We’ve talked here many a time about employment of prelicensed therapists. Most of our discussion has focused on employer abuses and how you can push back. But of course it’s worth noting that plenty of employers are fantastic, and that even a lot of the illegality in employment arrangements can be chalked up to well-meaning mistakes rather than purposeful villainy. It is in that spirit that we approach what seems to be one of the most common structures for paying prelicensed therapists who work in private practices here in California: Fee splitting.
Today, too many job listings for therapists and counselors are vague about pay, if they mention it at all. It’s part of a culture in mental health that keeps salaries low and professionals feeling disempowered. When employers #PostThePay — even as a range — both employers and applicants benefit.
That’s why we’re launching a social campaign encouraging employers to do exactly that.
As we put a bow on the end of 2017 and look ahead to the new year, many of us make resolutions, or plans, or promises. We make commitments for the year ahead in hopes of living our personal and professional lives that much closer to our ideals. One resolution I make each year is to update my office paperwork.
My informed consent always needs a few updates to reflect my changing practice. As I get older, I see each day a greater importance to having a Professional Will. And with technology changing so quickly around us, this year I knew I needed to add policies around social media as well.
Most of us avoid thinking about falling victim to a serious accident or illness. Should such a thing happen, we hope that we will be able to recover and our family will be taken care of in the meantime.
But what would happen to your clients? The day after you were seriously injured in a car accident, would they simply show up at your office, expecting to be seen as usual? Who would let them know what had happened, and when you might be back?
What if one of them went into crisis?
Every so often, we like to use this space to direct you to resources that might be useful to you. (See our earlier lists of resources for prelicensed therapists and for HIPAA compliance.) None of these are ads — they’re included here because we genuinely like the products and services offered, and the people behind them. We don’t receive any kickbacks or commissions for listing them, or if you choose to try any of them out yourself.
Streamlining licensure. Banning reparative therapy for minors. Fixing problems in child abuse reporting. Changing “interns” to “associates.” Saving Psychotherapy.
I’ve spent years now fighting for major changes in the world of mental health care, and winning. Many of the changes I’ve played a role in were ones that I was told would be impossible.
Today we launch Ben Caldwell Labs, the most important project of my career. The change I’m fighting for this time involves you.
Therapists, as a group, are pretty friendly people. We entered into a helping profession, one that relies on our ability to connect with a wide range of people. Generally speaking, we try to assume the best of others, whether friends or strangers. We go to great lengths to avoid jumping to negative conclusions. These are all great traits, and useful in the therapy room.
These same traits can also leave therapists and counselors vulnerable, though. Our desire to be on good terms with those around us can make it difficult when their behavior doesn’t line up with what we want or need. We’re trained and skilled at reducing conflict, so we’re typically not eager to jump into it (or create it).
Often, the frustrating things that other people and organizations do to therapists aren’t personal. They result from those other people and organizations doing exactly what they are supposed to do. They aren’t your friends, and they aren’t supposed to be. Understanding that can make it a lot easier and less stressful to deal with them.
Therapists and counselors in private practice find all kinds of creative ways to keep clients coming back. Some therapists offer clients package pricing, which they might also call a prepayment discount. For example, a therapist who charges $100 per session might offer five sessions for $450 if the client agrees to pay up front. Under either name, the therapist agrees to a price cut in exchange for a commitment to a certain number of sessions.
At first glance, everyone wins with such an arrangement. The therapist has cash in hand, the client saves money, and the client’s commitment to therapy may reduce dropouts and missed sessions. But such arrangements carry meaningful risks for therapists. These discounts can wind up costing therapists much more than they are worth.
Sites like Yelp, HealthGrades, and Angie’s List present problems for mental health professionals. We typically cannot solicit testimonials from clients, so most clients do not write reviews. When someone does, though, any response risks breaching confidentiality. So therapists usually stay away from review sites. But that leaves us with little recourse in the event that an online review is harsh, incorrect, or even fake.
These concerns are not merely theoretical. In a 2015 disciplinary case out of California, a therapist attempted to defend himself against what he considered false accusations in a Yelp review from an angry client. The therapist responded to the review, but then changed his mind, and took the response down. By the therapist’s report — and there is no evidence that either the client or the licensing board disputes this — his response to the client was online for no more than three to five minutes.
The Healthy California Act — California’s single-payer bill — continues to make progress through the state legislature. If signed into law, it would make California the first state to have a statewide single-payer health care system, even as the federal Affordable Care Act may be scaled back. How would single-payer health care impact therapists, counselors, and related mental health providers?
Here, I’ll do a quick review of what we know so far. It’s broken down into three questions providers rightly ask about the bill: How would it impact my client load? How would it impact my rates? And, How would it impact how I run my practice?