Occupy Mental Health! Countering the "Business Model" of psychology
The medical model draws a significant amount of critique in clinical psychology these days, especially from existential and humanistic psychologists, and for good reason. The medical model is deeply flawed in its basic assumptions, including its construction of mental illness and conceptualization of what it means to be human. Although ongoing critique of the medical model is needed, it is increasingly evident that another disconcerting model is also in need of our attention and critique: the business model.
The business model is nothing new in mental health. We were first introduced to it when managed care invaded mental health. Despite our complaining about the negative impacts of managed care, it is important for clinicians to recognize that it came about largely because of the abuses of the system perpetrated by many practitioners. With managed care, clinicians encountered lower pay and greater challenges in reimbursement, leading to the need for many therapists to give more attention to the business side of practice in order to survive.
Although often not acknowledged, managed care brought some needed reform. Individuals and groups that were exploiting the system were more closely regulated and many mental health organizations began emphasizing financial responsibility. Yet, this is not the business model I am addressing this article. In recent times, we have seen the introduction of for-profit companies, agencies, and models (including in nonprofit companies) into various levels of psychological training and practice. These for-profit models have infiltrated mental health hospitals, community mental health centers, prisons, education and training programs, and even hospice programs. The for-profits often have a different motivation than the traditional mental health worker: profit. Although it is important to emphasize that not all for-profits are problematic, increasingly it seems there are few exceptions.
The introduction of the for-profit model has changed the way people approach mental health. More emphasis is placed on marketing, “customer service,” the “product,” and how to increase profits and expand markets. These companies prioritize getting and keeping clients, making sure employees are working enough “billable hours,” and maintaining a good public image. The goal of making a positive difference in the world has shifted from being a lived reality to a tagline exploited for marketing purposes.
Existential and humanistic therapists should be particularly concerned about this. The for-profit model stands in opposition to many of our most dearly held values. Let me provide a few examples. First, existential psychology is a meaning-centered approach. Although money and profit are a popular sort of meaning sought, they are not a sustainable form of meaning. A sustainable meaning is one that helps people sustain in difficult times, transforms suffering into something manageable, and benefits the individual as well as the collective. Although in today’s modern world it is difficult to survive without some money, on the bigger issues of life, such as meaning, money is at best a means to an end. Too often, money just buys a bigger void that individuals seek to fill.
Second, humanistic and existential psychology speak of treating each other holistically, as other subjective beings. There has always been this tension in humanistic and existential psychology about the medical model language of “patients” and “clients,” as this brings the likelihood of treating people as things or objects. The business model language of customers is no better, and in many ways worse. As customers, mental health consumers are not only in danger of being treated like objects, they are also in danger of being treated as a means to an end. A certain level of exploitation is often inherent in the imperfections of the business model and readily tolerated in business ethics.
Third, existential and humanistic psychology has always adhered to a deep valuing of compassion. Yet, in the business model, compassion is too often replaced with what is financial viable. In a business model, caring too much is a liability. It may unduly influence people to make poor business decisions, such as helping someone in need when it may negatively impact the financial bottom line.
Last, reaching out to those in greatest need is often replaced by accessibility. Accessibility sounds nice and, when sought in a compassionate model, can be very good. However, in a business model, accessibility is about expanding into new markets, not compassionately meeting needs. Yes, they are often reaching people who were failed by the old system; unfortunately, too often, they are now being failed and exploited by a new one.
Humanistic and existential psychology flourished in the 1960s and 1970s in part because the moral issues of the time were urgently calling for the type of compassionate, person-centered ethics represented in existential and humanistic psychology. Now, again, we are experiencing such a time. The world needs us, and we cannot afford to fail by not speaking out loudly.
It is no wonder that we are seeing a renewed interest in humanistic and existential psychology right now; this is our fullness of time. We are emerging from a time of moral depravity witnessed by an unjust war. We are emerging from a time of financial irresponsibility and exploitation of the poor. And we are part of a coming together of the disenfranchised to stand up to the financial bullies of our time. This is our time. It is not just a time of expanding interest and growing societies. This is our time to once again change a world that desperately needs us.
-- Louis Hoffman