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March 21, 2020
Therapists Are Small Business Owners Too

Megan Rafuse

Headshot of Megan Rafuse smiling in business casual attire.

Therapists Need Your Help

It’s a stressful time right now for all of us, especially for the helpers in our communities— our frontline healthcare workers. 

Today I want to shine a light on the mental health therapists that live and work in our communities, and outline some disturbing corporate practices that have come to light during COVID-19. 

While we may not often think about it, therapists are both small business owners and helpers who will often put their own needs last. The reality that we face is simple and stark: Many of us will experience significant financial hardship due to COVID-19 — and unfortunately, some of it will be as a result of corporate greed rather than a lack of demand from consumers. 

So whether you are someone who regularly attends therapy or is considering starting trying therapy for the first time, please consider that therapists are small business owners too. That being said, not all ways of accessing therapy actually supports these small businesses and I think it’s time to make that distinction.

Why is it important to acknowledge that therapists are small businesses right now?

This morning, I had planned to go on a hike but first wanted to check-in on a Facebook group I manage aimed at supporting therapists in Canada to grow and sustain their practices. This is a free group that has over 1300 therapists as members. I’m proud to say that most are Canadian and support people all across the country! Honestly, it’s been hard for me to spend time in the group recently amidst messaging from my colleagues about how hard this time has been on their practices, and how financial challenges to keep their businesses open are at an all-time high. I care about these people, the therapists who often put their needs last to help so many of us, and I worry that if we don’t consider how to support them in the best way possible, we may lose some of the best in our industry.

As I was looking through the feed today I saw two things that stopped me in my tracks…

First, a message from a therapist stating that a mental health tech company she works for is offering a limited amount of free 45-minute sessions to anyone who is impacted by COVID-19. All you had to do was sign up with your email address and if you were eligible and if there were sessions left, you would qualify. Important to note, beyond that single session, you had to pay their regular rate for on-going support. They also had a disclaimer listed, “[Company Name] would like to extend a special thank you to our collaborating therapists who have accepted a discounted rate to help make this service possible!”. 

What the heck? Why is a tech company relying on therapists to take the hit during this already hard time versus relying on their marketing budget?

Let’s be real that offering one session free is a marketing tactic rather than a genuine attempt to help others. My colleagues are worried about how to feed their children and this company is asking them to discount their services and incredible skillset as a marketing ploy. I’m saddened. Therapists are innately people who want to help, often at the expense of their own well-being. This is not the time for companies to rely on that or take advantage of our goodwill. Especially companies that may have venture capital backing or other ways to cover the fall of business, if there is one. Therapists on the other hand, personally finance their practices and in tough times are impacted personally beyond measure, by way of spending their savings and retirement funds to stay afloat. We are entrepreneurs, after all.

Why should therapists be trading their time to help this company market its program? The short answer is that they shouldn’t be.

I wrote a couple of comments asking for clarification and kept scrolling. I’m mindful that this company very well could have had the best of intentions to support clients, and I would salute that under any other circumstance if it was not coming out of the therapists’ pocket. This seemed like a poorly thought out response to a big problem. We can not solve short-term problems with short-term thinking. There are long-term ramifications for all of us in the industry that come from this type of short-term and single-focused thinking. Therapists understand this. We support people every day in challenging this type of thinking. The irony here is hard to swallow.

Next, I moved on to read more posts. I stopped again. Some incredible therapists were sharing that a major national Employee Assistance Program (EAP) had emailed them this week to say that they are not willing to pay the therapists’ regular rate (which was already horrendously low) if the therapist is doing online sessions. 

Seriously? Therapists are acting responsibly and supporting our clients more than ever and we are being penalized for this due to a change in delivery format? I venture to guess the companies who pay for this EAP service haven’t suddenly reduced their contribution per employee. I see this to be incredibly opportunistic by the EAP,  simply because at a time when we all need to support the most and we have adapted as a profession to now offer virtual therapy, the big industry uses our strength and resilience to capitalize leaving us in the lurch.

I’ve witnessed colleagues tearful and full of worry about how they can continue to support their clients now more than ever. I’ve watched therapists pull together to brainstorm the best ways to support the most people possible, pull together resources for free or low-cost mental health support and to support each other with co-purchasing expensive and compliant video software just to stay afloat.

And now I’m watching big firms turn on the providers that keep their pockets lined. Frankly, I’m disgusted.

I have to admit, I too run a company that employs therapists as contractors. I am also a therapist myself. We too partner with a tech company that hires our therapists. But we have a strong ethical compass. What did we do?

We reached out to our B2B clients and inquired if they need more support. We offered our therapists more opportunities to make money via other means (like webinars or course creation). We listened to our therapists who wanted to help and found a way to support them in doing so that didn’t dilute their businesses or impact the bottom line. We acted from a place of upholding our profession as a whole, including supporting other small business owners and therapists who needed help turning on online work. We worked with our tech partner, Maple, to onboard more therapists nationally to meet demand and offer them the same fair wage we always have. We do not believe in a free first session as a marketing tactic. We believe in our team and believe that all therapists are worthy of being paid for their time and hard work. 

Most importantly, we did not decide to swim at the expense of others drowning.

That’s why I think it’s important to speak out. If you have ever benefited from therapy please consider what you can do and encourage your loved ones to do to support your favourite clinicians so that they can support their clients.

What should you do if you are buying therapy services personally?

  • Buy from independent practices owned and operated by therapists. These might be a group practice (like ours) or an independent private practice. In either case, you are supporting therapists in an equitable, sustainable way. 
  • Buy from virtual apps that treat therapists fairly. There are apps out there that provide therapy services in a way that is fair to the therapists (Maple being a great example, though there are others). If you see any apps that offer a first session free or significant discount, please be wary as their therapists are often the ones that bear that cost.
  • If you had a therapist that you enjoyed working with, share that person’s name with people close to you. Word of mouth is how therapists can market themselves without having to rely on big tech companies for their marketing help. If you feel comfortable in doing so, it can go a long way.

What should you do if you are a business owner or HR leader? 

  • Rethink your EAP coverage. EAPs make money by offering practitioners little money per session, limiting the number of sessions a client can have, and preventing a practitioner from seeing that client again even if the client wants to pay out of pocket to do so. Please think twice before hiring a massive company like Morneau Shepell or Lifeworks for an EAP service. Instead, support boutique therapist-led groups that are dedicated to the quality of care for your employees and fair terms for their providers. 
  • Encourage your people to use their benefits for therapists who work in group or independent practices. Healthcare benefits cover a good deal of therapy services for Canadians, and are an important part of a therapist’s compensation. Get familiar with several practices in close proximity to your business and encourage employees in need to reach out to them. You can rest assured that they’ll be well taken care of while supporting independent businesses. 

At a time when helpers are needed more than ever — and ready to help — it’s critical to ensure that therapists are supported ahead of corporate interests. 

I am speaking out because therapists are a group that care so much about your well-being that they may never speak out if it means impacting others negatively. Now is the time to lift up our helpers. I hope we can have your support in accomplishing that.  


Megan Rafuse
Founder & Clinical Director, Shift Collab 

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