Psychologist Kimberley Cairns explores the benefits of implementing a psychological business model into your practice, and gives some insights on how to go about it
Psychology is fundamental to aesthetic business, and many may argue that it underpins the commercial value of the entire aesthetic and non-surgical cosmetic sector. The practice of applying psychological theory to business models dates back to the early 1900s, when efforts to combine advanced business practices with the study of human behaviour offered insight into how individuals and groups behave.1
When applied throughout our industry, we can track the emergence of trends and accomplishments in our field, encouraging an inclusive stakeholder engagement approach beyond the clinic that extends to pharmaceuticals, research and development, manufacturing, advertising, marketing and personal relations, as well as training and education.
By definition, the psychology of aesthetics involves the study of interactions and reactions, and how relationships form to create interpretations of preferences and dislikes in the everyday material world around us, including experiences of beauty.2
Aesthetics are ubiquitous in our lives, and are intrinsic to each patient and their individual needs, which is uniquely nuanced by the implicit and explicit aesthetic consumer experience.3 Therefore, we can expect to expand the notion of psychology to aesthetic business further into the design of clinics and workplace environments, recruitment processes and the retention of talent, performance and appraisal, as well as continuous personal and professional development. Collectively, these organisational constructs work to protect mental health and foster substantiated health-promoting behaviours.
The business case for implementing psychology into your practice should not be regarded as a fleeting concept. It is a vital evidence-based component to identify the needs, gaps, barriers , responsibilities and ambitions of any healthy contribution to the aesthetic specialty. This has well-informed potential for preventing absence among employees and targeting poor mental health or stress-related symptoms at work, which can lead to increased staff turnover , reduced engagement, high presenteeism and poor business continuity – all negative business implications.4,5 Aesthetic practitioners who own their own clinics are most likely to be regarded as small business owners (SBOs). Research by Mental Health UK compared the mental health of SBOs at the beginning of the pandemic to January 2021.
They found that of the 984 SBOs surveyed, 80% of them reported experiencing symptoms of poor mental health at least ‘a few times’ per year.6 Of female SBOs, 86% reportedly experienced poor mental health compared to 77% of males.6 An inability to focus was most commonly reported (66%), followed by anxiety (64%) and disrupted sleep (63%).6 It was further reported that SBOs experienced more acute symptoms such as panic attacks (24%), and that symptoms of depression were more frequent since the pandemic began (37%).6
This is alarming given the need for our aesthetic SBOs to perform at a high level, and to execute superior decision-making to avoid faulty, distracted or unnecessary risk taking, especially when managing complications. Decision-making and business strategy are equally influenced by cognitive and social processes which are fundamental to safe aesthetic practice. A reduced ability to focus can be a catalyst for debilitated practice, affecting patient outcomes and practitioner health. Numerous studies, anecdotal reports, patient testimonials, recent surveys and the latest Health and Social Care Committee Report into the impact of body image on mental and physical health all make the strong case that aesthetic practitioners are in an unenviable position whereby they must navigate daily psychological threats and emotional liabilities in themselves, their peers and patients.7-10 Practitioners risk being psychologically compromised due to the unique demands and invisible cyclical burdens in-clinic and at home.11,12
Constantly striving to fulfil ‘realistic expectations’, overcome financial changes or constraints due to the current economic living crisis, endure the societal pressure to ‘look good’, manage time and diversify from competition, explore new product innovation and stay informed on industry developments such as licensing, as well as managing complication anxieties and fear of litigation, all create conflicts with maintaining good health. Simply put, these conditions demand necessary protection of psychological health in aesthetic practice.
Developing healthy psychological ownership of the products and services offered within the sector must reflect empowered consumers’ preferences, as opposed to exposing vulnerabilities or (unintentionally) exploiting them.10 Consumers must feel qualified to make a decision which begins at the first touchpoint of connection. Decision-making is a loaded psychological theoretical construct which is influential in achieving an empowered product demand exchange. If the patient doesn’t feel qualified to make a decision, the ‘empowerment-product demand’ effect diminishes, and adverse consequences to patient satisfaction, practitioner confidence and business growth will endure.13 What are the ethical considerations? Many of the problems affecting the aesthetic industry are driven by cultures and behaviours. Industry taboos and bad practice endanger the value, integrity and respect of the great work being done in the industry. Without a shift in mindset towards compassion and unity, integral psychological collaboration can never fully deliver its commercial and ethical benefits, and the industry will continue to underperform.
A psychological business model provides a pillar to safely ‘put the patient to work’ , allowing both the patient and practitioner to thrive through decision-making, which is synonymous with the consultation processes, informed consent, risk management and the commitment to undertake treatment. To demonstrate this, let’s consider the contentious free consultation. For some, this may be common practice, while for others it’s just not the right fit. Either way, free consultations themselves are not the problem when implementing them – psychological business solution boundaries around them often are.
A free consultation allows for signposting in a more comprehensive way. When the correct processes are in place, you can look a prospective patient in the eye and tell them why another service is better suited for them, or why another colleague or practitioner is a better fit. These messages are more likely to be taken on board if a patient is not ‘out of pocket’ and you are not in an ‘upsell’ or ‘conversion’ mindset.
If a prospective patient attends a free consultation, there is no direct monetary exchange, but they are making an invaluable commitment to you. If a patient does not attend a free consultation and they ‘ghost’ you, this can be excruciating, yet also immensely beneficial. This early business transaction allows you to make a judgement on whether a patient has the readiness, motivation and psychological flexibility required to break their normal routine and make time to see you on your terms.14 This practice sets the tone to ensure the right patient gets access to the right treatment by the right professional at the right time. Once you can collate imperative data about a patient’s readiness to engage with you, you can expect a positive business and psychological shift.
Assessing for ‘goodness of fit’ is a condition for every consultation, and can be conflicted by a fee-paying or redeemable model. It should be expected that not all enquiries will convert, and that you will not be the right practitioner for everyone. Undoubtedly, as you work to strengthen your relationships with your patients, elements of your personality will be brought into your patient interactions.
Laughter has been considered a holistic care approach due to its specific health benefits, and you may be familiar with the phrase ‘laughter is the best medicine’. Researchers have explored the acceptability and functions of humour and laughter in patients with prolonged incurable cancer, and reported that nearly all specialists reported using humour (97%) and all reported sometimes laughing during consultations, with 83% experiencing positive effects from this.15 The opportunity to showcase who you are and the way you work should be sensitively encouraged in the scope of professional practice, and this will include elements of your authentic personality. When you achieve this, you will become more equipped and confident in managing that feeling when you just ‘click’ with a prospective patient, or equally, when you know that you are not the right fit for them.
Conversely, it is important to recognise factors that may destabilise the consultation space for correct patient selection. Including a consent form in any onboarding paperwork prior to a face-to-face consultation can undermine your specialist judgement of that patient’s psychological wellbeing. Informed consent is a teaching opportunity and should be formulated in person and with good signposting opportunities. This is of paramount importance given the reported findings that those affected by poor body image often do not get adequate access to support services. Of these, 64% felt that their experience of accessing services was either negative or strongly negative, with only 14% saying their experience was positive or strongly positive.17 Perhaps most worryingly, 55% of respondents felt that they had been stigmatised when they accessed or tried to access these services.17 There is a possibility that those provided with poor access to first line services will seek other aesthetic providers who offer more support.
To demonstrate this further, recall the earlier use of the term ‘empowerment-product demand’ as we explore skincare.13 Skincare is often regarded as the foundation on which to build all other aesthetic interventions, and is considered a labour of love by many. Correctly understood and informed decisions can increase the perceived value of a product or service, but there are limitations and strict conditions to consider.18 Who do your patients blame if their skincare is not delivering the intended results? You! It is unlikely that a patient will offer their non-compliance as a cause, even if you know this to be the case. You may argue skincare isn’t for those who want a ‘quick fix’, in which case I invite you to re-read the last paragraph.
A psychologically sound business model will be ethically aligned and well-purposed. This will not lead to more patients, but will lead to the right ones. ‘Closing the sale’ gives no opportunity to recruit new patients. Talking about money can be uncomfortable, which will lie within personal mindset issues. It is essential to learn about the short-term blindsides of costs associated with psychology, as well as the longer-term longevity and financial gains to be made and preserved.
Empowering your pricing decisions for a psychologically informed business model must be implemented with clear boundaries. It is well known that lawyers, accountants, private GPs or hairdressers do not offer free consultations, for example. It is therefore of paramount importance to give clarity as to why seeking an aesthetic opinion is different to other professions, and that paying for any subsequent time in treatment along the patient journey is transparent and upfront, thus avoiding setting a precedent that time is not worth money.
Using proper, accurate and explicit pricing will bring prosperity with no danger of questioning a patient’s affordability. There are many ways to showcase pricing structures so that the financial conversation has already taken place, even if you were not directly part of it. This offers a compassionate space for the practitioner and the patient to separately construct future planning and investment. Finding out after a skillful consultation has taken place that they are a ‘good fit’ for you and are a suitable patient for treatment, but they cannot afford you, is a threat to potential income and drains credibility.
Increased offerings of heavily reduced prices, competitive marketing strategies, cumulative discounts and reward schemes all seem to be on the rise in an attempt to neutralise the industry’s complex psychological needs. Unintentionally, this can be extremely damaging to the mental health of the patient and practitioner. Flexing treatment prices to suit perceived financial affordability can be regarded as coercive and predatory, and risks silencing actual patient needs. Especially during the current widespread economic hardship, reducing prices or offering free treatments to oblige patients who can’t afford it helps no one, and a patient may be more likely to discredit you publicly if you are not protected with a positive psychological business model.
This may be a good time to question whether your fees actually pay you. Having unmet personal needs does not make for a good professional aesthetic provider, and you will not be able to deliver quality standards of care and service to the vulnerable groups who need you. Your pricing structure may need to be reworked if you are one of the many practitioners on the edge of burnout who are earning less than minimum wage or persistently work through signs of exhaustion, exposing you to increased risk of malpractice allegations and the onset of chronic health conditions.20
A psychological business model may result in a slower schedule, but it will give you an opportunity to reflect, practise self-care and potentially charge more for your quality services, which can act as a buffer against the increasing economic uncertainty. Considering your strength as a medical professional may touch on some deep internal work. This is encouraged and lends to the acceptance of mental health and psychological wellness in aesthetic practice.
Moving forward, it will be a requirement of aesthetic practice to be responsible for how we qualify patients for treatments at a much deeper level of emotional understanding within the scope of licensing.10 For an industry regarded as having a high rate of innovation and specialism, it is promising that as we enter the consultation phase for licensing, psychology is firmly on the agenda.10,24
Through integration, aesthetic practitioners can become prepared to explore, strengthen and contribute to the knowledge, education, skills and safeguarding requirements which deliver harm reduction approaches for an accessible, future-proofed psychological business model in the interest of public health.
If you experience a decline in your mental wellbeing, notice an unexpected change in a colleague you work with or think your patients could benefit from psychological services, say something. You may be the voice they need at that moment – someone to trust. Praise their courage and seek further support from agencies like the Mental Health Foundation to promote good mental health for all.25
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