Our First Study!

@GlenM As a professional counselor, I also have to say I'm a bit annoyed by the tone this thread quickly took, as it presents little compassion to people who devote their time, money, and energy to providing compassion.

A more effective way would be, in my opinion, a universal payer such that providers get paid but money is not the determinant in whether services can be provided/received. I provide good services both here and at work. However, if you ask my clients how they see me, you will see a different story than the ratings for many reasons.

Here are some examples:

1. We deal with people who are under court mandates to see us. They do not want to be there and would not voluntarily seek help. There can be punitive consequences on the line that would not apply in a context of anonymity such as this.

2. We have large caseloads and must be reliable for our clients. Here, is a listener chooses to disappear or refuse future contact, they have that option. People who experience the abandonment may stop reaching out for help and therefore disappear from your data. While my clients cannot reach me specifically at all hours, they know that I will be there for them for as long as it takes for as many years as it takes. I'm a provider in a situation where the clients are not the payers nor do they require insurance, so this is something I am required to provide of ALL clients who choose to play by the rules of the context.

3. There are rewards that exist in RL settings that do not exist here. In my context, a huge part of what I do is actually coordinating services and purchases for clients. There is a lot of money dependent on rapport and individualized services. As such, many people will malinger, act in dishonest ways, and throw tantrums when they do not get the "stuff" that they think they are entitled to get. They might know someone else who got something and therefore be mad that I won't authorize it for them too, as it might not be necessary for their treatment success, despite it being fun or comforting or convenient.

4. To state the obvious, I am trained to be able to handle crisis situations. Our volunteers are not. I can triage risk behaviors and understand when law enforcement needs to get involved, when intensive services (e.g. partial or full inpatient care) are needed, in need of detox rather than psych inpatient, and when someone is merely threatening when they mean to say that they are just distressed and not sure how to chill out about it but they are not a true risk to self/others. I know the questions to ask because I spent many years in specialized training, internships, and job placements. My education was extremely expensive in time, energy, and stress.

5. There are a LOT of misperceptions about how to be a patient and what your therapy fee translates into as far as therapist pay. I would make more as a cheese packer on a production line at a union factory. I would make more as a Walgreens Store Manager. I would make a LOT more if I actually used my abilities for corporate profit in so many other fields. But I choose to be a therapist because I mean well. I already put in countless unpaid hours and many more grossly underpaid hours. I tolerate incessant abuse and threats due to the nature of who my clients are, why they are referred, and what they perceive to be an effective way of getting what they want. Good luck ever finding someone to do my job for free. You would be amazed how many providers in my field become suicidal despite having excellent resources for coping. This attitude against these highly underpaid professionals is extremely damaging. This is a huge part of why so few medical students choose to become psychiatrists anymore. Why become a poorly paid (for a physician and for the training and liability requirements) psychiatrist that many people view as "not a real doctor" when you can become pretty much any other kind of MD/DO and still help people while taking so much less rubbish from everyone? And what is the consequence? Even with insurance, people have to wait months to be seen to get medication refills. So they go to their GPs for meds and the GPs get overburdened. So then they assign it to others who might not have the training to truly understand the complexities of each individual's situation. And even the psychiatrists that still practice can only see patients so seldom and for such short times that it's not particularly qualitative anyway. So you then put blame on them but that is not at all a productive thing to do.

There are many other examples, of course.

I've also used this service as a chatter and have had (sorry to say) more listeners that made things worse than listeners that have helped. I know many good listeners but prefer to go to the general request pool rather than to become someone's regular. There are very good listeners here--I'm not downplaying that. However, there are also listeners that have done significant damage. And some, despite reports, still are present and I even got a report from one of my own chatters a few months later about the same problems with one of the people I had experienced issues with as a listener, despite having filed a report.

If that happened in a professional context, the level of violation was such that someone would face disciplinary review of some level, dependent upon the offense. Here, if you are abusive or neglectful, maybe you will get banned. As a professional, you not only risk your job and licensure, but you also risk jail time. I have good reason to maintain exceptional compassion beyond goodwill. The incentive here is simply not possible in the same manner.

It is great that people can access free services. It's great that people can feel anonymous. It's great that this is convenient and available globally. I'm not downplaying those things.

What I am saying is, hey, how about we don't go "we're so amazing so screw shrinks--they will never be as good as us unless they go use their expensive training to work for free." Because that is a very dangerous, stigmatizing, and offensive attitude, even when expressing it in jest.

@adamabinta I like your idea - getting a job in another field in order to be able to afford to offer free therapy! What field(s) would you suggest?

Thanks,