Working Class Families, Free Therapy & Narrative Values
SCAMPI, Wellington, New Zealand
Hoping all is going well and you’re finding all sorts of ways to keep relational living, interesting.
This February 2021 newsletter is about a quick little idea I’ve been thinking about. The proposal was inspired by the pandemic and, extends itself far into the future - after we collectively crawl back out of lockdown.
What the proposal involves is inviting our world-wide network of narrative family therapists – specifically those in private independent practice - to consider offering 5% to 10% of your sessions - for free.
I plan to outline the proposal a little further down the page, but first . . . a bit of personal background to situate the idea.
When I first opened the independent clinic Yaletown Family Therapy (along with the Vancouver School for Narrative Therapy), I decided, from the outset, not to use a sliding scale for client fees.
I felt more comfortable with a billing structure charging an above average rate for 75% of my clients so as to allow 25% of my clients to come to therapy for free.
The billing formula afforded families, no matter where they were situated on the continuum of money privilege and class, access to my narrative therapy practice.
There have sometimes been slips below the 25% threshold but, for the most part, since the beginning up to the present, I’ve been happy and comfortable operating on this scheme - as have my clients.
The method is rather simple: couples, families and individuals with money privilege pay a premium and support other community members with less money privilege.
One friend calls this the ‘Robin Hood’ billing method.
I’m not sure what to called it but – it seems to work.
My dream, if I was ever voted in as ‘King of Canada’, would be to immediately institute a royal mandate stating no citizen of Canada (nor citizen waiting on citizenship) would ever pay for therapy - in much the same way present day Norwegians and their King don’t, pay.
One reason behind this billing method was based in the experience of watching many family therapists I respect, and more to the point, narrative family therapists I know (who collectively once formed the foundational bedrock of local public family therapy agencies), were, for many ‘structural’ and policy-based reasons, leaving publicly funded work spaces. Shifting instead towards opening and/or joining, private independent therapy practices.
Why the shift? There are numerous reasons, but four significant political changes to mental health policy funding and service stand out: local government moving towards right-wing neoliberal policies constraining mental health access and delivery; the rise, strength, and influence of American HMO’s shaping mental health policy; the push towards evidence based research; and government support for new public management.
As much as I comprehended the migration, the passage of narrative family therapists into private practice cut off all access of working class, lower income and government assisted families to our therapeutic services.
The result, for the most part, is that narrative family therapists work primarily with middle class and upper class clients.
So as much as I understand the politic behind the journey away from public government/agency service into private practice (that I myself have done), it nevertheless raises a very personal dilemma for me because, my family raised me with the idea that interests of the working class are the interests of all.
El Rey de la Ruina, Madrid, Spain
My background values (in part) were forge by immigrant working class Irish parents, who among other community activities, worked steadily as volunteers with the poor and dispossessed in our neighbourhood and others.
Although I was eventually afforded a ‘jump in class’, being born into and brought up with working class consciousness offers something of a double outlook involving a: 1) concurrent knowledge of the way in which class frames and shapes all experience (across many intersecting locations), and 2) a knowledge of the particular position we occupy within the class structure.
Here in Vancouver, Canada there is a common trajectory among narrative family therapists/counsellors/social workers where: after Grad school one begins working for government institutions and charity funded based agencies and then, eventually, one makes the move to join an independent practice and/or open up their own shop.
The move is understandable in that it affords independent practitioners, for the most part, to operate more freely and therapeutically creatively outside certain government policy restraints (that oversee government/public agencies).
Hyuro, Sapri, Italy
However, there is no doubt the freedom given to private practitioners to practice on their own terms has come at a cost to working class families and - to narrative family therapists as well.
Why? Well, the lack of financial access working class and under classed families experience restricts narrative family therapists to learn from, work alongside and form relationships with this vibrant and important part of the community. And similarly, not affording access to working class and government assisted families inhibits their ability to build relationships with skilled narrative family therapists.
Prior to the COVID pandemic, one in four Canadians in working families were financially vulnerable to a two-month work stoppage, meaning they did not have enough savings to remain out of low income during a two-month work interruption. But sole-parent mothers, recent immigrants, Indigenous people and young, less educated families were much more vulnerable than other families.
And - higher-income families were — perhaps unsurprisingly — in a better position to deal with a relatively long work stoppage and had jobs that are generally more conducive to telework, a partial “insurance policy” that increased their chances of remaining employed during the pandemic and, afforded them much more safety from exposure to the virus.
With this in my mind . . . I come to my proposal:
Let me begin by saying that offering a 5%-10% free service to working class and lower income families may not be possible for many independent narrative family therapists to pull off during the pandemic.
However, this doesn’t prevent planning a 5%-10% free service for working class and lower income family model – in the future.
And - I’m sure many of you know, or maybe you are yourselves, persons who do far more in the community of the working and under class than the average person. So, respectfully, this 5%-10% free service proposal does not apply to you. Let some of the rest us lead the way.
A Few 5%-10% free therapy service Tips for independent narrative therapist counsellors, family therapists and social workers:
A) When I first advertised a 25% free therapy service I quickly experienced a 6-month waiting list (I hadn’t planned on this!) Initially, I felt miserable and at odds with the wait time but came to realize how generous and appreciative clients were. As it turned out, and only after I got the hang of booking and seeing people for free, clients rarely had to wait long for a session.
B) You don’t have to publically advertise your 5%-10% free service. Believe me, word of free therapy alongside a solid hard working narrative therapist spreads fast - without advertising! And word of your free service hops into hyper-drive once clients begin circulating cool tales to other working class families and friends about working with an experienced narrative therapist.
C) There is nothing to suggest you have to do this free 5%-10% work alone. You can if you wish or - decided to grab a collection of independent free minded 5%-10% narrative therapists together during COVID. You may decide to focus on a particular group of struggling class workers/people, like a) under employed essential restaurant workers in your neighbourhood, b) a group of sole parent moms in an apartment block living near you, c) a group of exhausted frontline/peer support workers working with homeless people.
D) Let me repeat this. There is no need to do this free 5%-10% work alone. A group of free-minded independent narrative therapists might organise together after the pandemic (!) and focus on a particular working class neighbourhood, street, agency, or front-line essential service worker group who are in relationship with one common problematic issue like anxiety or helplessness.
E) In the past my 75%-25% project has focused on offering free service to specific groups by contacting agencies working with, for example: Survivors of torture; persons moving out of in-patient hospital to outpatient community placements struggling with anorexia/bulimia; families with members living in in-patient psychiatric wards; a first-nation group; groups for Graduate students struggling with a variety of issue and instituting a policy to always afford free registration scholarships to 15-20% of the total annual TC conference paid participant number (usually to students/low income persons).
F) Therapy clinics organizing their business model around Grad Students finishing their licensure hours through working class wages might initiate imaginative free services to working class families where the student therapist still gets paid.
G) And finally, please remember - when you enter into a 5%-10% free service model you will initiate the structure and amount of time you feel comfortable offering. Giving you the freedom to frame out the number of free sessions you’re comfortable giving at any given time.
The list of free 5%-10% service initiatives narrative therapists might initiate is never ending. All it takes is a little time and imagination.
So, without supporting any sense of therapist class guilt, shame or surveillance, I invite you to consider a possible 5%-10% free service model in your independent practice neighbourhood.
If you would like to contact me directly write firstname.lastname@example.org.
Take care, be safe, and try to keep things interesting.