing manager to help clients with any billing or insurance-related issues. I personally keep one slot open daily to squeeze in my clients for additional sessions as needed.
Unlike concierge medicine, concierge psychology does not usually have a retainer fee. Instead, the session rates are higher than traditional single psychological sessions. For instance, instead of charging between $150 and $300 for a 45- or 60-minute session, the fee might be closer to $350 and $550, depending on the location and cost of living. Quick emails and check-in calls are not billed.
Because concierge psychologists purposefully limit how many patients they work with, they can spend time outside of the session reflecting on the patient’s case and staying current with the field; this enables them to bring the highest quality of work into their sessions with the patient. In my case, teaching psychology graduate students keeps me up in the loop with new research and changes in the field and practice of psychology. I also spend significant time involved with various national and international psychology organizations.
Concierge psychologists make the time and have the desire to invest in collaborating with other care providers to help patients reach their goals. Like me, they might have expertise in leading interdisciplinary teams and act as a treatment team leader to coordinate care or just be a helpful team member available for consultations. I provide medical and other professional referrals frequently to my patients.
In my experience, the patients who benefit the most from concierge psychology include those with debilitating mood disorders (eg, severe depression, bipolar disorder, postpartum depression), substance use disorder, borderline personality disorder, or extreme anxiety (including obsessive compulsive disorder). Individuals with histories of being abused or neglected also benefit from more care and contact—they get to have an experience in which they are seen, and their needs are attended to, like Margot, perhaps for the first time in their lives.
Most people cannot afford concierge services. Some therapists, like myself, offer pro-bono slots but these are hard to get.
I decided to offer concierge sessions based on my experience that change does not always wait for an appointment time. My desire to provide extra support in between sessions is not for all therapists. Many of my colleagues prefer to have their weekends and evenings (or mornings) off for self-care.
For me, self-care is limiting the number of patients I work with in turn I get to participate in meaningful therapeutic relationships that are change-oriented. A few lessons I’ve learned along the path:
Overall, concierge psychology provides a unique opportunity to help patients develop into their healthiest selves.
*All identifying details have been changed
Original article available at Psycom Pro
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