The History of the Guild
In 1994, a group of Boulder psychotherapists joined together in discussions about how to preserve quality mental health care in the era of managed care. At the time, managed care had begun to control most of the mental health services that were reimbursed by insurance. Managed care dramatically cut the costs of treatment by creating restricted panels of providers and using a variety of techniques to abbreviate or discourage therapy. Their restrictions decreased the effectiveness of therapy and undermining the privacy essential to therapy. Moreover, managed care misled purchasers and consumers by advertising that their abbreviated therapy was actually as effective or more effective than allowing providers and patients to privately determine the type, intensity and length of therapy.
Realizing that managed care was intent primarily on cutting costs regardless of the impact on quality, the founding members thought that the best available alternative would be self-pay therapy conducted outside of the intrusions of managed care. They believed that by joining together, they would be able to provide consumers with accurate information about psychotherapy and its benefits, and about the negative impact of managed care on psychotherapy. Because many consumers have traditionally paid a large portion or all of their therapy expenses out-of-pocket, the founders believed that many consumers would prefer to pay for their own therapy if they knew about the managed care interference with effective therapy.
Ivan Miller, a Boulder psychologist, was involved in these discussions, and he realized that he could establish an organization that would accomplish the goal of promoting psychotherapy and the advantages for consumers of treatment outside of managed care. For efficiency, he established the Boulder Psychotherapists’ Guild, Inc. as a for-profit organization and invested his funds to establish the organization. Fifty-five other therapists joined and provided dues, ideas, and encouragement. A small group of therapists acted as an advisory committee.
The Guild was formed around a mission — “Our 56 therapists have joined together to respond to the growing impersonalization and decline in the quality of mental health care. We are dedicated to preserving the integrity of client-focused, confidential psychotherapy and counseling.”
The Guild is based on the principles of ethical marketing — providing consumers with accurate information about the benefits and process of psychotherapy so that they are able to make an informed decision about entering therapy. The Guild provides service to consumers by supplying information about psychotherapy and how to locate a therapist; to referral sources by helping them locate services or therapists; and to providers by educating consumers and referral sources about their practices, services, interests and specialties.
The Guild is a marketing company that promotes psychotherapists, the value of psychotherapy and develops the self-pay market. The Guild has been a success and has served as a model for similar organizations around the country. It has been described in a professional journal and a Wall Street Journal article . The Guild has created a leading model for giving consumers information about therapy and therapists.
Today consumers and providers are more aware of how managed care has interfered with quality, privacy, availability, and choice in therapy. Due to managed care and insurance restrictions, consumers are increasingly paying out-of-pocket for their therapy. The Guild therapists offer a discount for self-pay clients, which makes therapy more affordable. Many Guild therapists offer a sliding scale for people who cannot afford the full cost of treatment. Because many people need to use their insurance to help pay for therapy, many Guild therapists do work with insurance and managed care companies even as they remain committed to the mission of the Guild.
Since its inception, the Guild has continued to improve through the contributions of the Guild Managers and continuing support and ideas from members. It has developed a state-of-the art web site, distributes 5,000 Directories annually, provides free community presentations about mental health issues, and maintains a referral and information line.
An Alternative to Managed Care: A "Guild" model for the Independent Practice of Psychotherapy, Journal of Marital and Family Therapy, Vol. 25, No. 1, pp. 99-111, and With a ‘Guild’ Therapists Flee Managed Care, Wall Street Journal, Monday, November 22, 1999, p. B1