Free 4/29 Film

Posted By admin on April 16, 2016

“On April 29, VIP will show a documentary film, “Healing Voices” which questions the definition of “mental illness.” The film shows the lives of three individuals following an earlier period of emotional upset, confusion and hospitalization. Their lives are now substantially recovered — they have satisfying jobs and families — and they now question the meaning of their “mental illness.”

This film showing is sponsored by a group from the undergraduate psychology program at the University of Hartford, and community nonprofits Advocacy Unlimited and Volunteers In Psychotherapy. The event is part of a nation-wide release of this film, sponsored by the Foundation for Excellence in Mental Health Care. A panel discussion will follow the film.

The public is invited to this free film showing of the documentary “Healing Voices” at University of Hartford’s Wilde Auditorium, Friday, April 29, at 7pm. Free parking, near Wilde Auditorium, in Lot F.

More information is available through Volunteers In Psychotherapy [(860) 233-5115].”

Mental Diseases?

Posted By admin on November 19, 2010

Are personal and emotional problems diseases?

Read the Comments of:

- Physician Director of a Psychiatric Residency program

- Chairman of a Medical School Department of Psychiatry

- President of the American Psychological Association

- Drs. Kutchins and Kirk, authors of Making Us Crazy (a critique of psychiatric labeling)

- University of Michigan Neuroscientist, Professor Emeritus of Psychology, author of Blaming the Brain: The Truth about Drugs and Mental Health

- American Psychiatric Association letter of resignation, by a former NIMH official, psychiatrist

- David Kaiser, M.D., Northwestern University Hospital, Chicago

- Consumer Reports

- E. Fuller Torrey, M.D.

- Wall Street Journal


Charles E. Dean, M.D., Director of Psychiatric Residency, Minneapolis Veterans Medical Ctr.

“[T]here is no proven physical cause for any psychiatric disorder…

[W]hy are so many…convinced that the origins of mental illnesses are to be found in biology, when, despite more than three decades of research, there is still no proof?…

The absence of any well-defined physical causation is reflected in the absence of any laboratory tests for psychiatric diagnoses — much in contrast to diabetes and many other physical disorders.”

Minnesota Star Tribune, November 22, 1997


Gary J. Tucker, M.D., Professor and Chairman of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine:

“[W]e have no identified etiological agents for psychiatric disorders.”

American Journal of Psychiatry, February, 1998.


Dr. Martin Seligman, President of the American Psychological Association, asks

“Is depression biochemical?”, (APA Monitor, September, 1998).

He reviews research evidence, then concludes:

“So the actual evidence is weak that any known biochemical state can cause …depression…

“But CNN, Newsweek, most managed-care organizations, most psychiatrists and consequently the American public, think otherwise. Is there a double standard about evidence here? Why?”


Drs. Herb Kutchins and Stuart Kirk, authors of Making Us Crazy

(a critique of psychiatric labeling)

“…American psychiatry… has unsuccessfully attempted to medicalize too many human troubles…. Managed care companies recognize what the psychiatric bible has labored to conceal: not all human troubles contained in DSM [Diagnostic and Statistical Manual] are mental disorders of a medical nature…[A child’s] school difficulties, your neighbor’s marital problems, your friend’s drinking habits, and your anxiety about an upcoming speech may cause great pain and be worthy of help from a psychotherapist, but that pain and that need for assistance require no psychiatric diagnosis to understand, and no specific medical therapy to treat.

DSM’s definition of mental disorder is flawed, the claims of validity and reliability of the manual as a whole are shaky, and the causes of most mental disorders are unknown…”


Dr. Elliot Valenstein, University of Michigan Neuroscientist and Professor Emeritus of Psychology, author of: Blaming the Brain: The Truth about Drugs and Mental Health

“Contrary to what is often claimed, no biochemical, anatomical or functional signs have been found that reliably distinguish the brains of mental patients”.

“…many are not aware of the enormous influence that the [pharmaceutical] industry has in shaping our views of mental disorders and the effectiveness of psychotherapeutic drugs…”

“I am convinced that the pharmaceutical industry spends enormous amounts of money to increase its sales and profits by influencing physicians and the public in ways that sometimes bend the truth and that are often not in the best interests of science or the public”.

“Elliot S. Valenstein has spent most of his career searching for biological explanations for behavior. Now, after more than 40 years, he is attacking the prevailing biochemical explanations for mental illness.”

TREATING MENTAL DISORDERS A Neuroscientist Says No to Drugs

Excerpts: The Chronicle of Higher Education, December 4, 1998

“We have almost reached the point where there will be no limits to what people will believe brain chemistry can explain,” he writes in the introduction to his new book,Blaming the Brain: The Truth About Drugs and Mental Health (The Free Press).

It’s time to stop blaming mental disorders on brain chemistry, he argues….

The pre-eminence of drug treatments is no accident, he goes on. Pharmaceutical companies have a financial stake in their popularity, and promote them heavily among doctors and patients. … Valenstein cites studies that examined some of the literature distributed by the companies and found that much of it contained misleading or unbalanced information. Drug companies are also the largest sponsor of medical research in the United States and Canada, … Valenstein says. In some cases, they give complete freedom to researchers. In other cases, the contracts they require give them the right to exclude information from published reports, or to delay publication of the report itself… Psychiatrists, too, have supported the use of the drugs, he argues. For one thing, he says, an emphasis on medication allows psychiatrists to fend off competition from psychologists and social workers… While that may not be the reason for their support, he writes, “there is little doubt that since the 1960s, psychiatry has increasingly emphasized biochemical factors as the cause of mental disorders….physicians feel increasing pressure [e.g. from managed care] to ignore other treatments, like psychotherapy, in favor of costly drugs that may have serious side effects and little benefit.”


Loren R. Mosher, M.D., Former official of National Institute of Mental Health (NIMH)

Letter of Resignation to the American Psychiatric Association (excerpts):

“There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder… Is psychiatry a hoax – as practiced today? Unfortunately, the answer is mostly yes.”

Letter to the President of the American Psychiatric Association:

“After nearly three decades as a member it is with a mixture of pleasure and disappointment that I submit this letter of resignation from the American Psychiatric Association. The major reason for this action is my belief that I am actually resigning from the American Psychopharmacological Association…

At this point in history, in my view, psychiatry has been almost completely bought out by the drug companies. The APA could not continue without the pharmaceutical company support of meetings, symposia, workshops, journal advertising, grand rounds luncheons, unrestricted grants etc. etc. Psychiatrists have become the minions of drug company promotions….

Psychiatric training reflects their influence as well; i.e., the most important part of a resident’s curriculum is the art and quasi-science of dealing drugs, i.e., prescription writing…We condone and promote the widespread overuse and misuse of toxic chemicals that we know have serious long term effects — tardive dyskinesia, tardive dementia and serious withdrawal syndromes….

Finally, why must the APA pretend to know more than it does? DSM IV [Diagnostic and Statistical Manual] is the fabrication upon which psychiatry seeks acceptance by medicine in general. Insiders know it is more a political than a scientific document… The issue is what do the categories [diagnoses] tell us? Do they in fact accurately represent the person with a problem? They don’t, and can’t, because there are no external validation criteria for psychiatric diagnoses. There is neither a blood test nor specific anatomic lesions for any major psychiatric disorder. So where are we? APA as an organization has implicitly (sometimes explicitly as well) bought into a theoretical hoax. Is psychiatry a hoax – as practiced today? Unfortunately, the answer is mostly yes….”

Loren R. Mosher, M.D.


David Kaiser, M.D., Northwestern University Hospital, Chicago,  “Psychiatric Medications as Symptoms”
February, 1997

“…psychiatric medications often become symptoms, in the sense of symptoms as signs full of meanings which function to cover or fill in some lack in a person’s life — whether it is a lack of love, desire, purpose or whatever. The psychiatrist, as the dispenser of these medications, is often acting to reinforce the patient’s symptoms, further covering up of the patient’s ability to see the true source of their discontent or unhappiness. As a result patients often need medications in the way they need their symptoms, as a substitute for what they really need from people. Medications lessen their pain, help them forget, provide a kind of substitute for love, and these substitutes are all the more powerful because they are sanctioned by modern medicine, authority and technology. So it is possible for modern biological psychiatrists to unwittingly act out symptoms and fantasies with their patients, leaving them more alienated from themselves and more dependent on false forms of gratification….

Today’s patients, discontented, unhappy, fragmented and confused by an increasingly frantic, alienating and violent society, come to psychiatrists for help, only to have their illusions shored up by an increased dose of a technologic fix. They are told they have illnesses that are biologic and can be fixed, instead of being allowed to speak about their unhappiness, to speak about how difficult it is to be a human being, to speak about their suffering, because human being have always suffered and always will. To believe that we can conquer depression, despair, anxiety with modern technology is the height of hubris and bad faith, a mere childish fantasy, unworthy of any thoughtful person who has their eyes open to human history and modern culture. Psychiatrists have become part of the problem. Perhaps they have always been so….

An epidemic of depression? How about an epidemic of cozy relationships between academic psychiatry, pharmaceutical companies and managed care companies? How about an epidemic of psychiatrists who no longer think seriously about what suffering is? How about an epidemic of psychiatrists more interested in power and social legitimacy than in listening to their patients?

As a practicing psychiatrist, I often feel the pull of a patient’s symptoms, a pull in fact to participate with them to cover up what is really going on [by prescribing medication]. It is a seduction which should be resisted, because it is a seduction to enact a fantasy. Modern psychiatrists have been seduced wholesale, not only by patient’s wishes, which are fantasies, but also by positivistic science and technology, which are as much based on fantasy.”


Consumer Reports, “Pushing Drugs to Doctors”, February, 1992, p. 88, 90.

“Though doctors insist their scientific training, high intelligence, and sophistication enable them to resist manipulation, the truth is that skillful marketers can influence M.D.s just as easily as they can sway the rest of us. A landmark 1982 study by Dr. Jerry Avorn of Harvard showed that doctors’ opinions of two popular, heavily advertised drugs came straight from the ads and sales pitches. The doctors believed they’d gotten their information from objective scientific sources, but those sources, in fact , had said all along that the drugs were not effective for their advertised uses….

“From medical school on, physicians are taught to regard medical school faculty, medical journals, and professional meetings as sources of unbiased information. Pharmaceutical companies have found ingenious ways to influence all three. In the process, the distinction between promotion and true scientific exchange has been blurred and, in some cases, totally erased.

“The confusion is no accident; it serves drug companies well. ‘From a propagandist’s perspective, the less the audience knows it’s being manipulated, the greater the opportunity, because its defenses are down’…”


E. Fuller Torrey, M.D., quoted by Reuters Newsservice, “Researchers say drug companies, politics cheat mental health research”


July 17, 1998

“Researchers complained Friday that drug companies and political pressure have skewed the way mental health research is funded. Both the head of the National Institute of Mental Health and a prominent critic of drug companies and government agencies agreed that commercial and political influence have sometimes prevented vital research from being funded and carried out.

‘NIMH has not been doing the clinical trials, has really abandoned the field to the pharmaceutical industry,’ said Dr. E. Fuller Torrey… Torrey accused drug makers of bullying researchers and scientists of compromising their ethics.

‘There are colleagues of mine who have not only accepted tickets to football games, but been paid to go to football games, and then turn around and say this has not influenced them,’ Torrey said. He also noted that drug companies often pay researchers to speak at conferences. ‘Ten thousand dollars is not an unusual amount of money to be paid to stand up and make pronouncements,’ he said.

Later, Torrey told Reuters: ‘They are then given future speaking engagements depending on “how well they do.”’ The implication, he said, is that research must be reported in a way that puts the company’s drugs in a flattering light….

Dr. Steven Hyman, NIMH director, agreed with some of what Torrey said. ‘Dr. Torrey is absolutely right’, Hyman said. ‘The drug companies do what they do and they have certain goals, which are to get certain treatments approved…’”


Wall Street Journal, “Medical Journals Rarely Disclose Researchers’ Ties”


February 2, 1999

“Scientists are increasingly supported by for-profit companies, but a new study shows that critical fact is seldom revealed in published research.

To flag potential bias, researchers publishing studies are generally expected to disclose any financial conflicts of interest they have. But according to an analysis of 210 influential journals, mostly in the bio-medical field, authors almost never do.

The finding, presented at a meeting of the American Association for the Advancement of Science last week, raises questions about the independence of researchers and the credibility of their results in an era of creeping commercialization in science. Industry plies scientists with grants, fees for speeches and consulting, or gifts including lab materials. In many fields, its hard to find scientists who are conflict-free.

…a mere 0.5% of some 62,000 articles published in 1997 included information on the authors’ research-related financial ties, such as stock ownership or patent rights. The data startled prominent medical editors, who said authors who don’t disclose their business ties deprive readers of pertinent data in making health-care and other decisions.

…in a separate investigation of 800 scientific papers two years ago, [Dr. Krinsky] found that some 34% of authors had conflicts of interest, none of them disclosed.

…Last year, a New England Journal of Medicine study showed that virtually every researcher publicly supporting the use of new hypertensive drugs had financial ties to the drug manufacturers. And, significantly, none of their ties were disclosed…”

Profit Driven

Posted By admin on November 16, 2010

Profits and no Privacy in Psychotherapy: Managed Care

Read the Reactions of:

- Two Presidents of the American Psychiatric Association

- President of the American Psychological Association, Division of Psychoanalysis

- Timothy McCall, M.D., author of Examining Your Doctor.

- Dr. Elliot Valenstein, University of Michigan Professor Emeritus of Psychology

- Dr. Lawrence Sack, President of the American Association of Private Practice Psychiatrists


Reactions of two Presidents of the American Psychiatric Association:

Herbert S. Sacks, M.D. (President-elect):The New York Times, Sunday, October 27, 1996, “Connecticut Section”.

Dr. Sacks is described as having led, in the 1970’s, the “successful battle to mandate group health coverage for outpatient psychiatric treatment…” However, Dr. Sacks now describes managed care as “…totally undesirable in terms of people getting adequate care… Managed care operations of course would like…extraordinary profit for insurance companies… The greed is daunting… As an example of greed, the C.E.O. of USHealthcare will get in excess of $900 million plus… Where does the money come from? It comes from the denial and interruption of … patient care.

Harold I. Eist, M.D. (current President):American Journal of Psychiatry (153:9), September 1996, pp. 1123-1125.

“Make no mistake, we are under attack by a rapacious, dishonest, destructive, greed-driven insurance/managed-care/big business combine that is in the process of decimating all health care in America, particularly … [psychotherapy and psychiatric care]….

“The market is controlled by a few large corporations and the health insurance industry, stifling competition and excluding the choices of the people who need care and those who provide it. The health market is an imprisoned market, controlled by corporations, which operate identically to totalitarian states, with gag rules, discharge-without-cause clauses, and so-called appeals processes deriving directly from Machiavelli…. Society needs to know that managed care is a false promise based on a false idol”. Dr. Eist continues by emphasizing the need for his profession to fight the threats to ethics and confidentiality posed by managed care.


Dr. Nathan Stockhamer, President of The American Psychological Association, Division of Psychoanalysis:

“We must state emphatically that managed care is inherently flawed. We simply cannot let private entrepreneurs decide whether they want to spend money on behalf of patients or keep the money in corporate profits.”


Timothy B. McCall, M.D., Physician commentator, author of Examining Your Doctor, on National Public Radio, May 20, 1998

“Mental health care benefits have been cut by more than 50% in the last ten years. In particular, managed care plans along with employers have been reluctant to pay the cost of ongoing psychotherapy. Even patients with serious disorders that stem from such things as childhood sexual abuse are being limited to just a few visits. That’s if they are seen by a therapist at all…

The only area of mental health coverage that employers and HMO’s seem interested in funding is drug therapy. They’d rather just throw Prozac, or better yet, some generic substitute costing pennies a pill, at mental health problems”.


Dr. Elliot Valenstein, Professor Emeritus of Psychology, University of Michigan, author of Blaming the Brain: The Truth about Drugs and Mental Health.

“For psychiatrists, medical insurance companies, and especially the pharmaceutical industry the benefit derived from promoting drug treatment and chemical theories of mental disorders is primarily economic. Of course, the argument is never framed in that way…

Psychotherapeutic drugs, like the other physical therapies before it, have served the interests of the psychiatric profession. Of course, psychiatrists are not all of one mind, but in various ways the profession as a whole tends to promote drugs by exaggerating what is known about the chemical basis of mental disorders and the effectiveness of drugs, and often by discrediting alternative treatment modalities…

By adjusting payment schedules, medical insurers are playing a major role in shifting treatment toward drugs and away from psychotherapy.”


Dr. Lawrence Sack, President, American Association of Private Practice Psychiatrists,
”What Will Managed Care Do to the Profession of Psychiatry?”, August, 1996

“The managed care assault on all but the most brief psychotherapies, not just psychoanalysis, include excessive review, destruction of the doctor-patient relationship and environment for treatment, invasion of privacy, excessive demands for record-keeping and supposed standards of treatment that have as their goal a reduction in the availability of care….

The future of psychiatry is in doubt. [Psychiatric] Residencies in America cannot be filled with graduates from U.S. medical schools. Medical students know that psychiatrists are being coerced by managed care not to provide needed and often expensive…services. In many training programs, residents are not even exposed to psychotherapy. [Psychiatric] Residents are being trained with little understanding of how to listen to patients, and how to understand their thoughts, motivations, fears and feelings. There exists a very real threat of a mindless psychiatry, in which only chemical treatment will be understood and practiced…

Reviews of the necessity for the treatment being provided are undertaken by clinicians who profit financially, directly or indirectly, in proportion to the reduction in health care they produce. Often, these reviews are executed by inexperienced clinicians….

Psychotherapy instruction for medical students and [psychiatric]residents is in short supply. The result is residents trained primarily in medication management and severely limited in their ability…to talk meaningfully with their patients.”

Psychology Today

Posted By admin on November 16, 2010

Volunteers in Psychotherapy in Psychology Today

Excerpts from December, 2001 Issue CASH, CHECK OR VOLUNTEER WORK:

A NEW WAY TO PAY FOR THERAPY

Psychotherapy patients in Hartford, Connecticut are participating in a national trial, but no new drugs or behavioral tactics are involved. At Volunteers in Psychotherapy (VIP), patients volunteer [several] hours at a local charity [of their choice] to earn one free hour of psychotherapy. VIP participants have volunteered at a homeless shelter, a food bank or the Red Cross. “It’s a way to tell clients, ‘You have something of value to offer the community,’” says Richard Shulman, Ph.D., the psychologist who founded the nonprofit organization in 1998 after growing increasingly frustrated with managed-care medicine.

The community work provides its own therapeutic benefits… “It gets them into situations where they are helping others and are being thanked and rewarded with the approval of coworkers,” Shulman explains…

Shulman has raised [money] from private donors and philanthropic organizations to fund VIP. He and four additional psychologists are paid…slightly less than half the going rate in Hartford. [All administrative and development work is donated, as are office space and phone.]

Last year, VIP was honored by the Connecticut Psychological Association, but the real gratification for Shulman is the chance to practice in an environment free from managed-care restrictions. Shulman cites clients’ concerns about confidentiality with HMOs as an incentive to participate in the program. Clients also realize that they can receive therapy for as long as they like.

“It feels like the right way to do therapy,” says Shulman. “Clients know that they have earned the right for the session to be absolutely private.”

- Robert Whitaker [Author of Mad In America and Anatomy of an Epidemic]

VIP and APA

Posted By admin on November 16, 2010

Therapy that rewards clients and community
Psychologists’ nonprofit venture evades managed-care’s challenges and encourages volunteerism.

By MEL WATERS
Monitor Staff
The Monitor on Psychology  of the American Psychological Association 

May 2000, Vol 31, No. 5    Print version: page 38

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.

Win-win practice

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.

Letters of Support for VIP

Posted By admin on November 16, 2010

Letters of Support for Volunteers in Psychotherapy, Inc.

- Professor of Psychology & University of Connecticut Doctoral Program in Clinical Psychology Director of Clinical Training, Dr. George J. Allen

- Past President of the American Psychological Association Division of Psychoanalysis and Michigan State Professor of Psychology, Dr. Bertram P. Karon

- Distinguished Professor Emeritus, Rutgers University and Director Emeritus, New York Center for Psychoanalytic Training, Dr. Herbert S. Strean

- National Empowerment Center Director, Laurie Ahern

- Greenwoods Counseling Services Executive Director, Reverend W. David Dobbins, Jr.

- Trauma Research, Education and Training Institute President, Dr. Laurie Anne Pearlman

- Regional School District #10 Superintendent Dr. Evan Pitkoff


On behalf of the students and faculty in the Clinical Psychology Program at the University of Connecticut, I thank you for the very informative presentation you made about Volunteers in Psychotherapy (VIP). After hearing your presentation, we wish to provide our collective support to VIP. This innovative program provides a unique and vitally necessary service for those members of our society who otherwise would be denied access to psychotherapeutic services.

Psychotherapy is not a well understood process. It is viewed by many as providing an opportunity for others not like themselves (e.g., the “mentally ill,” the insane,” “crazy people,” etc) to talk about their problems. This tendency to maximize differences between “us” and “them” creates a sense of shame and stigma about the process and leads many troubled individuals to not seek the help they desperately need.

From a larger perspective, however, entry into psychotherapy represents an admission by individuals, couples, or families that their usual ways of dealing with problems no longer are effective. Within psychotherapeutic contexts, such life issues are explored in environments marked by concern, support, and privacy.

The expectation of privacy makes it easier for troubled individuals to fully share the extent of their pain and difficulties; it is only out of this, at times, brutally honest sharing that effective resolutions can be forged. The importance of privacy within psychotherapy has been upheld by multiple legal rulings and administrative statutes that protect patients or clients from having personal information disclosed without their consent and by ethical codes that demand confidentiality from practitioners. It is also clear from a variety of professional and media sources that psychotherapy is effective in promoting the greater public good and in improving the human condition.

Unfortunately, privacy and confidentiality rights within psychotherapeutic contexts have been breached, slowly, but inexorably. One primary culprit has been for-profit managed care companies, who demand summaries about clients to “ensure the medical necessity” of treatment. Despite assurances that such communications were “personal and confidential,” such information leaks out all too easily. Over the past decade, I had occasion to see in psychotherapy six individuals who worked in rather high-level administrative positions within the insurance industry. Without exception, all declined using their own insurance benefits to pay for services; one noted “I have no business seeing the personal information that comes across my desk. If my name was on those forms, I would most certainly lose my job.” Ironically, these individuals all had the financial resources to ensure their own privacy yet worked in contexts that denied the same basic rights to those who were less economically advantaged.

VIP combines two fundamentally basic human virtues in a manner that promotes human welfare. The system you developed permits exploration of personal issues in a context of total privacy while setting the expectation that those who receive help will themselves engage in charitable activities. The ability and willingness to “give back” to less fortunate others is incredibly healing in its own right. VIP provides privacy to those who cannot afford to purchase it outright while promoting in its clientele the values of charity, compassion, and service to the greater public good…

I, the clinical faculty, and our students wish you well in your future endeavors on behalf of VIP.

Best Wishes,

George J. Allen, Ph.D. Professor of Psychology Director of Clinical Training


“Volunteers in Psychotherapy (VIP) is a unique nonprofit organization in West Hartford, Connecticut, which provides a much needed relief for people in need of psychotherapy who cannot afford to pay the fees out of their own pocket.

 As a Professor of Clinical Psychology and a former President of the Division of Psychoanalysis of the American Psychological Association, who has spent more than 35 years teaching clinical psychologists, psychiatrists, and social workers, and doing research on psychotherapy and the delivery of mental health services, I am impressed with Volunteers in Psychotherapy.  I have known two of the principal founders of VIP (Drs. Shulman and Burrell) for years, through ongoing consultations, through mutual professional interests and review of each others’ publications, and through our joint symposium presented to the national conference of the American Psychological Association.  I have firsthand knowledge of the seriousness and ethical integrity of their perspectives and their work….

 Volunteers in Psychotherapy (VIP) is unique in providing first rate help that is confidential and affordable.  It is able to do so because of the altruism of a number of psychotherapists who are willing to accept low fees if the patient is willing to “earn” their treatment by doing voluntary community service for the charity of their choice…

 Volunteers in Psychotherapy is a nonprofit public service, which hopefully will establish a model in Hartford which can be imitated in other communities.  It certainly deserves all of our support.”

Sincerely,

Bertram P. Karon, Ph.D., Professor of Psychology and Past President of the American Psychological Association Division of Psychoanalysis


“I truly believe that your organization is the best alternative to managed care that I have seen.  Not only do you insure that the patient’s therapy is completely confidential, but by arranging for clients to work for charities, you are concomitantly enriching the patient’s therapy and enhancing a part of the community that needs help desperately… [Y]our clientele is getting very superior treatment in this day and age of third party payments.

You and your colleagues are to be congratulated on your very creative project. I am most admiring of your genuine professionalism and am very confident Volunteers in Psychotherapy will grow by leaps and bounds.”

Sincerely,

Herbert S. Strean, D.S.W., Distinguished Professor Emeritus, Rutgers University and Director Emeritus, New York Center for Psychoanalytic Training


“It is with great pleasure and honor and respect for your work that the National Empowerment Center, Inc. endorses and supports the mission and vision that is Volunteers in Psychotherapy, Inc.

As you are aware, the NEC is a national center founded by former psychiatric patients who have recovered…

Volunteers in Psychotherapy, Inc. is truly a unique alternative which embodies all of the elements needed to allow people to recover and return to happy and secure lives.

With the advent of managed care and the rationing of psychotherapy – coupled with the requirement to pathologize and medicalize problems in living in order to secure reimbursements, the ability to build a trusting and empowering relationship is elusive at best, if not impossible.  VIP’s model of offering totally confidential, client-controlled therapy in return for volunteer work of the client’s choice, allows true healing to take place.

We at the NEC only wish that VIP was available to us when we were in our most severe, emotional states.  We cannot express enough our deep commitment and support of the work you are doing and that of Volunteers in Psychotherapy, Inc.”

Warmest regards,

Laurie Ahern, Director, National Empowerment Center, Inc.


“Your plan to offer those in financial need the opportunity to afford their mental health care through community service impresses me as both creative and responsible:  it offers the patient the respect which comes from investing in oneself and the community, while assuring that the privacy of the patient-therapist relationship is preserved.

 You well know that with the changes in the mental health industry promoted by insurance companies, it is increasingly difficult for people to find therapy as both affordable and confidential.  It is refreshing and encouraging to know that an effort such as yours is offering an option which allows both therapists and patients a process free from the intrusion of third-party payers.

I applaud your commitment to the people of your area, and wish you every success in your endeavor!”

Yours Sincerely,


[Reverend] W. David Dobbins, Jr., Pastoral Counselor, Executive Director of Greenwoods Counseling Services, Litchfield, Connecticut


“I am writing to convey my support for Richard Shulman, Ph.D. and his organization, Volunteers in Psychotherapy.  I have known Rich since 1983, when we were psychology interns at the Greater Hartford Clinical Psychology Internship Consortium…

Rich Shulman is a man of the greatest professional and personal integrity.  He is a sensitive and talented psychologist who is unwavering to his commitment to the best possible treatment of psychotherapy clients.  He has made important personal sacrifices in order to meet his high ethical and professional standards of care, refusing to participate in systems that he thought did not have the clients’ best interest as a top priority…

I have become acquainted with many therapists and many therapy organizations.  I believe that VIP is unique, based in a deep commitment to serving the underserved, and likely to succeed.  VIP will be able to provide psychotherapy to some of the neediest people who would otherwise be excluded from top-notch treatment in Connecticut.  I strongly support his efforts and believe that his program will be successful…”

Sincerely,


Laurie Anne Pearlman, Ph.D., Clinical Psychologist and President, Trauma Research, Education and Training Institute, South Windsor, Connecticut, and co-author of  “Psychological Trauma and the Adult Survivor”.


“As an educational leader, with a background in special education and a degree in psychology, I have always tried to instill in students the values of providing community service and the need to know when and where to get help.  I applaud Dr. Shulman on the development of his nonprofit organization, Volunteers in Psychotherapy (V.I.P.) as this organization will allow people who are uninsured or who lack financial resources to obtain quality and confidential psychotherapy.  By the design of the concept, it will also instill in clients the importance of providing community service.  The rewards of community service, especially as it relates to the improvement of one’s self-esteem should serve as reinforcement to successful outcomes of therapy.

Furthermore, I have often seen the need for children and families to first address personal and emotional issues via therapy in order for the children to fully maximize their potential in the academic school setting.  Often, these same people are hesitant to speak to a school psychologist or social worker, or any therapist for that matter, about family problems under conditions that they may feel are not absolutely confidential.  This is where a program such as Volunteers in Psychotherapy can serve as a valuable resource to schools.

The creation of this program is a reflection of the altruistic nature of Dr. Richard Shulman in his belief that everyone who wants psychotherapy should receive quality therapy in a confidential manner regardless of ability to pay.  I support this program and believe that Dr. Shulman is on the cutting edge in his field in this endeavor.

Sincerely,

Evan Pitkoff, Ed.D., Superintendent of Schools, Regional School District #10, Harwinton and Burlington, Connecticut

Surgeon General Report

Posted By admin on November 16, 2010

The Surgeon General’s New Clothes:
How the press and the SG distort the truth about mental distress

(also available in Perspectives Mental Health Magazine, April-May, 2000):

By Richard Shulman, Ph.D.

Following the issue of the Surgeon General’s report on mental health (December, ’99), press headlines echoed Dr. David Satcher in declaring a new era of enlightened understanding. Headlines and media sound bites proclaimed science’s demonstration that emotional disorders and behavioral problems were truly legitimate physical illnesses, some would say brain disorders, rooted in genetics and biochemistry.

Imagine how surprised the writers of such headlines might be to discover these research summaries in the professional literature:

  • “Few lesions or physiologic abnormalities define the mental disorders, and for the most part their causes remain unknown.”
  • “[N]o single gene has been found to be responsible for any specific mental disorder…”
  • “[T]here is no definitive lesion, laboratory test, or abnormality in brain tissue that can identify …[mental] illness.”
  • “It is not always easy to establish a threshold for a mental disorder, particularly in light of how common symptoms of mental distress are and the lack of objective, physical symptoms.”

Surprise: these are QUOTES from within the Surgeon General’s report, just some of the many similar summaries of decades of research:

  • “The precise causes (etiology) of most mental disorders are not known.”
  • “DSM-IV [the diagnostic manual of the American Psychiatric Association] is descriptive in its listing of symptoms and does not take a position about underlying causation.”
  • “The thresholds of mental illness or disorder have, indeed been set by convention…”
  • “All too frequently a biological change in the brain (a lesion) is purported to be the ‘cause’ of a mental disorder…[but] The fact is that any simple association – or correlation – cannot and does not, by itself, mean causation.”
  • “[N]o single gene or even a combination of genes dictates whether someone will have … [a mental] illness or a particular behavioral trait.”
  • “Even with…schizophrenia, the median concordance rate among identical twins is 46 percent…meaning that in over half of the cases, the second twin does not manifest schizophrenia even though he or she has the same genes as the affected twin. This implies that environmental factors exert a significant role in the onset of schizophrenia.”
  • “Placebo (an inactive form of treatment)…is more effective than no treatment [for mental disorders]. Therefore, to capitalize on the placebo response, people are encouraged to seek treatment, even if the treatment is not … optimal…”

Why are headlines trumpeting that our emotional problems are best defined as medical illnesses, when physicians such as the SG can find no biological lesions or markers that define them? And why is the press simply parroting the SG’s summaries, when such headlines mislead the public, evidenced by details within the report?

Is it possible that this report, and the oft-repeated truisms that emotional problems are at root medical diseases, also reflect the influence of business interests, and not strictly academic science? Sound too paranoid? What’s next, would we suspect business interests of trying to influence government? Suspect the pharmaceutical industry of trying to influence the Food and Drug Administration and organized medicine? Could the press unwittingly be coopted by uncritically accepting the pronouncements of people in authoritative white lab coats?

We all know that emotional turmoil and human suffering exists — but is it disease? We’re so used to hearing that “mental illnesses” are “chemical imbalances” that we miss the point: Decades of research have failed to confirm this hypothesis. There are no “chemical imbalances” which validly and reliably define people’s troubles. That is why there are no lab tests or other assays of physical disease which confirm the “diagnosis” before you’re offered Prozac or your child is given Ritalin.

If your Aunt Doris is sad, demoralized or in a longstanding unhappy rut in her life, should we call her “dysthymic,” a psychiatric label with no demonstrable basis in biochemistry? If your 9 year old neighbor Andy’s parents inconsistently instill discipline in him, and he now misbehaves in school, do we affix the label “ADHD” [attention deficit hyperactivity disorder], a category for which there is no physical marker or disease entity? Yes, we can give Andy a medical-sounding label, and supply stimulant pills. We can give pills which have a sedative or stimulant effect on anyone; this does nothing to confirm the presence of a physical disease.

Misled by this medical paradigm, we frequently miss a key opportunity to understand the underlying personal reasons that someone is distressed.

A substantial literature now demonstrates that many psychiatric medications show only modest efficacy versus placebo, if studied scrupulously (and in research not funded or squelched by drug companies). [note: Some of this research has been published by Dr. Irving Kirsch right here at the University of Connecticut.] Interestingly, this perspective was briefly acknowledged, but minimized in the SG report.

The Wall Street Journal describes “an era of creeping commercialization in science,” citing an analysis of “210 influential journals, mostly in the bio-medical field” in which researchers publishing studies rarely disclose their financial ties to drug manufacturers. Such conflicts of interest have been covered in major medical journals and newspapers in the last year, even eliciting an apology from the New England Journal of Medicine recently, but this issue is not to be found in the SG report.

Surveys published in Psychiatric journals show that medical students are rejecting psychiatry as a specialty, often “citing a lack of scientific foundation,” with trends suggesting that psychiatry is viewed as “outside the mainstream of medical practice.” Psychiatric residents publish satires depicting their education as funded and shepherded by pharmaceutical companies, with little attention given to the subtleties of understanding the personal turmoils and hidden dilemmas of another human being. Loren Mosher, M.D., formerly a prominent researcher with the National Institute of Mental Health, published his resignation letter from the American Psychiatric Association in Psychology Today (Sept./Oct. ’99), documenting how the organization is “unduly influenced by pharmaceutical dollars;” over-relying on drugs, underemphasizing their shortcomings, side-effects, and toxicities, and virtually ignoring psychotherapy.

Even Consumer Reports and JAMA (Journal of the American Medical Association) reveal how drug companies conspire to influence prescribing Physicians and the consuming public.

But pharmaceutical company funds and influence aren’t mentioned by the Surgeon General, nor by uncritical publicists in the popular press. Nor does the report highlight that actual consumers of mental health services can be critical of groups comprised largely of family members of consumers, such as NAMI [National Alliance for the Mentally Ill]. The leadership of these latter “family” groups don’t advertise that they are covertly funded by pharmaceutical companies. Remember the group CHADD, a major proponent of stimulant medication for children, later revealed to be secretly subsidized by drug makers? NAMI advocates for biological treatment, even forced drugging, for what they repeatedly call “brain diseases.” The SG report portrays NAMI positively, minimizes the conflict over forced treatment with consumers themselves, and says nothing of NAMI’s multi-million dollar drug industry funding.

Are behavioral and emotional problems illnesses if decades of research have failed to find physical disease entities which cause them? The headlines surrounding the SG report blind us to this confounding miscategorization. Is this a summary of science, or is it marketing of psychiatric guild interests? Isn’t it in the financial and professional interest of psychiatrists (and drug companies) to insist that all of life’s confusion, unhappiness and conflict is their domain, over which they hold unique medical expertise? Especially when managed care will only pay for services deemed “medically necessary,” and clearly prefers to pay for pills over the expense of psychotherapy.

Without demonstrating any physical abnormalities, we can give disease labels that then grant a child the advantage of an extra hour and a half to take their SAT’s. Or we can fabricate disease labels which allow a criminal to murder, rape or embezzle, and then avoid legal consequences due to “psychiatric illness.” But isn’t this a subversion of logic and responsibility that the profession is purveying? Why is the press so uncritically accepting of this illogic, which spins medical illness labels out of no identifiable physical pathology, while benefiting particular “special interests?”

Here’s how two professors summarize this issue: “…American Psychiatry… has unsuccessfully attempted to medicalize too many human troubles…[A child's] school difficulties, your neighbor’s marital problems, your friend’s drinking habits, and your anxiety about an upcoming speech may cause great pain and be worthy of help from a psychotherapist, but that pain and that need for assistance require no psychiatric diagnosis to understand and no specific medical therapy to treat.”

The SG does endorse psychotherapy, but emphasizes primarily more simplistic forms of therapy that can be easily researched; those that are short-term, focused on limited problems, and that often have manuals. As H.L. Mencken said “For every complex problem there is an easy answer, and it is wrong.” Most people’s lives and problems are complex , and so is thoughtful therapy and the research which tries to document its helpfulness.

Why do we accept such oversimplified and medicalized truisms about life’s problems? Are we all blinded by the trappings of science? By misleading explanations repeated often? By appeals to political correctness? Do we prefer dreaming of “magic pills” rather than facing complex and upsetting human dilemmas that inevitably are part of life?

Why did the Surgeon General’s “sound bites” in the press misleadingly summarize the report in the first place? And why did the press repeat the SG headlines without 1) reading the report, and 2) thinking critically? There may be different answers to these questions, but none serves the advancement of the public’s knowledge.


Dr. Shulman, a Licensed Psychologist, is the Director of Volunteers in Psychotherapy, Inc. VIP provides psychotherapy in exchange for volunteer work clients donate to the charity of their choice: A nonprofit alternative to the loss of client privacy and control experienced under managed care. More information at (860) 233-5115 or on the web at www.CTVIP.org.

Lost Confidentiality

Posted By admin on November 16, 2010

Lost Confidence and Confidentiality in Psychotherapy
Richard Shulman, Ph.D.

Originally published at MentalHelpNet

We don’t know what psychotherapy is anymore: It is not the screaming, finger pointing and denuding to the crowd of TV’s Sally, Jenny or Jerry, nor is it the moralistic pronouncements of radio shrinks to submissive callers. Therapy is not casting people to the lions in the coliseum, even if some do crave the limelight and temporary glory. We’ve lost confidence and confidentiality in psychotherapy.

Therapy is quieter, more private analysis of personal problems. It’s the girl labeled psychotic who describes visions of snakes coming into her room at night, and the careful exploration that unveils a family secret — incest that’s driving her crazy. It’s the little boy who tantrums while his parents unwittingly cower. When they’re helped back in charge of the family, the boy draws a picture of a monster who’s been tamed, and who says “thanks.” It’s the woman who talks a mile a minute. She’s been told she is “manic” and must take medication throughout her life. Gradual conversation reveals that she was raised to never commit “the sin of anger.” Her internal pressure fades as you both acknowledge her hints when she’s angry at you. Then she more directly faces the stockpile of unacknowledged transgressions that have fueled her fire since childhood.

These sorts of personal conversations don’t happen in public arenas. They reveal foibles, misunderstandings and family conflicts that make people nervous or ashamed and could easily propel them into fight or flight. To defuse the tension and permit rational exploration, you need privacy.

It is ironic. The Supreme Court (Jaffee v. Redmond) recently reaffirmed the right to ironclad confidentiality in order to promote honest and helpful discussion in psychotherapy. Managed care requires the breaking of confidences.

Every three, six or ten sessions, your managed care psychotherapist sends a required report to the insurance company, detailing your private discussions.

We shrinks are ultimately responsible for this. Years ago we fought for health insurance coverage to include the problems for which people sought psychotherapy. Now we are caught in our own lie. Many therapists and clients were happy at the prospect of a “free lunch”, of therapy sessions paid for by someone else. But those “third party payers” (employers, governments and insurance companies), eventually realized that “he who pays the piper calls the tune”. Great fortunes have been amassed for third-party payers by managed care executives and reviewers as access to therapy has been denied and rationed. The denied services are often labeled “not medically necessary”.

And in fact, therapy is not medically necessary. Emotional and personal problems may affect people’s lives powerfully, but they are not diseases of the body. (Look in Medical Pathology textbooks. Despite the parottings of some in the popular press, no biological causes for emotional problems have ever been verified. That’s why there are no medical tests for these mislabeled “mental illnesses”.) Psychotherapy is not a medical procedure. It is a discussion that explores subtleties of what a person says and does in order to understand complicated underlying human problems. Honest exploration of sensitive personal matters requires privacy and patience.

In order to be paid, therapists sign contracts with insurers requiring that they divulge information about clients to managed care reviewers. A steady flow of referrals at inflated fees comes at the cost of client privacy.

I’m not just spreading paranoia about peoples’ therapy reports becoming available on the Internet (though there are documented cases where health care information was sold for commercial purposes). Privacy is spoiled more insidiously.

An example: A young woman volunteered to have me publicly present her previously confidential therapy for a Psychiatric Hospital case conference. That’s what she said directly.Listen to how she then contradicted her offer, but indirectly:

She began to talk about all the “gossips” where she lived. They talked behind people’s backs, inhibiting what you could say openly and honestly. You might be sad or angry on the inside, but around such gossips you learned to just “talk the talk but not say much.”

Why did she let others take advantage of her, she wondered? She described her sacrifices to help others in exchange for the smallest crumbs of appreciation. She remembered a physician she consulted who angered her relatives by only discussing her condition with her, not them. She thought he was right though.

She embellished these themes — but I thought I understood. Indirectly but convincingly, she was saying that I would be wrong to violate her privacy by presenting our personal discussions to other staff. I would be gossiping and taking advantage of her, unlike a trustworthy doctor who would only talk directly to her. In the face of such gossip she would just “talk the talk but not say much”. She would be “smiling on the outside” as she later said, but she would be sad and angry inside.

She was starved for love and appreciation, for sensitive reasons she eventually divulged. She didn’t realize that her overt offer to sacrifice her privacy was contradicted by her indirect, camouflaged hints.

Modern psychoanalysts demonstrate that we best understand our clients by listening for a constant flow of indirect reactions they offer us — if we will only listen for it. My clients taught me to translate their talk, seemingly about others, but ultimately about how my actions and statements fit with their own submerged personalized views of themselves and others. That, in plain language, is what the concepts of “transference” and “the unconscious” are basically about. This may be the most valuable perspective that psychotherapists have to offer to people who are trying to understand themselves and their characteristic ingrained difficulties. Yet we therapists now collude in an economic system that obscures these insights and destroys the best of what we can offer people.

The most profound and consistent way in which our relationship to our clients will be undermined may be subtle. We therapists should be trained to hear it, but perhaps our financial self interest will deafen us to it. We will hear stories like my client told me: about gossiping, corruption and betrayal, and about how people learn to censor what they say outside of trustworthy sanctuaries for exploring sensitive personal matters.

This is why some of us now work completely independently, with no insurance payments. My clients have told me — indirectly but repeatedly and convincingly — to do this. Fees must be lower, but my clients have less need to conceal what they’re saying in sessions. No reports about therapy are sent to others.

And we are developing new ways to preserve confidential psychotherapy outside of managed care. Volunteers In Psychotherapy (VIP) is a new nonprofit organization that allows clients to receive truly private psychotherapy for no fee, in exchange for volunteer work they independently provide to the community charity of their choice. Clients’ “payment” in this way guarantees their privacy and control of their therapy. No reports go to insurers, and no managed care reviewer can dictate that only three therapy sessions are authorized before pills are recommended. Clients benefit both from volunteering in the community, and from being active therapy consumers rather than passive recipients. As a nonprofit, VIP is eligible for donations and grants that modestly reimburse therapists who preserve their clients’ privacy and trust. No third party will profit from the enterprise. But confidence and confidentiality in psychotherapy should be preserved all around.

MentalHelpNet Interview

Posted By admin on November 16, 2010

Interview with Richard Shulman, Ph.D.
Cynthia Levin, Psy.D.
Published on Mentalhealth.net on Jul 1st 2000

Richard Shulman, Ph.D. completed his doctoral degree in Clinical Psychology at the University of Toledo after having graduated Phi Beta Kappa from Wesleyan University and then attending the University of Michigan. He is currently the Director of the nonprofit organization, Volunteers in Psychotherapy (VIP). As a Licensed Clinical Psychologist, he founded VIP together with three other psychologists and two nonprofit specialists. Volunteers in Psychotherapy, Inc. provides psychotherapy that is truly private, in exchange for volunteer work that clients donate elsewhere to the community charity of their choice. VIP is a nonprofit alternative to the loss of client privacy and control experienced under managed care.

Dr. Shulman helped to create VIP after roughly a decade’s work at Hartford Hospital – Institute of Living, where he had provided psychotherapy to Hartford’s poor or uninsured population and had supervised and trained therapists at the outpatient clinic. He continues to serve, now as a volunteer, on the Institutional Review Board of Hartford Hospital – Institute of Living, which oversees ethical and informed consent issues in psychiatric and medical research. He had completed the Greater Hartford Clinical Psychology Internship Consortium, including Hartford Hospital, University of Connecticut Health Center, Newington Veteran’s Administration Hospital and Capitol Region Mental Health Center.

He previously worked at the Children’s Outpatient program of Wheeler Clinic, and served as Psychological Consultant to Nutmeg Big Brothers – Big Sisters. He had delayed graduate school for one year to serve as a Community Service Volunteer, working with troubled boys in a Dr. Barnardo’s school south of London.

Essays by Dr. Shulman and news articles describing Volunteers in Psychotherapy, its functioning and rationale, are available on the VIP website: www.CTVIP.org. Dr. Shulman will participate in a symposium about Volunteers in Psychotherapy at this summer’s annual American Psychological Association convention.

Dr. Shulman can be reached at:

Volunteers in Psychotherapy, Inc.
7 South Main Street
West Hartford, CT 06107
(860) 233-5115
ctvip@hotmail.com

Dr. Cindy Levin (CL): Over the past 2-3 years, Rich, you’ve been working hard at developing an organization called Volunteers in Psychotherapy (VIP). Can you please explain to our viewers what Volunteers in Psychotherapy is all about?

Dr. Rich Shulman (RS): SureWe’re a small and relatively new non-profit organization that was founded by four psychologists and two non-profit specialists. Volunteers in Psychotherapy makes psychotherapy available to anyone – and at no cost – in exchange for them doing volunteer work elsewhere, for the community charity of their choice.

In a sense, our clients “pay” for their therapy through VIP by independently picking a charitable organization in the community where they want to donate volunteer time. They pick their volunteer organization independently of us and without that agency knowing of their connection with VIP. The clients go and do volunteer work at that organization and in exchange we see them in therapy.

We wanted to set up a method of offering psychotherapy that was distinct from what have become standard practices, in private practices and especially in public clinics and hospitals. Several other psychologists and myself had worked in settings where we felt that there were a lot of problematic standard practices that would be best avoided if we could set up this independent structure.

Another significant focus of VIP was to be able to provide psychotherapy independently of the influence of insurance and managed care. We particularly wanted to make therapy available to people who either couldn’t afford to pay for truly private psychotherapy of reasonable length, or to people who felt that managed care damaged and encroached upon useful private psychotherapy for themselves.

CL: Can you please explain to our viewers in more detail about how managed care affects the delivery of psychotherapy services and what some of those problems are that managed care creates for therapy clients?

RS: First, when a person seeks out psychotherapy through managed care it’s the insurance company that’s making decisions about their therapy. The insurer decides whether the patient gets referred for therapy at all, as well as determining the length of time that they are referred for psychotherapy.

When I worked at a poor person’s clinic several years ago, I had two separate instances in which young adult women came in for therapy stating that they finally wanted to talk about being sexually abused when they were children. In both cases, their “third party payer” insisted that they would not pay for such “unfocused” or “exploratory” therapy discussions. The payer wanted to decide what would be discussed. Managed care has been criticized for dictating the nature or focus of therapy.

The flip-side of this is that the insurance company, the third-party payer, can financially benefit by limiting access to psychotherapy or by rationing access to the length of someone’s therapy. Considering that private psychotherapy often costs in the realm of $100 or more per hour, although it can be less, it’s greatly to the third-party payer’s financial advantage if they don’t pay those types of fees. Insurers simply limit access to psychotherapy or encourage people to take medication. This is one of the ways that the third-party payer really intrudes very much into psychotherapy.

Another big problem with managed care is the lack of privacy. Most managed care organizations require therapists who work with them to send them detailed reports about the psychotherapy and private life of the client. This is often part of the managed care contract the therapist signs. A consumer who isn’t savvy about how managed care works might assume that when they see a therapist using their insurance they are having a strictly private discussion with their psychotherapist. In actuality, though, the psychotherapy client probably has signed away the right to their privacy because the contracting therapist is typically required to send off reports about these private discussions to the insurer at some set interval, say every three sessions or every six sessions. The managed care company may say that they require these reports in order to decide whether they will continue to fund the psychotherapy.

CL: How is the client affected by this requirement of the insurance company to obtain private information about the client’s therapy?

RS: Clients are greatly affected. People just don’t speak as openly when they know that their privacy is not absolute. For example, you made a point of giving me informed consent that this conversation is being taped. Whenever I have gone on TV or on radio or had taped interviews like this, I point out to whoever is interviewing me, that both of us are very conscious that there’s a tape recorder going right now – it obviously influences how frankly and spontaneously you talk about things.

People are always conscious of the context in which they’re speaking, and therapy is no different. People tend to censor themselves and to be much more circumspect about revealing details of what’s going on in their lives, or in revealing aspects of themselves that they’re ashamed of or that they find a bit problematic, when they know that there is the possibility that someone else will hear what they have said.

Now this is part-and-parcel of psychotherapy in general. If one person is talking to another and giving them great detail about the ins and outs of what their life is really like, how they think, and how they see things, people can be anxious enough in psychotherapy about revealing these things to a therapist. People only develop trust in their therapist gradually, over time (and rightfully so). Now, how much more inhibited are they going to be if they know that this is not strictly a private conversation, but that it is being reported to a third party?

In an article that I wrote called “Lost Confidence and Confidentiality in Psychotherapy,” which is posted on our website at http://www.CTVIP.org, I provide an example of how people may hint that they know when therapy is not private. People will give clues that they know they’re going to censor themselves and hold back what they talk about if they are aware that there is some risk of the therapy not being totally confidential. The example I give in the article demonstrates all the subtle, somewhat camouflaged ways in which a person may allude to the fact that their therapy is not totally private, and how that impinges on the types of private and frank conversations that they can have with their therapist.

If you’re working with somebody in psychotherapy, if you’re really trying to understand another human being and what makes them tick, and if you’re paying attention to all the subtleties of how they talk to you about their life, a well-trained therapist should be able to hear all the indirect hints by which that person talks about how they’re experiencing talking to you in psychotherapy. People will intimate to you that they can’t speak openly if reports about their private lives are being sent out to an insurance company.

Managed care has just decimated privacy because of the financial power that they have since they are the ones paying for therapy. Their power is quite widespread considering that 80-85% of people who are insured have some type of managed benefits in their mental health care insurance plan.

However, even the Supreme Court has emphasized the crucial feature of privacy in psychotherapy. A person must be certain that what they talk about in therapy remains their private business.

All of these reasons made us feel that it would be crucial to set up an old fashioned sort of framework for doing psychotherapy where there was no third-party payer making decisions about people’s therapy; where there was no third-party payer demanding to have information about somebody’s private psychotherapy discussions. That’s why we constructed Volunteers in Psychotherapy.

VIP permits people to be completely in control of their therapy. VIP returns the client to their position as the consumer who is, in a sense, paying for their therapy. Accordingly, no one else has a right to know about their private discussions concerning their personal life.

CL: Now that you’ve clearly delineated the problems with managed care, can you give an example of what some of those problematic standard practices are that you had experienced in other mental health settings, which you had alluded to earlier?

RS: When I was working in the outpatient clinic at Hartford Hospital, a downtown, urban hospital that merged with the Institute Of Living, it was obvious that much less psychotherapy was being offered to patients. The clinic mostly treated people who were on state and federal support. It was financially beneficial even for the government as a third-party payer (and for the hospital) to limit people’s access to psychotherapy. In that clinic, people were increasingly cut off from individual therapy and put into short-term therapy groups and medication groups; there was much more emphasis on medication and much less on psychotherapy over the years I worked there.

Having worked for years in Connecticut in local clinics and hospitals, I can tell you that there are severe compromises that people have to make if they go to public institutions for psychotherapy. They’re not in control of their own therapy. They don’t have privacy. Decisions such as the type of treatment they will receive and how long their therapy might continue, whether they end up in a group or a short-term group, or get nudged towards medication, are substantially in the hands of the insurance company and of the institution that they go to.

CL: Rich, thank you for spelling out many of the problems of managed care and some of the problematic standard practices that have developed in different mental health settings. This is all so important for clients and the general public to be aware of so that they know what they’re getting into when they decide to enter psychotherapy through a managed care company and/or how managed care can affect the delivery of psychotherapy services in general.

CL: Clearly, though, a significant benefit of Volunteers in Psychotherapy is that it affords the patient the opportunity to speak openly and frankly without having to worry about a third-party person or lack of confidentiality.

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Another significant benefit it would seem that is built into the organizational model of VIP is the act of volunteerism. Considering that there’s a large literature about the benefits people receive when they go and give help to others, how have you seen the act of volunteering impacting your clients in therapy?

RS: The requirement of having clients volunteer their time to a charitable cause they believe in provides another crucial constructive element of VIP. It requires people, first of all, to not just be recipients. It sets up VIP as being an exchange between equals; it is egalitarian in a sense because we’re giving somebody the opportunity to buy our services if they want them. The way they do that is by picking a charitable cause that they think is important and going and putting their efforts into it.

Also, the act of volunteering puts the person in the position of being the helper to other people. They are not simply recipients of help. Volunteering and helping others reverses that image of themselves, which can be quite therapeutic. By putting in a substantial amount of time where they are the person helping out other people, it also typically puts them in the position of being appreciated and valued by the organization where they donate their time.

Volunteering also provides people with the subtle symbolic message of “Hey, you have something to offer to the community.” We built this element into the program because we’re implying to people that they have something valuable to offer. Ultimately, it means that people go out and they rub elbows with other people in the community. It all constructively builds confidence, appreciation, and self-appreciation on the part of the volunteers.

CL: Volunteering sounds very effective as a conjoint therapeutic intervention.

RS: Yes it is.

CL: Rich, does the client get to choose on their own the organization they want to volunteer their time at in exchange for psychotherapy?

RS: Pretty much. We have people check with us because we want to make sure their volunteer agency fits within our guidelines, which is that it has to be a 501(c)3; the legal designation the IRS gives when they approve a charitable organization that aims to serve the community. But, we do give credit to people for working at just about any non-profit organization of their choice. There is a little leeway to this where we will give credit, say if someone works at a state hospital that isn’t technically a non-profit, but it’s certainly still in the same spirit of serving the community.

CL: So, when a patient comes to you for therapy services, what is the range of services that you provide at Volunteers in Psychotherapy?

RS: Well, we think part of the strength of what we offer is that we only provide psychotherapy. We make clear to people that our organization is only an avenue towards them getting private discussions about their lives. It’s varied enough that it could be individual therapy for an adult, it could be couples therapy, or it could be family therapy that may involve children.

We make it clear to people that we won’t do evaluations for any third-party, that we won’t be giving out any reports to any third-party, that we won’t get involved in custody battles or legal issues with them. This practice is meant to obviate or make impossible that VIP be used for any, what you might call, secondary gain. For instance, that a person might be coming in because they really just want to satisfy their probation officer.

Sometimes people come to therapists with all sorts of other hidden agendas. One of the ways that we’re very efficient is that we say to people “That’s not a service that we offer; it’s strictly psychotherapy and strictly private.” This helps to really focus people on what it is that we have to offer and make sure that none of these resources are wasted.

RS: Another way that we enforce the notion of taking responsibility for their psychotherapy is that we require people to be responsible for the sessions. We have a no-show or a cancellation fee that they would have to pay if they were irresponsible about appointments with us; and again, it’s meant to be egalitarian. It respects the client and the therapist in their work together.

CL: An arrangement that probably over the long term leads to a greater sense of empowerment for themselves.

RS: Right, exactly.

CL: How do people find out about Volunteers in Psychotherapy? Where do most of your referrals come from?

RS: Most are self-referred, and in fact, we think that’s ideal. Ultimately, I think psychotherapy is self-examination and it’s often an attempt to look honestly at things that we all tend to kid ourselves about, or blind ourselves to, especially our difficulties in life or our personal and inter-personal difficulties. Our clients are mostly people who are self-referred and have an interest in pursuing therapy and this kind of self-exploration.

Most of the people who come to us have heard about our organization in the media, in some form. They pursue contacting us on their own, getting more information about us, and calling our phone number where we have an outgoing information tape that describes the program. We have brochures that we put out at all sorts of libraries and social service institutions, YMCA’s, and volunteer centers. People may hear about us through Infoline (a statewide information and referral service). Or people will privately learn about us through our website at http://www.CTVIP.org.

One significant subgroup that has an interest in us are people who have already had a bad experience with their own insurance or who have gone through the experience of trying to get psychotherapy say through an EAP (Employee Assistance Program) where they work. They may be concerned about the potential lack of privacy, or the possibilities that an employer who is self-insured may permit the personnel department or other people to have information about whether they seek psychotherapy for themselves or their family.

We also get people who have tried using their managed care benefits and are very unhappy when they realize that they are limited in their access to therapists — or they realize the lack of privacy involved when reports are sent to their insurer. Some people have resented their insurer pressuring them to take medications; or finding out that their insurer pressured their therapist to get them on medication.

So, we get people who are delighted to find out that there is an option to get therapy in the community that does not involve the lack of privacy and the lack of control that comes from insurance. Some people are thrilled that they can do volunteer work to pay for their therapy. They like the fact that VIP is not a “hand out.”

CL: I’m sure the benefits that VIP provides are a big relief for many people seeking out therapy services, and are clearly some of the reasons that your organization stands out.

I can’t help wondering, though, how you’ve been able to make VIP happen in a time when, unfortunately, so many aspects of our society, including healthcare, have turned very much towards the financial bottom line and away from such pure altruism?

RS: Well, although it’s true that money is a part of life, people also realize that important personal matters are what make people tick;that there is a need for most human beings to have some comfort about how they feel about themselves and how they go through living their lives. And sometimes people need to have privacy in order to honestly explore what is going on in their lives when there are difficult personal matters to discuss.

One of the reasons that VIP has financial support to do this work is because we make the case to individual donors that there is a glaring gap and a pressing need in the community for there to be some resource like us. Managed care benefits for psychotherapy have been drastically cut back in recent years -much more so than even medical services have been cut. We need to preserve a private place where people can talk about their lives. People have responded and have financially supported us so that we can do this work.

Now, in part, they partner up with us and choose to donate to us because they recognize that we are making a financial sacrifice in order to make this service available. For example, our Board of Directors is made up of all volunteers, and all of the administrative work we do to set up this service is unrecompensed — unsalaried. Also, I provide the office and the telephone for VIP, which limits overhead.

We applied to the IRS who conferred on VIP our status as an independent, charitable, tax-exempt organization. Our mission is not in lining our own pockets, but rather our mission is in serving the community. I think donors recognize that there is benefit in having this type of safety valve in the community and we make this same case when we apply to local philanthropic or charitable foundations. Over the course of our first year in applying for grants, we’ve been awarded seven grants, six of them from Connecticut Philanthropic Foundations and one from an international charity. They have all given us small to moderate amounts of seed money to get VIP up and running. Obviously this is seed money, and we are still looking for more financial support.

I should also point out that the therapists who provide therapy through VIP are reimbursed; we do get some reimbursement for providing therapy services. However, in order to establish the amount of reimbursement, we had an independent committee of our board do a survey of what were the average fees locally for therapists. We cut that fee in half and then lowered it even more – so we’re paid less than half the average local private practice fee.

This reduced amount of reimbursement that VIP therapists get signals to people who might support us financially that, again, we’re not lining our own pockets. We’re doing this because therapy is an important service to make available and it currently isn’t available to the public without clients making serious compromises in their therapy. Also, the fact that clients are willing to provide volunteer services in exchange for psychotherapy is evidence that people value therapy and they are willing to work for our services. Therefore, this is not a charitable “hand out.” Everyone involved in VIP contributes to the common good.

CL: Can you describe in more detail about what your professional background has been, since it sounds like some of the work experiences you had in the past helped to push you towards the development of Volunteers in Psychotherapy?

RS: Sure, I had worked at a Connecticut outpatient clinic where I’d worked more with children and families. Then I worked for years with adults and families at a downtown, urban hospital, Hartford Hospital, which merged with the Institute of Living. We provided sort of a “poor persons” clinic.

Especially in that clinic, I felt that the clients were cut out of the loop; that they were not the ones seen as the consumers. There was a third-party payer involved, and so it wasn’t that the clients themselves were absolutely deciding that they wanted psychotherapy. There was no symbolic sense that they were willing to pay for it by giving something towards their own therapy.

I thought that putting the client back into the position of being the consumer would ultimately serve the psychotherapy much better. We needed a way to put the client back in control – to have them “pay for” their therapy, and decide if it was worth continuing to work to pay for. And of course, clients then get to preserve their privacy. People who come to public clinics don’t tend to feel that they are the consumers who are purchasing the services they want – much of what they get is dictated to them. I’d been discussing some of these problems for years with the psychologists who are on our board (Drs. Mark Burrell, Karen D’Avanzo and Rachel Sampson), and we’d been brainstorming about ways to make such improvements. Volunteers in Psychotherapy was meant to reverse these problems.

When I left the Hartford Hospital – IOL clinic to set up a private practice, I specifically publicized the fact that I would not work with any insurers. Instead, I set a low fee in my private practice and saw people for that fee. I publicized the compromises that managed care demanded. I also started a pilot program, offering short-term no-fee therapy sessions in exchange for VIP-style volunteer work.

CL: So, since Volunteers in Psychotherapy focuses purely on psychotherapy without the bothers of insurance companies, do you think you will eventually offer training opportunities for psychology graduate students who want real in-depth training in psychotherapy?

RS: Well, I think that you are touching on something where there’s a real need. Through VIP, I give a lot of talks in college and graduate school psychology classes. I think that students are in a real bind right now, especially for people who are in training, because of managed care taking over the economic landscape.

Students who are bright, sensitive, and attuned to what it is to be a human being and the problems that people can face in their lives, have an opportunity to learn all sorts of subtleties and complexities about doing human service work. However, they often come to realize that psychotherapy is being undermined by the current predominant economic system (managed care). I think that many social work students and psychology students, marriage and family therapy students, all sorts of people who are training to be therapists in one form or another are confronted with the fact that there are going to be economic realities that may severely undermine and distort the type of therapy that they’ll be able to provide.

One of the reasons we give public talks is to say to people “Look, we don’t think you have to compromise your standards. We don’t think you have to compromise the types of best practices that should exist in psychotherapy, either as therapists or as clients who are trying to make sense of their lives and improve them.” We make the argument that it’s possible to set up these independent non-profit organizations that would allow you to work in the way that you think would be most valuable and helpful to people. As therapists, you don’t have to compromise your principles within managed care or existing institutions. You don’t have to resign yourself to work your entire career doing things that you don’t believe in and that you think are ultimately harmful or not as helpful as they should be for the people that you work with. You can work with people in the same way that you would want for yourself or others you’re close to.

Many established therapists recognize all the compromises that go on in managed care and they chafe at them tremendously. Many therapists struggle with the fact that managed care pays them to work in a way that they bridle at; that they think is ultimately highly compromised. In a sense, we say to them and we say to students “Yes, we think you can set up independent nonprofit approaches like VIP. Or a modified version of VIP.” We encourage people to do that.

We would love to do training here at some point, although it’s just the realities of logistics right now that we are not yet doing that. We need to focus on establishing VIP in its service to the community, we need to make VIP more visible to the public, and we need to establish funds to continue. But ultimately, yes, we’d love to work with students. In fact, we’ve had a fair amount of contact from local students who are pressed to find a Practicum site that they find is meaningful. They want to have the experience of learning about in-depth therapy; what it means to sit with another human being and help them make sense out of the complexities and the problems in their lives. We hope that somewhere in a few years we will be providing that kind of training opportunity, which also helps to preserve meaningful psychotherapy in the community.

CL: That sounds great. There must be so many students right now in graduate schools that would chomp-at-the-bit to get an opportunity to be able to see what kinds of alternatives are out there, to see that they don’t have to deal with managed care, and to truly get that in-depth training in psychotherapy.

CL: What are some recommendations that you would offer to other clinicians who may be interested in starting an organization similar to Volunteers in Psychotherapy?

RS: Well, I guess just encouragement that it’s possible to do. We’re happy to consult with people about how to get started and we’ve already started to brainstorm with people about how they might set up programs similar to VIP in their own communities; or perhaps modified based on their own particular interests and local needs. Hopefully we can help people just as we have been helped — so they don’t “re-invent the wheel” — or help them avoid mistakes that we made in setting this up.

CL: And where do you see the future of Volunteers in Psychotherapy going? Where would you like to be say 5 years from now?

RS: I suppose as you mentioned in that earlier question, we’d love to be a place where students could get a taste of what it’s like to do therapy unimpeded by some of the problematic constraints of managed care. To help students develop respect for the complexities of doing psychotherapy and understanding another person in depth. Beyond that, we’re not sure. I think we want to be able to offer these types of services in the community and we’d like to have perhaps a range of therapists who we could offer to potential clients.

But outside of that, setting up a non-profit like this has been a bit of an adventure and probably we can’t really foresee bends in the road in terms of what things will be like in 5 years. But, I think those of us who set this up and have spent some years doing it, we certainly want to be around to help offer this to others. We want to be a reminder to a lot of people in the community that therapy is not just any type of talk, that you need to have certain ground rules laid out in order to be effective in helping people with their lives. That privacy and client control is crucial, before you even begin listening to people and trying to understand their lives.

We hope that VIP will be an example that says it is still possible to do something like this.

CL: Well, it certainly sounds like Volunteers in Psychotherapy has set a wonderful example for many people who would like to start a similar organization. I really want to thank you, Rich, for sharing all of the positive ways that Volunteers in Psychotherapy benefits people’s lives.

The Hartford Advocate

Posted By admin on November 16, 2010

A Sane Solution to a Mad World
By Jayne Keedle
Published in Hartford Advocate on 07/29/99

Call him crazy, but psychologist Dr. Richard Shulman doesn’t think every patient who comes to him for help should have to pay an exorbitant fee. Nor does he believe his patients’ employers have a right to know who among their staff is seeking mental health treatment. That’s why, when he left the Institute of Living three years ago to set up his own practice, Shulman didn’t become part of an HMO.

Shulman doesn’t believe in putting his diagnoses in writing to insurers. He worries it violates his patients’ rights to privacy. “I know some people are concerned their employers would know simply that they accessed their psychiatric care benefits,” says Shulman. Nor did he want to have to justify recommended courses of treatment, or exaggerate problems, just to make sure the insurer would pay up.

Of course, not every patient can afford to pay out of pocket for treatment. So Shulman searched for a solution. He founded a new non-profit organization, Volunteers In Psychotherapy, Inc. (VIP) which offers no-fee psychotherapy.

Instead of paying for their sessions, Shulman’s patients volunteer at local charitable organizations. In exchange for helping others, Shulman and two other like-minded psychotherapists help them.

“I thought this would be a workable approach,” says Shulman. In fact, he tested his theory on a small scale first, offering a maximum of four sessions per person to people who donated their time to nonprofit organizations.

Now VIP is officially a non-profit, with a board of six directors, (four psychotherapists, two nonprofit specialists). It is also the recent beneficiary of a $7,500 grant from the J. Walton Bissell Foundation of Hartford. The new influx of funds has enabled Shulman to expand his private experiment into a program he hopes could be duplicated.

“We think this is an approach which could be replicated elsewhere,” says Shulman. “I don’t know of any other organization that’s doing anything like this [but] we see no reason why other groups couldn’t do this.”

The concept is certainly simple enough. For one hour of therapy, patients must perform three to four hours of volunteer work. Shulman specifies it has to be something that directly benefit others, (singing in the church choir, for instance, doesn’t count). The therapists also offer a sliding scale for people who want to pay for part of their sessions, but as a nonprofit, their rates are less than half the average fee set by area therapists.

Shulman, who has worked in the past at clinics where patients pay nothing at all, thinks it’s a mistake not to ask clients not to make any sort of contribution. In that situation, he says, “you are seen as ministering to them or taking care of them, and not having it be an equal exchange in which they show their commitment.”

By contrast, asking people to contribute their time and energy to something that benefits the community, Shulman feels, “says you have some assets and something to give. Everyone is contributing to the common good.” As Shulman sees it, doing volunteer work is good therapy, too.

For information about VIP, call 233-5115.