Commentary

Division 39 practice survey: A guide to the main results

A presentation of the data collected by a practice survey on clinical psychoanalysis conducted by the author in 2008-2010, the basis for the roundtable featured in this issue

By Steven D. Axelrod

The charts presented here summarize the results of the Division 39 Practice Survey. This material was presented at the 2010 Spring Meeting to the Division's Board and again in an open roundtable discussion. This data constitutes the bulk of the survey findings, edited for clarity of understanding and ease of interpretation. In what follows, I will summarize the key findings and implications in narrative form.

The survey was designed to obtain data on the current realities of the Division membership's independent practices and their attitudes toward practice. With much discussion of the threats to practice, the supposed low morale of practitioners, and questions about the profession's future, we felt it was important to know in detail what our members' practices actually look like as well as relevant attitudes.

The survey was distributed online to 2,919 Division members in the fall of 2008. After excluding surveys that were "bounced back" without reaching a member and those that were opened by members but not submitted, we obtained 603 usable surveys. The response rate of 22.8 percent compares very favorably to response rates reported in the literature and exceeded the response rates of several other web-based surveys recently conducted by the APA Practice Directorate. The survey covered four major areas—demographics, practice patterns, practice finances, and attitudes toward practice and practice development. The results are presented in that sequence. Data analysis was done in conjunction with the APA Practice Directorate, which has been extremely helpful and supportive of this effort.

Survey Demographics

As you will see, our sample roughly corresponds to the demographics of the Division's membership. With an average age hovering around 60, our Division's membership is some 10 years older than the APA membership at large. Our sample, like the Division membership, also skews female—approximately 60 percent. Our sample had a high degree of section membership—section membership ran at least twice as high as for the Division at large. The racial/ethnic composition of the survey sample was overwhelmingly white (93 percent), as it is for the Division at large. Thirty-eight states, the District of Columbia, and ten foreign countries or territories were represented in the sample. States with the most respondents include: New York (n=182), California (n=82), Illinois (n= 9), Massachusetts (n=44), Pennsylvania (n=30), and New Jersey (n=29). The mean number of years in practice for the survey respondents was 21.4 years, with males having been in practice significantly longer than females.

Practice Patterns

Survey respondents in independent practice saw an average of 18 patients (not hours) per week, with males seeing significantly more patients than females. Respondents in practice longer reported seeing signifi cantly more patients per week. The great majority of patients are seen for once-a-week therapy— almost 70 percent of the average respondent's caseload consists of once-a-week patients; 20 percent of the average respondent's patients are seen two or more times a week.

Approximately 46 percent of the average respondent's caseload has been in treatment for one-five years; 22 percent have been seen for more than five years. Like the respondent sample itself, the caseload of the average survey respondent is mostly female (61 percent). Patient age is fairly evenly distributed across decades, with almost half being between 30 and 49.

Practice Finances

The majority of the survey respondents (63 percent) are not managed care providers, and most of the respondents' income (68 percent) comes from patient self-pay. Patients are most commonly charged in the range of $100–150 per session; 65 percent of respondent's patients are charged between $100 and $199 per session. Approximately 25 percent are charged less than $100 per session.

Gross income and income from practice are shown, and relevant comparisons of income differences are highlighted. A majority of survey respondents (53 percent) report that their incomes from practice have increased over the past five years; approximately a quarter report their income has stayed the same, and a quarter report a decrease in income.

Practice Attitudes

Survey participants were asked to rate their degree of satisfaction with the size and scope of their practices, the mix of patients, and their income from practice. Most seemed relatively satisfi ed with aspects of their practices other than income. Overall satisfaction correlates with income level, and males, who earn more than females, are more satisfi ed overall with their practices. Those in practice longer report being more satisfi ed overall with their practices.

Managed care and insurance reimbursement rates are viewed as the major threat to independent practice. The majority of respondents are also either "fairly" or "very" concerned about the impact of flat or declining fees, the media portrayal of psychotherapy and psychoanalysis, and the negative social and cultural attitudes toward the profession.

When asked for their professional goals over the next five years, 53 percent of the respondents said "grow professional reputation" was either very or extremely important. The next most strongly endorsed goals were to "improve confi guration of patients" (47 percent) or "obtain higher fees" (42 percent). When it comes to the goal of growing and developing a private practice, the most favored methods used by the participants are "internal to the profession" —i.e., teaching and supervising, networking with colleagues, and attending study and supervision groups. Advertising, noncolleague networking, and developing specialized clinical or applied psychoanalytic skills were endorsed much less frequently. Perhaps even more signifi cantly, the respondents don't seem to have much conviction that any particular method is helpful in expanding their private practices other than obtaining psychoanalytic training (53 percent rate it as either very or extremely effective).

Finally, while the majority of respondents would like the division to do more to identify business of practice issues, they are particularly interested in "public advocacy for psychoanalysis" (67 percent rate this support either very or extremely important).

Conclusions

The following are some preliminary conclusions, and provide a jumping-off place for our discussion:

  1. The graying and feminization of our profession is very evident from this survey, as indeed it is from the Division's membership demographics

  2. While respondents who have had psychoanalytic training value it highly, they see most of their patients once a week.

  3. Male survey respondents who have been in practice longer see more patients, earn higher incomes, and overall are more satisfied with their practices.

  4. While overall income figures are open to interpretation, the survey respondents are not satisfi ed with their incomes from practice and want to obtain higher fees. (This appears to be an important professional goal in particular for the less senior and female respondents.)

  5. Survey results suggest that respondents adhere to a fairly traditional model of practice development. That model is based on the use of "internal to the profession" methods that respondents are not terribly confident will be effective. Our respondents seem to believe that "bread and butter" issues are addressed by growing one's professional reputation and by organized psychoanalysis using public advocacy and public relations to address negative social and cultural attitudes toward the profession.

About the author

Steven D. Axelrod, PhD, practices psychotherapy and psychoanalysis as well as organizational consultation in New York City. He is a graduate of the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis. Steve initiated the Practice Survey in 2008, has been active in a number of division-wide efforts to advance the profession, and is a Contributing Editor to DIVISION/Review.