Is Therapy Becoming Too Regulated for You?
Regulations: helpful or handcuffs?
When the No Surprises Act got rolled out a few weeks back, my instinct was to feel really upset for all the therapists out there.
It wasn’t just about the new regulations themselves, but also the way they were rolled out.
I know regulations are intended to protect the safety of clients and clinicians, but the truth is that sometimes increased rules do more harm than good.
Join the conversation about regulations and get my thoughts on the latest podcast episode.
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Show Notes:
Hey, Risers. Welcome to episode 144 of Empathy Rising. Side Hustle is well underway. We are just about to start week three of the program—yeah—week three of the program. We have a welcome week, so I had to think which one we were on. Week three of the program and the students are really starting to jive and come together.
There has been so much community this round. Normally like I have to drum it up, I have to, like, start conversations and be like, what do you guys think? But this round, I didn't have to do any of that. They are talking, they are collaborating, and it's just really cool to see. I'm freaking loving it.
So today might be a little bit of a sensitive topic if you couldn't tell from the title, but I want to go ahead and paint a picture for you. Take you back. Close your eyes if you're not driving or walking on a treadmill or something like that. But I want to take you back about six weeks ago or so. And it's the last couple of weeks of 2021 coming off kind of a crummy year like most of us, and you're really looking forward to a little bit of silence and downtime.
You shut your practice for the next 10 days. You really went ahead and just made it a priority to take some days off because you're very committed to catching up on Ted Lasso and the other shows that you've missed. You might just want to read a book or sip some tea. You just want to be a lump for a little bit, and you have totally earned it.
Yes, Omicron is beginning to be a thing, but you're decidedly just not going to worry about it for right now. You're going to stay home for these 10 days and you will think about that later. But then all of a sudden, you look at your phone and you've got 23 notifications on Facebook. You're like, what is going on?
And you click them and all of your colleagues are panicking and stressing out about the No Surprises Act. Colleagues are texting you, other therapists, friends, are asking if you know what the heck is going on and what you're going to do about it. How are you going to word your good faith estimate?
Is this actually something real or something doctors need to do? Does this apply to us? Does this apply to private practice? What about private pay? And all of a sudden your pre-planned 10 days of nothingness and quiet have been totally taken over by a new regulation that you now have to figure out in your downtime and you have to rework into your practice.
Now, come on out, open your eyes, come back to the present moment, right? I'm sure me just recounting this is bringing you back there. I was furious during this timeframe. I think I had a little bit of a luxury to be furious because I'm not practicing clinically. If I was practicing clinically, I would have had my head down, just like all of you, just buried in figuring out what the heck I was supposed to do and making sure that I was compliant and ethical and all of that stuff. But because I was a little removed, I was so angry.
What made me angry about this was it came down so that therapists were forced to react quickly and sacrifice the small amount of downtime they had, after the shitty 2022 and shitty 2021, adjust to satisfy some new regulation, just ensure that they were in compliance. And I watched this unfold on Facebook. So many people were like: "I knew nothing about this. If it weren't for these Facebook groups, I would have had no idea."
So the information wasn't even disseminated well. It wasn't given out well, and it wasn't given out with time to adjust or time to make pivots, and it really got to me. There's also the fact that some of the regulations felt like it conflicted with some core foundations of what we do as clinicians and core foundations of the way that we protect our patients and our clients, and so it just felt like a mess. It felt like a giant mess, and it just got me thinking even more about the idea of regulation in our field. And I just wonder when enough is going to be enough, right. Is therapy becoming too regulated?
And, personally, I'm somebody who does not love authority, so it's probably always been too regulated for me. And that was probably one of the reasons that I did not stay in the field, but five years or so, six years, and I got out pretty quickly because I did not love the idea of regulation. So if you're a little bit more of a rebel like me, you probably feel this, but some of you who maybe have always been fine with the level of regulation until now might've had a little bit of a taken aback feeling or a pissed off feeling, or just a frustrated feeling at this rollout.
I don't know if it's necessarily the actual regulation, like, letter of the... not letter of the law, but you know what I mean? Like the actual requirements or the way it was rolled out. I think it's both. I think it's both, but I just didn't like it. And I know a lot of you didn't like it either. I was just watching—sitting back and watching these conversations about how many people were surprised or angry.
Now I do want to say regulation has its purpose. There's a reason we're a regulated field, and there's a reason that healthcare is regulated. It keeps clients safe and it also keeps clinicians safe. If you heard the quotation marks around that word, they definitely were there. But clients who are seeking mental health care, they're likely in a fragile state.
Sometimes we have the worried well coming to us and they're just maybe in a maintenance mode or maybe they're in self-actualization mode and they might not be as fragile. But there is definitely a time and a place where our clients are in crisis, or where they're seeking us out after a tremendous loss, or they're seeking us out in a fragile state.
And so we have safeguards in place for these individuals, and that make total sense, especially if their decision-making capability is diminished temporarily or permanently. Like, there is definitely a time and place for protecting people who are seeking our help and seeking healthcare. But I do think that clinicians are sold this idea of "safety" through regulation.
A part of me—all of me—can't help but see it as a way of conformity in a way of constraint and the way of compliance. That word compliance just gives me the heebie-jeebies. I think it is wise that we have a firmly defined scope of what we do and what we don't. I think it's wise that we have certain populations that we are well qualified to treat right out of school, right out of internship.
And I think it's wise to go and get certifications for eating disorders or other presenting problems that need more information, more education, more experience, whatever. So I think it's wise to have a defined scope. Totally. I think it also can make our jobs easier in a way to show up and know exactly what we're doing once we've learned the rules. The rules make it so that we don't have to question the authority very much. We don't have to question. We know our path, and I think that can bring a sense of security and a sense of comfort.
We have a benchmark from which to measure if we're doing a good job or not. And so I think that can be helpful for people who need maybe more structured. But I also think it can bring headaches. It can bring on burdens of proof. It can bring on jumping through hoops, red tape regulation, and just headaches. It can be like handcuffs, and it can be limiting in our ability to do the work that we actually want to do, or the work that we actually are called to do because we're spending so much time, so much effort, and so much energy, making sure that we are abiding by the rules that were in the box that has been set for us.
And I do believe that this is what No Surprises, Good Faith Estimates, and these most recent acts have done. They're amazing for those who are seeking medical and mental health services. They protect the people who are in need of services—the clients and the patients. They protect them well, but they feel like handcuffs and they feel like hoops for the providers, which burns us out.
Which makes us more likely to opt-out, to find a way to do our work without doing the regulation. And so we're less likely to serve the people that the regulation was designed to support in the first place. This is a cycle, and this is a cycle that's been going on and on for a while. I mean decades, maybe more in our field of people.
Needing to get away from insurance companies, needing to get away from some of the heaviness so that they can have more autonomy, so they can do life and they can do business and they can work their capital W work in the world on their own terms. Another regulation comes down and it's just the same thing over again.
This is one of the reasons I'm such a huge proponent for adding on, or perhaps moving into, the online space and for separating your online business from your therapy practice. I don't want you, necessarily, unless it just makes perfect sense. There are some circumstances where it does make sense to keep your side hustle under the umbrella of your therapy practice. But for the most part, I'm a big advocate for separating it out because then you are not regulated. The online income industry is almost totally unregulated.
There's no overarching, authoritative body, like a state board or licensure committee or anything like that, that's peeking over your shoulder and ensuring that you're complying to the rules that they have laid out for you. Or there's no one peeking over your shoulder and limiting your actions. The other side of this, though, is there's no authoritative body ensuring that online entrepreneurs act ethically or with integrity and don't screw people over.
So honest regulation of an industry does have positive aspects. Totally has positive aspects, but it's often the negative side that outweighs them. When I look at it, the regulation has a handful of positive things to it and a bushel basket full of negatives. And I'm totally open for discussion around this.
If you want to talk about this, bring it to the Facebook group. Like I'm happy to see the other side of this. I'm just really passionately sharing my side. Now I do want to mention that there are a few regulatory bodies that do have influence in the online industry. They're not like the overarching, right?
They're not in charge of every single person who's a course creator or a coach, but they do have influence in the industry, and the first one is the federal trade commission. What they do is they have a bureau, a division of consumer protection. And so this bureau of the FTC regulates marketing claims.
So they regulate product claims made in advertisements in newspapers, magazines, direct mail, internet, media, television, and radio. And this edition of internet media is probably within the last 15, 20 years or so. But internet media is going to cover your social media and your email marketing.
So for instance, if back in the day an infomercial about a product claim to regrow hair or something like that, and then it was proven that the product didn't work, the FTC could come down on that company. And now because internet media is included in what they protect then if there are claims in an online business, the FTC has recourse here. We want to just make sure that the promises we're building for our programs are things we can actually deliver on, and I have a lot of podcast episodes on this.
So if you're curious, just take a look in the archives because I know I talked directly about promises and guarantees and things like that at length. Now the other thing that we have to pay attention to, if you're in the US or if you're in Canada, it is canspam, C A N S P A M. And if you're in the EU, it is GDPR. If there's some back and forth about this, but if you know that you are directly marketing to people in the EU, even though you're in the states, you probably want to abide by GDPR anyway. If people happen to land on your list or your stuff from the EU, but you're not specifically targeting them, you don't have to abide by GDPR. So just so you know.
But what these two bodies are doing are two things. They're ensuring that you cannot send unsolicited marketing emails. They make it so that... or the regulations under the acts or whatever they're called, make it so that you can not just cold email anybody with your sales and your marketing emails. You could potentially send a cold email with your opt-in and ask somebody to then opt into your funnel.
It's an interesting strategy that I've seen, but you cannot just put people in your funnel just because you want to. They have to self-select and claim that they want to be part of these emails. This is why a lot of people do this, and this is technically not correct. If you join a Facebook group, they'll be like: What's your email? Can't do that. You can't do that because the person hasn't actually opted in to receive emails from you.
So you can put your opt-in there or potentially you could say: To hear from us outside of this group in your email, and you consent to that, put your email here. That's technically okay, but you people need to consent to receive emails from you.
The other side of this is the protection of privacy and data. So you're not allowed to sell email lists. Does it happen? Yes. I don't know how they do it and how they get around it, but when somebody is on your email list, you're supposed to be obligated to protect the privacy of that data. So there are a few things that happen in the online income industry and that are trying to set some standards.
And I think that's good. But two standards feels good to me—22 or 2200 standards does not feel good to me. But I get that there's some feelings that come up with the total lack of regulation. Okay. The total lack of regulation can trigger a lot of things, especially in clinicians, especially in people who are coming from a highly regulated field.
And the first one I see is that clinicians get scared. Like it's scary to have an industry that no one is policing. You mean anybody can claim to help with anxiety, or anybody can help to claim to help with trauma, or anybody can help with depression, even though they have no proper training? That's terrifying.
We know that those people, those coaches, or those course creators and membership site owners, or whatever they're doing, can actually be doing a lot more damage than they are good. So that is a little bit frightening. It's also fricking frustrating. It feels like a slap in the face after we've spent tens of thousands of dollars and also thousands of hours qualifying ourselves to be able to do what we do, and somebody out there read a book one time, and now they're making money helping people. That can be hella frustrating.
There's also a lack of guidance, I think. Because there's so much regulation, there's a very clear path about what we're supposed to do. We go from grad school, then we go to insurance internship, and then we get our pre-licensure hours and then we get a national exam, and then we have licensure, and then we have continuing education.
It's all laid out for us. Some would say we're being shepherded right, towards one outcome. And we could say we're being forced toward one outcome, but it's also nice to know what comes next. What comes next? Okay. What's my next step? Cross it off the list. Entrepreneurship is amazing for the freedom it provides, but there's no roadmap, right?
Stepping out on your own into the online industry has so much leeway. It can feel like moving from, like, a grid city where the roads run like north and south, east and west, to the wild west where there aren't even roads, let alone roads that go in clear directions, right? There's no one there to guide you.
But what I see as the positive of that is there's also no one there to limit you. So you've got to have some vision. You've got to be able to be self-directed, but there's no limits. And so what this ultimately I believe leads to is freedom. This is what I think is so beautiful about the lack of regulation is that you're operating in a totally different economy.
You've got to think about that. An online customer is not a therapy client. The burden is on the customer to do their research and their due diligence, and if they make a poor purchase in a program that's bad for them, that's their fault. That's on them—not on you. Not on you. This is a very different flip, whereas in the therapy room, the burden is all on us.
Whether that person becomes a client of ours, then it's definitely on us. But also even if that person calls and we're not a good fit, what do we have to do? We have to make referrals. We have to make sure they get to the right fit. And so it's just more burden and more stress on us. So when the burden is placed on the consumer, what happens is a giant weight lifts off of your shoulders and it frees you up to do the work you want to do without all the red tape that holds you back and burns you out. So I think lack of regulation, or less regulation, is actually a positive thing.
There's also a really cool opportunity here to raise the standard. You're coming in from a regulated industry to an unregulated industry and you get to be the groundbreaker and the change-maker in that industry. What keeps you regulated is your integrity, right? Not some external body because we all know some shady therapists and they know the rules and they don't play by them.
So ultimately what keeps you regulated is your integrity. So we introduce quality coaching and quality education services that have a foundation in real experience and real education. We get to change the landscape of that marketplace. Other people who are less qualified course creators are less qualified coaches, they're going to be less marketable compared to the standard that we bring.
They're going to be a less marketable company to how we present ourselves in the industry. And so they're either going to lose out on sales. This is a free-market economy, right? They're either going to go out of business or they're going to have to raise their bar.
They're going to have to come up to our standard and they're going to have to do better. And that just raises the quality of the industry as well. So I think it's really cool to have the chance to be the trailblazer for once instead of the people who have the rules put down on us from other people.
So only you can answer the question if therapy is becoming too regulated for you. I want you to see that there's an opportunity out there for you that is regulated, that gives you more autonomy and gives you more freedom, and you can strike a balance. You can be a therapist and a course creator, a therapist and a coach, a therapist and a membership site owner, facilitator.
It doesn't have to be an either-or, but there is a really cool thing here. It's really neat that you can take your skills from the therapy room, transfer them 100% over to an industry that allows you to have that freedom and be that standard setter. So I think it's neat.
If you're somebody who wants to enter this new industry that is less regulated and gives you the opportunity for freedom and autonomy, there are a few questions that I want you to explore first, and I covered them all in my free masterclass. In this training, you'll explore the work style you want to embody, the money you want to make, and the marketing that you need to do to get you there. And that will help you determine your next steps online.
So head on over to marissalawton.com/masterclass to register. Remember it's totally free, and also what's cool is it's on-demand, so you don't have to wait for a certain time. You can watch it, push pause, come back to it after a session, or whatever. So it's really flexible for you. I hope this has been helpful, and I will be back next week. Until then, keep on rising.
