I had been working for roughly 10 years as a licensed clinical psychologist in a downtown Hartford psychiatric clinic (part of Hartford Hospital - Institute of Living) that primarily saw poor, uninsured people, many of whom originally came to us first through the emergency room, or had been referred from the local state psychiatric hospital.
Increasingly, people who sought psychotherapy were instead diverted into medication groups, or short term "educational groups" on a particular topic. This was a cost-saving measure, while also deriving from the increasingly biological perspective on "psychiatric disorders" of the heads of the psychiatric services. Almost every clinic patient was prescribed medication, no matter what their original preference.
By coincidence, two young women came to my clinic for separate "intake" interviews with me -- both within the same summer of 1995. Each of them individually confided to me that they had been sexually abused as a child, and that they thought that they were still greatly troubled and led their lives in self-destructive ways because of their pasts.
However, given the "managed care" procedures that had been instituted, both of them were blocked from the individual psychotherapy that they had been seeking. The insurer who would have underwritten their sessions both times indicated that they would not pay for such "open ended" explorations -- but instead, they would be happy to pay for these women to enter medication groups, or to take part in a time-limited psycho-educational group.
Research has documented the alarming frequency of child sexual abuse. Psychotherapists frequently learn, in the course of their work, that sexual or physical abuse, growing up in a home where a parent was frequently drunk or violent, or other upsetting, confusing of shame-producing secrets from someone's past can often be the root of problems which linger in that person's life.
Trustworthy and strictly private discussions about such sensitive topics, with an experienced, well-trained third party (psychotherapy), can be a powerful method of exploring and helping to resolve such problems.
The fact that third party insurance reimbursed psychotherapy has become increasingly inaccessible, and much less private, doesn't have to block people of modest means from access to therapy.
I constructed VIP together with two colleagues (clinical psychologists) whom I’d known for years. We had often shared major criticisms of the different hospital and clinic programs we’d worked in, which often made the requirements of psychotherapy (particularly privacy, voluntary participation and exchange or payment for services received) secondary to their own institutional needs.
We specifically designed VIP's "payment system" of volunteer work in exchange for psychotherapy for a number of reasons: it makes clear that the psychotherapy is voluntary, and is a fair-trade system in which someone is choosing to earn the help they are getting in exchange for help they give to others. It implicitly says to all VIP clients that they have something of value to offer to others. This is not a “hand out,” but instead is part of an exchange system in which everyone is sacrificing a bit and contributing to the common good (clients, therapists and VIP administrators). VIP clients feel they have earned their psychotherapy services through their own work. The volunteer work brings a sense of accomplishment, meaningful work, contribution to a good cause, and social interaction and community teamwork to VIP clients.
