I'd been working for 10 years as a licensed clinical psychologist in a downtown Hartford psychiatric clinic (Hartford Hospital - Institute of Living) that primarily saw poor, uninsured people, many of whom came to us first through the emergency room, or from the state psychiatric hospital.
Increasingly, people who sought psychotherapy were instead diverted into medication groups, or short term "educational groups" on a given topic. This was a cost-saving measure, and also reflected the growing biological perspective on "psychiatric disorders" of the heads of the psychiatric services. Almost every patient was prescribed medication, no matter what their stated preference.
By coincidence, two young women came to my clinic for separate "intake" interviews with me -- in the same summer. Each confided to me that they'd been sexually abused as a child, that they were still greatly troubled and led their lives in self-destructive ways because of their pasts.
However, under new "managed care" procedures, each was blocked from the private therapy that they were seeking. Both times the insurer stated that they wouldn't pay for such "open ended" explorations -- instead, they'd be happy to pay for these women to enter medication groups, or to join a time-limited psycho-educational group.
Research has documented the alarming frequency of child sexual abuse. Psychotherapists frequently learn secrets, 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 unsolved problems in someone'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 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 therapy (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 therapy for a number of reasons: it makes clear that the therapy is voluntary, and is a fair-trade system where someone gets help for giving help. It implicitly says to all VIP clients that they have something of value to offer others. This isn't a “hand out,” but instead is part of an exchange system in which everyone sacrifices a bit and contributes to the common good (clients, therapists and VIP administrators). VIP clients know they've earned their therapy services through their own work. The volunteer work brings a sense of accomplishment, contribution to a good cause, and social interaction and community teamwork to VIP clients.
