When I asked today’s guest blogger for a short bio to share with you, admittedly it was impressive – “Counselor . . . Supervisor . . . Consultant . . . Faculty member . . . and, Executive Director” were all included. But, in my mind, the descriptions that were glaringly obvious – but not included – were those of “Activist . . . Ambassador for Social Justice . . . Change Agent.”
But, in my mind, the descriptions that were glaringly obvious – but not included – were those of “Activist . . . Ambassador for Social Justice . . . Change Agent.”
Paul Fugelsang’s career has been one of commitment to creating positive change . . . in organizations and in individuals’ lives. Today, he is sharing with us one of his most recent attempts to create change by increasing access to the very mental health services that you and I provide.
It is my pleasure to introduce you North Carolina-based Licensed Professional Counselor Paul Fugelsang.
(If you are interested in writing a guest post, check out the guidelines here.)
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A Guest Post by Paul Fugelsang, MA, LPC
Falling through the Cracks
We all know that for many, therapy is expensive.
Even with the introduction of the Affordable Care Act, there are still people who don’t have insurance, or who can’t find the mental health care they need with the insurance they have.
Like most private practitioners, I started my practice by roping off a few slots for lower fee clients.
I would typically dip as low as $65 in my sliding scale, and as low as $40 for the occasional client.
Once those slots filled up, I became dismayed that I didn’t have a good place to refer those clients who wanted to work with me, but couldn’t fit into my caseload because of limited resources.
I was also acutely aware that there is very little motivation to offer low-fee sessions for many therapists, besides the sense of altruism and the quality of the relationship that may come forward as a result of the work.
While I believe these two things are crucial ethical ingredients in this profession, I started wondering if there might be another way of approaching this.
A New Alternative for Referrals
After months of spinning different scenarios in my mind, in the spring of 2013 I launched Open Path Psychotherapy Collective.
The idea behind Open Path is simple: we invite psychotherapists in private practice from around the country to set up a profile with us, and see one very low fee client (between $30 and $50 a session).
In exchange, Open Path provides our member therapists with a series of benefits that include our partnerships with Psychotherapy Networker, Goodtherapy.org, Brené Brown’s The Daring Way, and Psychotherapy.net.
(There are many others that can be found by scrolling down on our web page here).
Because I wanted to bring as many therapists into the fold as possible, we decided to never charge the therapists a fee to be members.
When they see the quality of the profile page that our therapists receive, many therapists are surprised and ask about hidden costs.
I’m always thrilled to reiterate that there is no fee whatsoever for therapists to join Open Path. To take a look at one of our profile pages, please click here.
[vimeo]http://vimeo.com/62034548[/vimeo]
What Clients Can Expect
On the client side of things, we ask for a one-time lifetime membership fee of $49.
We ask for this fee for two reasons:
- As a nonprofit organization run by an all-volunteer staff, it is crucial to have some money coming in to cover our basic operating expenses, which mostly revolve around IT and marketing costs.
- It is our goal to send quality referrals to our therapists. We see the fee as a buy-in to encourage a deeper ownership over the experience that the client has with their treatment. We are in the process of working hard to establish a financial aid fund for those clients who could afford a $30 weekly fee, but not the $49 membership fee. If you would like to donate to this fund, you can do so here.
It’s Working
After just shy of 18 months I am glad to say that we are a success.
At this point we have over 950 therapists signed on with profiles active, and we are connecting between 80-90 new clients a month.
While we are hesitant to grow this network to a place where it is too large (quality control is always our number one priority), we would like to continue to grow, especially in those areas of the country where our reach is still limited.
Many therapists who have decided not to become members have written to thank us for creating another resource in the psychotherapeutic community that encourages more individuals to seek the treatment they need, but feel they cannot afford.
We have already seen many examples of people who have become insured through the Affordable Care Act, but can’t access the mental health benefits that are supposed to be essential to their policy.
To learn more about this, please feel free to check out this blog post that was in the Huffington Post recently about Open Path.
There’s Room for You
We’ve reached many people, but we would like to reach more.
If you are interested in joining up with us, you can start by filling out this simple, online application.
Additionally, we ask our applicants to send a copy of their insurance and license.
For those that are pre-licensed or provisionally licensed, there’s space for you here too.
If you’re practicing under a supervisor, we just ask that you send us a copy of your registration and your supervisor’s liability insurance, if you are not insured yourself.
We do not work with student interns at this time.
(One must have completed their graduate training to be a member.)
If you’ve gotten this far and are not interested, please consider forwarding this post to a colleague or supervisee who may be interested.
And we love it when people share information about Open Path on Facebook.
I’m extremely grateful to the 950+ therapists who have pioneered this movement so far.
Many individuals, families, and children are receiving treatment who otherwise could have fallen through the cracks.
We are creating a movement, and we would love to have your support.
If you have any questions, feel free to write me at: paul@openpathcollective.org
About the Author: Paul Fuelsang, MA, LPC has worked in the mental health field since 1996 with a focus on projects committed to improving mental health services for lower income individuals and families. Currently , he is a mental health consultant for several overseas and national volunteer organizations. A graduate of Naropa University’s Contemplative Psychotherapy program, and a faculty member of the Trauma Resource Institute, Paul is the Executive Director of Open Path Psychotherapy Collective and maintains a private practice in Asheville, NC.
Yay, I love this! Didn’t know about it, but I just signed up. I am always concerned about the accessibility of quality mental health care.
Hi, Lauren! I know! Isn’t this cool?
Paul, thank you so much for taking time to guest post here today. Hey, I’ve had several therapists ask . . . is Open Path Psychotherapy Collective a 501.c.3?
Hi Tamara,
Thank you for the opportunity. Yes, Open Path is a 501c3. We have been working under the sponsorship of a parent organization while applying for our own status. We just received confirmation from the IRS last week that our application has been approved.
Congrats on getting your non-profit status. That paperwork can be a bear!
I was just taking a second look at your website and noticed all the great benefits and partnerships that you are forging, Paul! This is such a win-win for every single qualified therapist reading this post – Psyhchotherapy Networker, Brene’ Brown, The Gottman Institute . . . . You are modeling so many things that can be in service to a private practice – building alliances, creating a niche, choosing a social justice focus, etc.!
Paul,
I love this idea. I am a member of a group private practice. I haven’t broached the subject with them yet, but is there any way that the practice can be listed. I only ask because I’m not seeing anyone privately (in my own office), but I would love to do it in the private practice group office if possible. Thanks for doing this!
Hey, Lauren, does that mean that you are seeing individuals in the group practice? If so, I can’t imagine that they wouldn’t allow you to join them as long as you meet the credentialing requirements.
Yes, I’m seeing individuals in the group practice. Of course, I would need to check with the particular practice to see whether they are okay with the reduced rate, but I believe we are talking about one client at a time, so it wouldn’t be a large reduction, overall.
Actually, I believe that you get to decide how many Open Path clients you see at any given time. I didn’t realize that you were seeing clients in a practice, Lauren. That’s cool!
Hi Lauren and Tamara,
We have many group practices that list with us. Each practice is able to have its own page, and every clinician who wants to be a member can have their own page as well. It makes sense from a marketing perspective for a practice to list with us, given the no-cost increased exposure they will get.
Lauren, I understand that it might be different in your practice. Tamara is right when she says that the Open Path therapist takes on as many clients as they would like. Some are up to six clients and counting, while others take on just one and switch their status to “not accepting new clients.” (We can’t guarantee referrals though, and this is an important point).
We hope to hear from you soon, Lauren.
Thanks, Paul, for the information. I have sent an e-mail to the group private practice about the idea.
Have you ever thought about advertising in Counseling Today, a publication of the American Counseling Association? I think you would get a lot of other professionals involved. Here’s the information about advertising: https://www.counseling.org/publications/counseling-today/advertise-in-counseling-today
And, I’m thinking that you wouldn’t need to advertise with the professional associations, Paul. I’ll bet someone at each of the professional associations would feature an article on Open Path Psychotherapy Collective!
Paul, do you actually vet your therapists? And, once they have joined you, is there any monitoring / paperwork that goes on? Or is it pretty much on the honor system once they’re in?
We do. We ask for our therapist applicants to fill out an application that is reviewed by two different licensed therapists. From there we ask our applicants to send us copies of their license (or registration) and a copy of their liability insurance. We re-check licenses through online verification every two years.
Thanks, Paul, for staying engaged with us here! I so appreciate it!
I’m not comfortable with clients having to pay a fee to access lower cost mental health services. Seems to me therapists would gladly pay to be listed as providers since many do already on other directories like Psychology Today. I did search for therapists in a couple of different zip codes in the Open Path directory and the majority of therapists listed were pre-licensed. Great way for them to get clients but wondering if once they’re fully licensed they will no longer want to be a provider as they will probably be able to provide services to those who can pay their full fee.
Hi Pam,
Thanks for your comments. I’ll address your point regarding the fee first, and then the issue of therapist participation.
We are trying to create a therapeutic landing place for middle income individuals. Since low income individuals typically qualify for county/city/federal services, and wealthier people have sufficient insurance or the cash to pay for $125+ weekly sessions, the middle income demographic is often squeezed out. Think a single person with no dependents making $35,000 a year. This person makes too much to qualify for low-income services but couldn’t begin to pay $125 a week for therapy. We are counting on the fact that while the $49 fee might be a pinch for this client, he/she would typically have that amount at their disposal.
In terms of creating an organization that is starting from scratch with no outside funding and an all volunteer staff, a fee is a necessary component for us to exist as a small, tightly managed nonprofit. At this point the money goes towards our basic expenses — mostly IT, start-up costs, and marketing. While we debated charging a fee for therapists as we crafted our model, we were (perhaps overly, who knows) concerned that any sort of fee might discourage therapists from joining. We’re already asking them to see clients at rates much lower than they might normally dip for a low-fee client, adding an extra fee made us feel like it might be discouraging enough that we wouldn’t be able to sign up enough therapists to be a viable organization — no therapists equals no service. We have conducted surveys amongst the clinician members and less than 20% said they would be willing to pay a fee for providing lower income therapy.
As I stated in the blog, we like to believe that the fee represents a deeper level of commitment on the part of the client. Most of us have had the experience of working with lower fee clients where the service we provide is unfortunately devalued — sessions are skipped, and the work may become less meaningful. The fee is meant to work against that trend.
We also like the idea of this being a true collective — the fee a client in San Francisco pays enables a prospective client in Miami to look for a therapist who will dip far lower than most do in their sliding scale offerings. This goes on all across the country every day of the week.
In terms of our therapist-base, the majority of our clinicians (more than 50%) are licensed. I would also wager that the majority of therapists in our collective are members first and foremost out of an ethical obligation combined with the fact that they appreciate the model and the way that we make it easy for therapists to streamline the sliding scale portion of their caseload. There are definitely therapists involved that are building private practices. Many who have been with us from the start have gone from a caseload of 4 or 5, to well over 20 clients a week. These therapists by and large are keeping one slot open for Open Path clients. When the slot is filled, they indicate they’re not accepting new clients, and when it’s open again, they change their status back.
Thanks for your feedback. If you would like to continue the dialogue either here or via an email, I’d be happy to know your response.
-Paul
Oh, Pam! I’m so glad you spoke up to voice this opinion. One of our colleagues was expressing this same opinion on Facebook and I had hoped she would drop in here to continue the conversation. It will be interesting to hear Paul and others’ opinions about this,too.
I actually feel differently about this than you do. Most often folks who cannot afford the clinical services of a private practitioner are those who fall in the cracks for health care i.e. they make “too much to qualify for community services and too little to be able to afford those of most private practitioners.” I love that there is a third alternative that allows those individuals to pay for my services at a significantly reduced rate and still receive mental health care through private practitioners! I love that!
I also love that Paul has created a way for therapists to choose to give back as they are able and as they see fit without having to reinvent that process for all 900+ therapists that are providing care through Open Path Psychotherapy Collective.
So often when I talk to new graduates they don’t have a clue how to engage in acts of social justice in moderation. By that I mean that they often are giving away their services (sometimes without even realizing they are doing so) in haphazard and unhealthy ways. After all, you can’t give away what you don’t have – right? If you can’t pay your rent and your utilities, then you can’t be giving all your time away at your own expense. In my opinion, Open Path affords us all to easily give what we can and choose to give.
And, finally, I don’t think that pre-licensed therapists suddenly get licensed and no longer want to give. They just want to be able to join the licensed community of mental health professionals and still give their fair share of services. Perhaps they do move into an agency to hone their skills and don’t have time to participate in Open Path for a few years or perhaps they do move into private practice and simply need every dollar they can get for a few years. But, most of the therapists I know once they get over that beginner’s hump really do want to contribute to a greater cause . . . to their local schools or their religious communities or something entirely different . . . and Open Path again makes that really easy for us to do.
I get that the indigent man or woman on the street can’t likely access Open Path’s services yet. But, I also heard Paul indicate that that’s in the works, too. In the mean time, I’m really happy to provide a platform for Open Path and for you and others, too, to weigh in on the subject.
And, thanks, Pam, for taking time to share a different opinion! I so appreciate you doing so!
Paul and Tamara,
This is so timely! In our area (and I’m guessing all over the country!) alternative health community parlors are popping up and they have so much more style and dignity than the community mental health clinics. I’ve wanted to figure out a way to engage in community mental health like these acupuncturists, massage therapists, etc… do to help folks who “fall between the cracks” and your post has really helped me find some direction.
I plan on filling out an application ASAP.
Be well,
Katie
Hi, Katie! Thanks for dropping in tonight to chat. Remind us where you are and what is an “alternative health community parlor?” I’ve never heard of such a thing.
Hi Tamara,
I’m in Baltimore- practicing therapy in Towson, MD- and we have community acupuncture and massage places (like this: http://mendacupuncture.com/) that provide individual services in a community setting. I guess the counseling equivalent would be group therapy?
Groups like Mend Acupuncture (linked above) also have cool deals for different professions/interests each month. For example, this past month health professionals received $10 off the regular $25 treatment fee. I think this month the deal is for bartenders…
Anyway, their whole way of doing business has inspired me to think more creatively about providing affordable counseling. I know that their business model doesn’t translate perfectly to a counseling situation but still, it’s been fun to brainstorm and think outside the box!
Katie
Katie Cashin! YOU are a therapist after my own heart! Like you, I am always looking beyond my own backyard for ways to innovate in my business. I love this example you have provided! What a cool marketing idea for an acupuncturist! I love this and will be taking it to a blog post for others to learn from, too! Thank you, thank you for taking time to drop in, chat, and share a little inspiration with us so that we can all grow stronger and vibrant private practices!
I’m so glad this was helpful! Again, I’m still trying to figure out creative ways to make counseling more accessible and thanks to your site (and these comment sections!) I’m getting a lot of great ideas.
Happy to inspire you on your journey, Katie!
Katie, that’s great! I hope you’ll be back to share your new ideas with us soon!
Thanks Katie! I’m all for alternative ways of looking at delivering care while preserving the integrity of the profession. I look forward to hearing from you soon!
Hi Paul and thank you for sharing this. I like the idea of helping those squeezed out because they are in the middle. I have a question.
How do you ensure that someone actually qualifies for these fees? So that, for example, someone who doesn’t really value the cost associated with providing counseling services in a private practice setting or just wants a lower fee because it’s out there doesn’t take advantage of the system.
It also seems to give the public an unfair view of the value of counseling, at least in the feedback I have heard from clients over the years.
Thank you,
Camille
Good morning, Camille! Thanks for dropping in and asking this question! I was just wondering if / how they are qualified, too.
What is it “seems to give the public an unfair view . . . ?”
Hi Camille,
Thanks for writing.
On our client registration form we ask our clients to state an income range, and then electronically sign that they are unable to afford weekly rates for psychotherapy at current market price. We debated asking for proof of eligibility, but decided against it for ethical reasons. People on the higher end of the economic scale are rarely asked to prove their wealth or poverty, but those on the lower end are routinely asked to jump through this hoop to qualify for services. We think it can be a demeaning obstacle and didn’t want it to be part of our initiative. Additionally, research shows that income eligibility requirements can be a strong deterrent for people who would otherwise seek treatment. Finally, studies also show that when it comes to mental health services, people by and large do not opt to pay a lower fee when they can afford more. As we know, generally speaking we have a different economic relationship with the treatment of our minds and bodies than we do our automobile repair. While I’m sure some people take advantage of our program, it is the exception. (If you would like for me to share some opinions on the therapeutic implications of what might happen when this occurs, please let me know!)
As to your second point, I think you’re referring to an argument that states that by providing a sliding scale alternative that we are devaluing our work, and thus in danger of driving prices down. While I have heard this argument and understand the theory behind it, I’m not sure what the ethical alternative is. If we decide that this argument is true, then as a profession we would have to push to have sliding scale eliminated entirely from our offerings as clinicians. Mental health centers would also be suspect and therapy would gradually return to an offering that only a select few could afford.
If I misunderstood your point and just ranted about the wrong thing, please let me know! Also, if I addressed the point you were making and you have some more thoughts, I would love to continue the dialogue.
Paul, I’m interested in the therapeutic implications of requiring proof of eligibility. That’s something I’ve really not explored or considered in depth. Thanks for offering to share!
Yes, I was referring to what happens when you offer a client a $30 a week slot and they start coming in week after week regaling you with stories about their weekend spa trips in Aspen. This (somewhat unlikely) event could happen with an Open Path client or with another private practice client who is receiving a lower fee.
In my therapeutic orientation, the fee is part of the treatment. A therapist can use a conversation about the fee as an entryway into both the client/therapist relationship and the relationship the client has with his/her treatment. In my opinion it’s very fertile ground!
When the therapist and client arrive to the nuts and bolts of discussing what happens with the fee, one hopes (quite obviously) that a fatal rupture can be avoided and the fee can be adjusted to a level that feels more in keeping with the spirit of the idea of a sliding scale. To my knowledge this has never happened with an Open Path client, but our starting point is to back the therapist and their judgment in almost every instance.
Did that answer your question?
Yes, it did, Paul. It’s just one more example of the many judgement calls that mental health professionals are required to make every single day. What is in the best interest of a clients may or may not be what is in the best interest of a business.
I get why Open Path has made the decisions that they / you have made and appreciate your transparency in sharing your decision-making process with us. While your conclusions and policies may differ from a particular therapist’s own decisions and policies, it is obvious that you have thoughtfully created them.
No, I don’t think we are devaluing ourselves at all. Matter of fact, I offer a sliding scale fee in my practice. I ask because I like to be able to be fair to all clients and I have had an opportunity to get a glimpse of what “needing a sliding scale” means to different people once they are aware that proof of income is required.
Can you share more about ethical and legal reasons for not asking for proof? I know some therapists go on the honor system but I have heard this may not be legal and it’s not equitable across the board.
Thank you,
Camille
Hi Camile,
It looks like I misunderstood you earlier in the thread. This is the first I’ve heard it mentioned that it may not be legal for therapists to charge clients a lower fee without verifying their income. In terms of the ethical implications I mentioned earlier, I see it this way: when a client comes into my office to work with me, I start from a place of believing what I’m being told. It may come to pass that I’ll become curious about certain details and wonder if they are misrepresenting the truth as a defense (consciously or not, as we all do from time to time). If that’s the case, I’ll explore it with them in a way that respects the defense as opposed to one that challenges it (I think we all do this, no?). Because Open Path is an entryway into the therapeutic experience for many people, we want to grant the people that see therapists in our Collective the same consideration. As I mentioned in my reply to Tamara above, if someone is taking advantage of this in some way, my guess is that it will be revealed throughout the course of treatment. It’s my hope then that the conversation about the fee can be therapeutically integrated into the relationship as well.
I appreciate your comments about the shoes down below. (My fashion sense is still lagging behind somewhere in the 80s but I think I was able to follow). As you and Tamara point out, every client is different, and every therapist has their own nuanced ways of working with the stuff that goes down daily in our offices. The fee question is all grist for the mill, I suppose. I’m happy that in forming Open Path I was able to structure it in a way that felt most aligned to my principles.
Also, it’s worth saying here that in this exchange with you I’ve been trying to win you over in the most subtle way possible. We would love to have you as a member therapist! If you want any more information about how the program works, please let me know.
And thanks again for dialoguing…
Thank you for keeping up with this dialogue! I know it can get hard to keep up with a blog post that keeps going and going. Thank you for the offer.
You know that is a good question! I suspect it’s similar to the way we look at products as consumers. If store X has black heel for $50 but store Y has the same for $200 there might be two views.
Person #1 might say: What’s the difference? They are both the same thing. So how come I am asked to pay $150 more for the same thing? They probably just want to make more money off of me. I’ll buy the $50 shoes.
Person #2 might say: Hmm I wonder about the quality of those $50 shoes. I bet they hurt your feet and are not made with the quality of material as the $200 shoes. I better go for the $200 shoes because I don’t want my feet to hurt.
Clients have asked in the past what was the difference between my price and another professionals. So I guess this is something on certain people minds.
Oh, I get it, Camille! And, that’s such a great analogy! I’ve never had someone ask about the price difference between me and a colleague but I assume they are wondering anyway.
I’m trying to find a counselor in the Open Path network in or near Fayetteville, NC. Can you help me?