A therapists’ union is not the answer

USCurrency_Federal_ReserveFirst thing, to be clear: I am pro-union. If there is any possible way that employees at your workplace can unionize, you probably should. Union workers have significantly better pay and working conditions than their non-union counterparts, and the notion that union dues will outweigh the gains you make as part of a union is typically false. Unions are good.

Psychotherapists often decry the current state of the field. Education and training costs continue to rise. Reimbursement rates are not rising. Salaries aren’t keeping up with inflation. The list goes on. (I discuss each of these issues at some length in Saving Psychotherapy.) It makes sense to wonder why there isn’t something like a therapists’ union to protect the interests of psychotherapy professionals.

However, the idea that a union of therapists will fix the problems in the field is largely wrong. A union for psychotherapists is not the solution we’re looking for. Here’s why.

Most therapists can’t join a union.

Unlike professional associations, which any member of a profession can join, union representation is limited to those who are legally able to unionize and work for an employer. About half of all licensed therapists are in individual private practice, immediately rendering them ineligible to unionize — they aren’t employees. They would be negotiating pay with themselves. Thousands more work for government entities in states where such workers cannot unionize by law.

Unions work best with larger employers.

The whole point of a union is to give employees the ability to collectively negotiate pay and working conditions with their employer. That works well for teachers, auto workers, and grocery store employees, as just three examples, because they work in settings where hundreds or even thousands of workers are employed by a single employer. But many of the therapists who are employed in union-eligible settings work in small businesses with just a handful of employees. In such settings, a union may still have benefits. But the employees simply don’t have the leverage for negotiation that large groups of employees do. (Notably, in the rarer instances where lots of therapists do work for a single employer, they use that leverage successfully.)

Again, if it is possible for you to unionize your workplace, there are a lot of potential benefits. It just isn’t an option for most therapists, so unionization isn’t likely to have a significant short-term impact on the field. But there are still ways you can be involved in pushing for better working conditions for yourself and your colleagues.

If a therapists’ union is not the answer, what is?

Sometimes, the calls I hear for a therapists’ union roughly translate to, “I want someone else to fix these problems for me.” If you’re worried about what’s happening in the field, you can and should be an active part of the solution. Don’t wait for someone else to do it for you. If your workplace could be unionized, here’s how to get the ball rolling. Even if it can’t, here are four things we all could do to improve our pay and working conditions:

  • Join your professional association, and demand more from it. The associations are keenly aware that they can’t negotiate pay rates or set standard fees. That would violate state and federal antitrust laws. But associations can help teach members how to negotiate better with insurers and employers. They can help gather and share normative data on what other therapists make. And they can help with the complaint process when employers and insurers abuse their roles. But if they are going to do these things, they need to know that members prioritize these over other activities. Make your voice and your priorities heard in your association.
  • Help organize independent contractors. Several states have been considering laws to help independent contractors organize, given the pressures of the “gig economy” and the rise of companies like Uber that use large networks of independent contractors to provide services. In Massachusetts, a recent effort focused specifically on therapists working with insurance. Elsewhere, independent contractors for Uber are forming quasi-unions to have a larger collective voice. Learn about misclassification of employees as independent contractors and California efforts to organize independent contractors.
  • Negotiate. Many therapists don’t ever even attempt to negotiate pay or benefits with their employers. Many of those who accept insurance never attempt to negotiate their reimbursement rate with the insurers. These are missed opportunities. Therapists sometimes naturally shy away from conflict, but we need to be able to stand up for ourselves. If a job or an insurer isn’t paying you enough for you to do the work without resentment, negotiate for more. If they refuse, consider leaving. Better for those you work with to see and honor your value as a professional.
  • File complaints. If you are owed back pay from an “internship” that was really a job, demand it. Be willing to file a complaint with the state labor board if necessary. If an insurer is breaking the law by delaying or denying payments, complain to the state agency in charge of them. Those complaints work.