Frustrated by managed care's limits on therapy and breaches of confidentiality, Richard Shulman, PhD, has been searching for a way to put clients back in charge of their treatment. Now he believes he may have hit on a solution that dodges managed care's restraints--and rewards clients for volunteering in their communities.
Shulman and three other psychologists have created a nonprofit organization called Volunteers in Psychotherapy (VIP), Inc., that accepts the hours a client volunteers at a local charity as payment for psychotherapy.
VIP psychologists provide therapy for people who cannot afford therapy, as well as those who can but want to avoid managed-care intrusions.
"There's a bit of idealism in this," says Shulman, a private practitioner in West Hartford, Conn., VIP's director. "It reminds people of how therapy should be done with real privacy and the client in the driver's seat."
The psychologists at VIP, who work full-time elsewhere, volunteer their personal time for all administrative work. The psychologists receive a low fee for the psychotherapy they provide through VIP, but that fee is set at less than half the average private practice rate.
Through VIP, Shulman says, psychotherapists are able to practice without insurance companies demanding to know the details of a client's session--creating an atmosphere where clients feel they can talk freely about their problems.
"The need for this approach is enormous," says Bertram Karon, PhD, past president of Div. 39 (Psychoanalysis), who has practiced psychotherapy for 45 years. "Patients need absolute confidence in knowing what they say will be kept private."
VIP has served 20 clients.
Back to basics
VIP clients can choose to fulfill their volunteer requirements three different ways:
Four hours of volunteer work for a no-fee session.
Three hours of volunteer work for a $15 partial fee.
Two hours of volunteer work for a $30 partial fee.
Clients sign an agreement holding them responsible for missed sessions and late cancellations.
"Obviously they're not going to make much money," says Karon, "but their [VIP psychologists] view is there is more to this than earning money, and what you're doing is making help readily available to people. It's why we're in the profession."
Clients may choose a particular charity or community work as long as they document that they volunteered the required hours at a legitimate nonprofit organization. When people cannot fulfill their hours for any reason--a broken leg, for example, preventing a client from soup-kitchen duty--the psychologists will work with them to find another way to complete their hours of service--perhaps by doing volunteer work over the telephone.
Since its founding in March 1999, VIP has received funding from private donations and seed money from seven philanthropic foundations. Because VIP functions on such low overhead, Shulman's office also serves as VIP headquarters, where he spends an average of 30 hours a week on VIP activities.
VIP provides only psychotherapy services to clients--they will not evaluate people for outside parties to use in legal proceedings, such as divorces, custody disputes or placement of a child in school.
"If you want therapy, we'll see you," says Shulman, "but we won't wear multiple hats. This ensures that there's no other agenda going on. "
And just as for traditional psychotherapy, VIP psychologists are bound to the ethical boundaries and guidelines established by law and APA. So, even though the rules of this practice are slightly different, therapists still must report incidents of abuse, suicide attempts or threats to others.
Shulman finds that the clients' volunteer work boosts their self-esteem by helping them feel good about contributing to the community. It also gives clients who feel isolated a chance to relate to others and provides recognition for their efforts.
"The Board of VIP is very excited about creating a system that preserves a sound framework for psychotherapy regardless of clients' ability to pay," says Shulman.
VIP clients, instead of the insurance company, can decide whether therapy is right for them. And not only does it place therapy back in the hands of the client, but the volunteer aspect prevents people from wasting or misusing therapy, he says. In previous years when Shulman worked in a public clinic, he saw high rates of no-shows and late cancellations--and the government or the hospital ultimately footed the bill.
Since VIP began, Shulman reports only two no-shows and one late cancellation.