"Sliding Scale Sessions for Pro-Palestinian Student Activists"... ethical?

[Cheetah89]

I recently came across this post on Instagram by @theexpansivegroup, a private practice group whose self-described services are "s-xuality, gender, and relationship counseling":

"In response to the incredible student activism for pro-Palestine efforts that has been growing across college campuses, The Expansive Group will be opening up a number of sliding scale spots for college student activists at $25/session. BIPOC students will be prioritized for these sessions.

Applying is easy – simply head to the link in bio
select the “$25/session - Student Activist Rate” option when asked about your budget

Once your form has been submitted, you’ll hear from our intake team who will quickly match you with an experienced provider that best suits your needs and identities.

We are so proud and impressed with all of you, thank you for everything that you’re doing <3"

Per their website, most of the providers are midlevels, but there are a few doctoral level psychologists on staff.

Thoughts on this? I'm specifically thinking of APA's General Ethical Principles of Justice ("Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices") and Respect for People's Rights and Dignity ("Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices.").

Not looking for an Israel v. Palestine debate, obviously. Just curious about your thoughts on whether you personally would find this to be an ethical violation (or boundary pushing), and why or why not?

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[Sanman]

Someone has provisionally licensed therapists in need of some hours...

No idea who owns the practice, so I am not going to comment on ethical responsibilities...

 

[WisNeuro]

Personally, I think it's unethical, and I imagine you have some legal challenges as well, if anyone really wanted to push the issue.

 

[futureapppsy2]

Personally, I think it's unethical, and I imagine you have some legal challenges as well, if anyone really wanted to push the issue.

Political belief isn't a protected class (outside of Washington DC, IIRC), so I'm not seeing how this would be illegal?

These sliding scales for certain populations that providers support or want to curry favor with are pretty common in my experience.

 

[WisNeuro]

Political belief isn't a protected class (outside of Washington DC, IIRC), so I'm not seeing how this would be illegal?

These sliding scales for certain populations that providers support or want to curry favor with are pretty common in my experience.

It seemed to suggest that preference for discounted services would be granted according to protected characteristics "BIPOC students will be prioritized for these sessions." We have lawsuits, some that have succeeded, for governmental grants and such that also stated preference based on similar characteristics. This group is likely more protected being private practice, but if this were a non-profit, or group that received governmental grants or tax exemptions, there is definitely grounds.

 

[borne_before]

I hope they can treat axis 2 stuff...

 

[PsyDr]

Hey, do you get angry while talking about politics that you can't change? Come see me, for less money than a barista! Surely my workplace will be full of interesting people I can help.

 

[Sanman]

Hey, do you get angry while talking about politics that you can't change? Come see me, for less money than a barista! Surely my workplace will be full of interesting people I can help.

The real question here is what therapy do they plan to use with people that are angry about things they cannot change? Not sure ACT is going to be popular when marketing to the group specifically...so, terrible supportive therapy or are we crossing lines between therapist and social justice warrior?

Also, how does one enforce know who a "student activist" is? Can I just claim it even though I am twice the age of a college student and not enrolled in a university? What if I identify as a student activist?

 

[Shiori]

I pretty much do a modified version of CPT for my social justice-y clients. I try to help them find shades of gray and allow them to find some peace.

 

[Sanman]

I pretty much do a modified version of CPT for my social justice-y clients. I try to help them find shades of gray and allow them to find some peace.

I imagine this means the answer will be EMDR for their trauma in PP.

 

[BuckeyeLove]

..so, terrible supportive therapy or are we crossing lines between therapist and social justice warrior?

This is 75% of all therapists today.

 

[Sanman]

This is 75% of all therapists today.

The real problem here is that therapists think in terms of small potatoes. Meanwhile, reddit has taught me that life coaches think bigger. This guys is charging $4-5k/hr for life coaching. Any takers?

Coaching – Steve Hardison

 

[The Cinnabon]

The real problem here is that therapists think in terms of small potatoes. Meanwhile, reddit has taught me to life coaches think bigger. This guys is charging $4-5k/hr for life coaching. Any takers?

Coaching – Steve Hardison

Life coaches make me wish I didn't have a moral compass/some semblance of ethics. It truly seems like a cushy path.

 

[BuckeyeLove]

The real problem here is that therapists think in terms of small potatoes. Meanwhile, reddit has taught me that life coaches think bigger. This guys is charging $4-5k/hr for life coaching. Any takers?

Coaching – Steve Hardison

Have you seen what Tony Robbins charges? Last i heard, you pay him 1 million up front, and you get him for like 2.5 days, where he just hangs out with you. He is booked out for YEARS apparently. And big business entrepreneur bros just can't get enough of his stuff.

 

[psych.meout]

I hope they can treat axis 2 stuff...

Gross.

 

[albatross_at_crossroads]

Also, how does one enforce know who a "student activist" is? Can I just claim it even though I am twice the age of a college student and not enrolled in a university? What if I identify as a student activist?

I know what you meant, but I recently met a 60 year old who is studying their nth degree, now doing a social work master's, still highly involved in social justice stuff on campus. So, I think the social justice inclined therapists would not dare to question you just because of your age

I pretty much do a modified version of CPT for my social justice-y clients. I try to help them find shades of gray and allow them to find some peace.

Oh I really like this idea! Seems quite interesting, I wish people would use this approach more.

The real problem here is that therapists think in terms of small potatoes. Meanwhile, reddit has taught me that life coaches think bigger. This guys is charging $4-5k/hr for life coaching. Any takers?

Coaching – Steve Hardison

I've never heard of this guy, but wow! How do they keep charging these amounts for so many years? Mind boggling!

On topic: I recently had many similar conversations on a related topic - mostly whether psychologists should offer sliding scale options for particular groups (low SES, people of color, etc.). The socially justice inclined therapists tend to jump at the answer that yes, we should. My very knowledgeable Ethics professor seemed to disagree (she is also one of the more active people on the local ethics committees). What my professor argued was that it was unethical to offer this (or quite difficult to be ethical), because it's often challenging to establish where do you set the line - as in, this person qualifies for a lower rate, while this person does not. The idea is that people have multiple identities and things can stay in a mostly gray zone, so there is a risk the therapist chooses based on their own biases instead of what would be ethical and fair. Another argument that my professor brought is that, as the lead of a private practice for example, one of your ethical duties is also to your employees/colleagues and their families (and this includes a financial responsibility as well). So to ensure that things are fair and ethical, this professor suggested avoiding sliding scale, and focusing on other things the psychologist could do to give back (perhaps through pro bono work/consultations for other professionals in the community, or other types of activity outside their therapy practice). From my point of view, it seemed like a reasonable argument. Of course, there are local therapists that offer sliding scale and I've never seen anyone legally/ethically challenged for that. And full disclosure, I am in Canada, and the CPA Code has some slight differences to the APA one. But something to think about definitely!

 

[Sanman]

I know what you meant, but I recently met a 60 year old who is studying their nth degree, now doing a social work master's, still highly involved in social justice stuff on campus. So, I think the social justice inclined therapists would not dare to question you just because of your age


Oh I really like this idea! Seems quite interesting, I wish people would use this approach more.


I've never heard of this guy, but wow! How do they keep charging these amounts for so many years? Mind boggling!

On topic: I recently had many similar conversations on a related topic - mostly whether psychologists should offer sliding scale options for particular groups (low SES, people of color, etc.). The socially justice inclined therapists tend to jump at the answer that yes, we should. My very knowledgeable Ethics professor seemed to disagree (she is also one of the more active people on the local ethics committees). What my professor argued was that it was unethical to offer this (or quite difficult to be ethical), because it's often challenging to establish where do you set the line - as in, this person qualifies for a lower rate, while this person does not. The idea is that people have multiple identities and things can stay in a mostly gray zone, so there is a risk the therapist chooses based on their own biases instead of what would be ethical and fair. Another argument that my professor brought is that, as the lead of a private practice for example, one of your ethical duties is also to your employees/colleagues and their families (and this includes a financial responsibility as well). So to ensure that things are fair and ethical, this professor suggested avoiding sliding scale, and focusing on other things the psychologist could do to give back (perhaps through pro bono work/consultations for other professionals in the community, or other types of activity outside their therapy practice). From my point of view, it seemed like a reasonable argument. Of course, there are local therapists that offer sliding scale and I've never seen anyone legally/ethically challenged for that. And full disclosure, I am in Canada, and the CPA Code has some slight differences to the APA one. But something to think about definitely!

Something else to think about if you are taking insurance is whether you will be violating your insurance contracts by offering a sliding scale fee.

The other question is how far will the sliding scale go. Certainly, I would consider sliding scale if the fee was in line with an insurance contract. Say $150/hr instead of $200-250/hr. At $25/session, I am not sure how the practice is not losing money unless they only offer this via telehealth with some seriously struggling clinicians. That would not justify daycare and gas for me.

 

[WisNeuro]

I know what you meant, but I recently met a 60 year old who is studying their nth degree, now doing a social work master's, still highly involved in social justice stuff on campus. So, I think the social justice inclined therapists would not dare to question you just because of your age


Oh I really like this idea! Seems quite interesting, I wish people would use this approach more.


I've never heard of this guy, but wow! How do they keep charging these amounts for so many years? Mind boggling!

On topic: I recently had many similar conversations on a related topic - mostly whether psychologists should offer sliding scale options for particular groups (low SES, people of color, etc.). The socially justice inclined therapists tend to jump at the answer that yes, we should. My very knowledgeable Ethics professor seemed to disagree (she is also one of the more active people on the local ethics committees). What my professor argued was that it was unethical to offer this (or quite difficult to be ethical), because it's often challenging to establish where do you set the line - as in, this person qualifies for a lower rate, while this person does not. The idea is that people have multiple identities and things can stay in a mostly gray zone, so there is a risk the therapist chooses based on their own biases instead of what would be ethical and fair. Another argument that my professor brought is that, as the lead of a private practice for example, one of your ethical duties is also to your employees/colleagues and their families (and this includes a financial responsibility as well). So to ensure that things are fair and ethical, this professor suggested avoiding sliding scale, and focusing on other things the psychologist could do to give back (perhaps through pro bono work/consultations for other professionals in the community, or other types of activity outside their therapy practice). From my point of view, it seemed like a reasonable argument. Of course, there are local therapists that offer sliding scale and I've never seen anyone legally/ethically challenged for that. And full disclosure, I am in Canada, and the CPA Code has some slight differences to the APA one. But something to think about definitely!

Pretty much this. You're making value calls, and usually on very subjective things. I don't think most people would raise a stink about pretty cursory means testing and sliding scale based on financial means. Makes sense to most people. But once you stray into more anomalous categories, you are then picking and choosing, usually based on your own values and biases. Part of me is ok with this. But, most people who would advocate for the situation in the original post would likely be the first to raise an objection when the show is on the other foot. Taking an opposing, but bot too outlandish example in today's political climate, what if a more conservative therapist was offering sliding scale fees, but only to white men, whom this therapist argues face a lot of vitriol and shaming in several societal spheres of influence. Are we ok with this as well>?

 

[PsyDr]

I wonder how the treating psychologist avoids personal disclosures in this situation.

 

[WisNeuro]

I wonder how the treating psychologist avoids personal disclosures in this situation.

I imagine the treating psychologists in this situation are all about personal disclosure and the primacy of lived experiences over all.

 

[EnPsychlopedia]

Can I just claim it even though I am twice the age of a college student and not enrolled in a university?

Really? Only twice the age? Here I was thinking you have a reputation for being the old, white dude on SDN.

I jest, I jest...

 

[smalltownpsych]

One of my supervisees offered no cost sessions for veterans so he could get some experience and because he was one too. We anlso offer sliding scale based in financial need. We don’t take insurance so we don’t have to worry about that aspect. Offering lower cost services based on political beliefs is not something I would think is ethical. Offering them based on racial characteristics would be discriminatory. On related lines, there are the Christian type counselors that tend to work with their own group and probably offer lower fees for fellow church members this is a little fuzzier as to ethics.

 

[Sanman]

Really? Only twice the age? Here I was thinking you have a reputation for being the old, white dude on SDN.

I jest, I jest...

Some of us age like fine wine and others not so much. This is what I looked like at 27:

 

[WisNeuro]

Some of us age like fine wine and others not so much. This is what I looked like at 27:

When did you turn into Sanman the White?

 

[smalltownpsych]

Also to tie this into another thread, maybe I could offer sliding scale for the really really good looking.

 

[EnPsychlopedia]

When did you turn into Sanman the White?

Live look in at Sanman judging folks for all the woo they promote:

 

[WisNeuro]

Also to tie this into another thread, maybe I could offer sliding scale for the really really good looking.

View attachment 386817

Even they can get into freak, gasoline fight accidents.

 

[Sanman]

When did you turn into Sanman the White?

When I completed fellowship of course. That licensing process...