Below is the full, cranked-up cheat sheet from Rob Danzman’s presentation (Understanding and Working with Affluent Clients: Surprising Findings, Best Practices and Effective Strategies) given on October 18 at the NATSAP Southeast Regional Conference in Asheville. We added some juicy bonus information and links to spice it up a wee bit. Don’t hesitate to contact us with any questions.
Current Research and Findings
1. Substance Abuse
Children of wealthy parents tend to have higher rates of alcohol and marijuana use than their poorer counterparts. Researchers believe this is due to multiple factors:
a. Money: Increased access to money without having to earn it or pay it back.
b. Supervision: Lack of adult supervision especially after school creates an environment of boredom and poor reinforcement of rules and boundaries.
c. Self-Medication: Increased use of substances to relieve anxiety and stress associated with achievement pressures.
2. Mental Health
Some of the major issues include entitlement, anxiety, depression, eating disorders (male/female are both at risk), and narcissism. Here’s where many of these issues originate:
a. Over-scheduled: They work hard on academics and generally feel over scheduled. There is significant pressure for achieving public success.
b. Only Children: They have fewer siblings and often were not raised with the need to share and have limits the way other children are.
c. Parental Critique: One of the most significant issues found in most of the research highlighted parental criticism. Having high standards is important for kids, but research showed that affluent parents will often push and push for greater and greater test scores, athletic success and social placement. Parents see a correlation between childhood success (grades, soccer, violin, etc.) with college success and, ultimately, career success. We could go one step further and say that the ultimate success parents are looking for is that of how the child contributes to the family’s legacy. Going to Harvard and becoming a respected attorney entrenches and builds the family’s prestige. Unfortunately, this pressure overwhelms many kids and adult children.
3. Access
For many reasons, mental health and substance abuse services can often be easier to get for poor families due to a significant safety net system created by Medicaid, Medicare, HealthChoice as well as churches and local schools. Fonthill started out as a medicaid provider to families and, ironically, the same service we provided initially were not available to wealthier counterparts due to income limits. Poorer families can move up and down levels of care (outpatient up to hospitalization), get medication, therapy, family therapy, case management, etc. with little difficulty. The family see’s virtually no bills and no paperwork.
Another phenomenon is that, though in their financial best interest, many therapists report they do not like working with wealthier clients. There is a perception that a wealthy client does not appreciate the great life they have. This is addressed in further detail below.
4. Quality of Service
You would think that more money = more and better service. Not in mental health and substance abuse care. Many families’ first connection with services is through an outpatient therapist. Interesting research has found that a high percentage of therapists experience what is called schadenfreude – The enjoyment obtained from the troubles of others. If we were talking about not wanting to work with Black people or Chinese people, we would be branded as racists. Yet, when therapists make fun of or diminish the pain wealthy individuals feel, it’s socially acceptable. Pain is pain and it’s unprofessional and just bad business to ridicule those we serve.
There certainly are high quality programs with commendable outcomes but, as a percentage, wealthier families have a much harder time finding high quality service. One reason is the significant gap between services which, for their lower Socioeconomic Status (SES) counterparts, is less of an issue due to continuums of care being mandated in many states for Medicaid clients.
Best Practices
This refers to what clinical staff as well as non-clinical staff (and management) can do from a clinical or ‘quasi-clinical’ perspective to support and promote progress among affluent clients.
1. Structure
Affluent parents thrive in their professional life while their personal life comes undone. They want and need us to be directive and not waver from what we know is the effective approach to treatment and services. They want to know that your program or service is tight and runs seamlessly. Being firm, direct and clear with your expectations for the parents as well as the children is essential. It will actually relax them to know that you do not compromise or waver on any issue.
2. Curiosity
Express interest and concern for the individual (yes, the parents as well as the acting-out teen sitting in your admissions office). Many of us assume that these people are constantly being supported or, if not, they can easily ask for support or share their thoughts and feelings. Just not true. Ask open-ended questions, even during intake or admissions when your primary job is to get client information or give them instructions. These open-ended questions can go a long way. “What has it been like for you Mr. Johnson to try and balance a successful business while also trying to keep your daughter sober?“
3. Nurture
Parents often feel the need to create or perpetuate the myth that ‘everything is ok.’ Let them know you are listening loudly and everything is not ok, that’s why they are in your office or on the phone with you. What is ok is them trusting you. Trust has been in short supply in their lives. Let them know things are not ok and that, over the coming months with the team’s help, things will become more and more ok. “Seems like you’ve been caught between doing what is best for the whole family and not wanting your son to feel like you are singling him out. This must be an incredibly challenging time for you.”
4. Treatment Models
Fonthill recommends that professionals (clinical, support or management) use the following treatment models due to their evidence of the effectiveness.
a. Family Systems: Here are the 8 concepts Dr. Bowen discusses as influence within a family system – Triangles, Differentiation of Self, Nuclear Family Emotional System, Family Projection Process, Multigenerational Transmission Process, Emotional Cutoff, Sibling Position, Societal Emotional Process. Having staff do a basic in-service on this would catapult their understanding of why families act the way they do.
b. Cognitive Behavior Therapy: Developed by Dr. Beck, Cognitive Therapy (CT), or Cognitive Behavior Therapy (CBT), is a form of psychotherapy in which the therapist and the client work together as a team to identify and solve problems. Therapists use the Cognitive Model to help clients overcome their difficulties by changing their thinking, behavior, and emotional responses. Cognitive therapy has been found to be effective in more than 1000 outcome studies for a myriad of psychiatric disorders, including depression, anxiety disorders, eating disorders, and substance abuse, among others, and it is currently being tested for personality disorders.
c. Dialectical Behavior Therapy: Dialectical Behavior Therapy (DBT) is a treatment designed specifically for individuals with self-harm behaviors, such as self-cutting, suicide thoughts, urges to suicide, and suicide attempts. Many clients with these behaviors meet criteria for a disorder called borderline personality disorder (BPD). Recent research shows that DBT is also effective in treating substance abuse, depression, anxiety and numerous other issues. DBT is great for staff to use in their professional as well as personal lives. DBT is more like an instruction manual for life rather than a cold, scripted way to solve or process a problem.
Effective Strategies
Professionals and programs are not just made up of clinical programming and require some tailored approaches that come from the world of consumer psychology and marketing specifically regarding the affluent community. Ignore the following section at your own peril.
1. Identify the Boss
This may not be the parents calling on the phone or sitting in your office. Sometimes, grandparents have the power, write the checks and have veto power over what services are allowed. Sometimes there is a Special Needs Trust with several trustees that must sign-off on everything. Get curious about ALL of the stakeholders in the family. Fontill staff do this within the first few meetings/sessions/contact in the form of a genogram (family tree).
2. Target Wants vs. Needs
What you about to read is heretical within therapeutic circles. It disrupts the stogy, dusty, old philosophy that mental, behavioral health and substance abuse interventions should be treatment-focused and marketed on their interventions and outcomes. Fair enough. But we live in an age when we know more about how people make decisions and the rules for how to communicate about products and services are being constantly rewritten one industry at a time. Enough of ranting, let’s get you some solid advice…
Most programs target and sell their services to needs of the families (ie. Length of program, therapy sessions, what type of evidence-based model is used) instead of speaking to their wants (ie. Hope, safety, progress, return on investment). Seems counterintuitive but these parents can’t be expected to really tell the difference between all the great (and not so great) programs. They look the same on the websites, brochures and even on site. The main difference can come when program staff speak on an emotional level to families – connect at their core rather than rattling off program features – tell how the program features eleviate pain, fear, and instill hope and change and investment in the families’ future.
Staff should learn about the lifestyles of wealthy families (ie. Visit lateral websites like BMW, Pelligrino, Coach, Whole Foods, Umstead Hotel). Each of these examples is selling a promise of what you will experience and feeling when you buy their stuff.
3. Customer vs. Client
Families would prefer to be treated like valued customers rather than parents of clients. They want to be informed, but they also want to be treated like the substantial amount of money they are paying you grants them exclusive, members-only access. You and your staff are consultants, concierges and customer service reps rather than LCSWs, LPCs, and LCASs. Differentiate between clinical info and customer service. This ties nicely into our little piece above about speaking to their wants more than to their needs.
4. Use Better Language
Use correct, effective, and positive terminology. Here are some sample word make-overs
Investment vs. Cost
Exclusive vs. Availability
Concierge Service vs. Instructions
Orchestrated vs. Planned
Artisan vs. High Quality
Summary
Want More Detailed Information? There is much more we could cover but this list should get you and your staff headed in the right direction. For a comprehensive list of most of the research published over the last 20 years, contact us here and ask for Affluent Studies Research List. We’ll send you a PDF of what we’ve got.
Want Your Staff Trained? For more information on working with the unique needs of affluent families, contact us here and ask for more information about having Rob Danzman come and speak or train your staff. He is available for half and whole day staff training and management consultation to make sure that your resources are used in the most effective ways.