Public policy Archives - Psychotherapy Notes

Is therapy more effective when people pay a fee for it?

February 4, 2020February 4, 2020 by Ben Caldwell

Matthew Henry / Burst / Used under license

The idea that clients should pay at least a small fee for therapy in order for therapy to be effective has been around for a long time. But it doesn’t hold up as well as you might think.

This is one of those things that I learned in grad school and simply accepted as truth for a long time. And then I was startled when I actually looked into it. Not only does forcing clients to pay even a small amount for therapy not help outcomes, some evidence suggests it makes outcomes worse.

California’s AB5 signed. How will it impact therapists’ work as independent contractors?

September 29, 2019September 29, 2019 by Ben Caldwell

Despite what you may have heard, the passage of AB5 will not cause the sky to fall.

California’s independent contractor bill, Assembly Bill 5, was described in media reports as an effort to regulate the gig economy, more specifically Uber and Lyft drivers. It actually impacts many, many more workers than that. But it doesn’t change anything for master’s-level mental health professionals in the state. The change that matters for us happened more than a year ago, and most employers have already adapted to it.

Why the Kaiser mental health strike matters

June 3, 2019June 3, 2019 by Ben Caldwell

Thousands of California mental health professionals working for Kaiser plan to begin an open-ended strike on June 11. They are protesting the company’s ongoing failure to staff up their mental health operations, resulting in Kaiser patients waiting several weeks between appointments. More than 700 stories of the human impacts of these wait times can be found at kaiserdontdeny.com.

I initially posted about Kaiser’s mental health labor force struggles late last year, when therapists staged a five-day walkout. Kaiser has told its workforce that they believe progress has been made since then on a new contract, but Kaiser’s NUHW workers have been working without a contract since September, and are clearly tired of waiting. The dispute hasn’t fundamentally changed since the December walkout. In April, NUHW workers staged a one-day work stoppage in Pasadena.

My original post, published December 12, 2018, follows:

On Monday, roughly 4,000 mental health professionals employed by Kaiser Permanente in California began a planned five-day strike. The therapists (and nurses, who also walked out in solidarity) say they are protesting the massive and continued failure on Kaiser’s part to provide adequate mental health care to its own patients.

This strike is, in some ways, like other strikes you’ve heard about. While the therapists are highlighting client care issues, Kaiser itself notes that those therapists also are demanding better pay and working conditions — common demands to strike over. But this strike is also deeply unusual in the mental health world. Even when therapists are in a union, strikes are very rare. For that reason, this strike is uniquely important.

Public Service Loan Forgiveness is a mess

November 4, 2018November 5, 2018 by Ben Caldwell

When the Public Service Loan Forgiveness program (PSLF) started in 2007, mental health professionals all over the country expressed optimism and relief. Student debt is crushing younger mental health professionals — hear two stories, in their own words, here. The PSLF program promised those working in nonprofit agencies and in public service that if they just stuck it out for 10 years, the remainder of their direct student loans would be forgiven.

Any kind of mental health work is challenging, but nonprofit clinics and public systems are notoriously difficult to work in. They offer low pay, low-functioning clients, a ton of paperwork, and often, little support. It’s no wonder that many counties struggle to fill those jobs at all.

For those clinicians who experience the work as a calling, though, the PSLF program offered a lifeline. It would be a reward for staying put in positions that most therapists understandably leave. For those who otherwise faced a possible lifetime of debt, PSLF suggested a way out.

It’s not going well so far.

Why I left full time academic work

October 21, 2018October 22, 2018 by Ben Caldwell

A little more than two years ago now, I left my position as an Associate Professor at Alliant International University in Los Angeles. Many people have asked me since then why I left full time academic work. The position was relatively well-paid, with good job security. I had good colleagues, many of whom are friends to this day. I had the closest thing to tenure that the university offered: A five-year rolling contract. And I was teaching and doing research, both of which I love.

I’ve gotten used to providing a diplomatic answer to that question. My wife and I were starting a family, and the time had come for me to make a change. That’s true, it’s just purposefully incomplete. Here’s the full story.

The ESA backlash has arrived

June 3, 2019September 24, 2018 by Ben Caldwell

If you’re a counselor or therapist, there’s a good chance you’ve had at least one client ask you for a letter that would designate their pet as an Emotional Support Animal (ESA). There’s also a good chance they didn’t really need it.

ESAs are allowed in airplane cabins and in housing situations that otherwise do not allow pets or charge extra fees. Beyond that, very few standards govern what an ESA is or does. ESAs are not service animals and do not need any training or certification. All someone needs to have their pet be an ESA is a letter from a qualified therapist. But there’s no law or standard to help a therapist determine whether to write that letter.

Attending my first licensing board meeting

August 6, 2018August 8, 2018 by Jeffrey Liebert

The first licensing board meeting that I attended was in Sacramento. I did not live locally, so I had to travel to attend the meeting. I can remember well that trip and all of the expectations that I had. Basically all I knew about the California Board of Behavioral Sciences (BBS) was what I had heard from professors while in my master’s program, which was that the BBS was some ultimate authority that was to be revered and respected.

Because of what I had been told, I had honestly expected the meeting to be at some lavish location with lots of amenities. I expected the board members to be sitting on a platform, similar to a judge in a court, to highlight their authority. I had expected there to be structured, pre-arranged seating for those in advocacy positions. (I was attending as part of my advocacy role within the California Division of AAMFT.) Arriving early seemed critical, as I had expected there to be a relatively large crowd of attendees present.

None of those expectations came to pass.

Are therapists replaceable?

July 24, 2018July 25, 2018 by Robin Andersen

Ben recently published an article on the shortage of therapists in California. He discussed the “supply-demand disconnect” and why it’s so difficult to meet the needs of clients across the state. Toward the end of the article, he remarked that due to this shortage, “more of our functions will be turned over to substance abuse counselors, peer counselors, and other professionals and para-professionals.”

What did he mean by that? How can therapists possibly be replaced by individuals who haven’t earned a master’s degree, aren’t registered with the Board of Behavioral Sciences, and aren’t supervised by a qualified mental health professional? Unfortunately, I can cite examples from my own personal experiences in the workforce that support Ben’s claim.