Dear mental health private practice owners: STOP IT!

STOP TRAUMATIZING CLINICIANS

I have been a long-time fan of two authors/advocates and the movement called Decolonizing the therapy space. I must pause to give credit to Dr. Jennifer Mullan. Her website is here: https://www.decolonizingtherapy.com/book/. This book (Decolonizing the therapy space) and this book: "Rest Is Resistance," by Trisha Hersey, https://blackgarnetbooks.com/item/oR7uwsLR1Xu2xerrvdfsqA. These authors and advocates have taught me so much. In my own journey through a variety of work environments, I have noticed many of the violations pointed out in both of these authors' works. There are too many violations to name in one blog post, so to keep it short, I will focus on the tendency to overwork our mental health workers and normalize these behaviors. Recently, I came across a colleague's job posting on social media, which stated that they are hiring a leadership position in their private practice.

What pained me was that this colleague should have known better, given the fact that they are certified in trauma therapy. This colleague does not appear to know better and, in fact, is just perpetuating oppression by taking advantage of those who not only need a steady income but also need health insurance. We who rely on our health insurance more than the average American (have medical issues ourselves or a family member who has medical conditions, for example) are more vulnerable than the average employee who may go to the doctor twice a year, max. We, who are more susceptible, may have to look past oppressive tactics to receive the health insurance we desperately need for ourselves or our families. The colleague's job description specified that the person in this leadership position would need to see 20 clients a week, in addition to XYZ. XY, and Z, had a whole entire page of other jobs listed that the employee would also be responsible for, in addition to the 20 clients a week.

What inspired my title, "Stop it!" is that we need to stop normalizing heavy caseloads in private therapy practices. We need to stop normalizing the expectation of seeing many clients a week, as insurance companies don't pay well. Instead, we should focus on people who can make a difference and start changing how insurance companies treat mental health professionals. A more ideal situation for all would be for mental health workers to be paid more per session by insurance panels, thereby reducing the need to see multiple clients consecutively to maintain a decent income. If we continue to expect our employees to overwork, then we are just a part of the problem and very far from the solution. Some examples of why private practice owners behave in abusive ways include failing to conduct thorough research before hiring and requiring staff to overwork to keep the business running. Other examples include some owners hiring enough clinicians to reduce their workload, or they are already well-off and disconnected from the human story behind those who depend on their employer for a stable living, safety with health insurance, and a steady income. Essentially, some private practices are simply designed to make already rich people richer (these are my bitter, lived experience examples).

20 clients a week is very full-time for a private practice therapist. That in itself is 40+ hours a week, and that doesn't account for the CEUs we often need to pay for to refresh our skills and better serve our clients. Practice owners need to find alternative income streams that aren't dependent on the backs of vulnerable clinicians. That don't expect clinicians to fill their caseloads with 30 to 35 clients a week to meet their financial obligations and provide the bare minimum treatment. Most private practices are too small to offer comprehensive benefits packages, so their employees are expected to work long hours to receive only the bare minimum benefits. This is abusive and oppressive.

This post will upset a few, as we are so entrenched in a pattern of overworking that it is against the grain to pause and be curious about any other way of working. People viciously defend what they know because it's just that, it's what they know. My goal is to invite curiosity around the work of the authors named above, or to explore how taking care of people's nervous systems can influence their continued engagement with their practice that they work for, and to encourage a more human approach.

There is a website where you can report bad ex-partners to warn others. I wish it were ethical to have something similar for private therapy practices. Private therapy practices often feel like they're operating in the Wild West, applying rules to themselves only when convenient and making things up as they go. For example, how do they determine PTO pay? How do they determine the number of clients a therapist must book or see a week to be eligible for health benefits? I know friends outside of the mental health field who often have very "light" workdays, with only a meeting or two and some emails to handle. However, it's a part of the package that they and their families receive health insurance, regardless of whether their workload is heavy or light. Therapists who own a Private Practice expect their clinicians to see a certain number of clients per week, typically 20, or face the threat of losing their insurance. You can only work a heavy workload to get health insurance; there are no consistent light days allowed. This should be illegal. How can a therapist help clients with anxiety if their job, as it is designed, is anxiety-provoking? To worry weekly that if your client(s) cancel enough, you might lose your health insurance. We need more mandated business ethics training for private practice owners. We need more standards and regulations from state to state for private therapy practices to stop this abusive behavior. I don't have quick solutions to include here; I'm bringing awareness to an ongoing concern for my colleagues who depend on private therapy practices for income. If this blog is landing somewhere in your system and validating feelings for you, feel free to list below any other rants or complaints you want to name.