A few weeks ago, Open Path Psychotherapy Collective founder Paul Fugelsang talked with Mike Shook, creator of the podcast The Thoughtful Counselor, a series “dedicated to producing great conversations around current topics in counseling and psychotherapy.” Below, a few highlights from the episode featuring Paul, which includes reflections on the origin and evolution of Open Path Psychotherapy Collective.

On why he founded Open Path Psychotherapy Collective:

“Like most [therapists in private practice], I had a couple of slots for sliding scale. Once those slots were filled I started to realize that there was nowhere I could refer people who perhaps made too much money so that they didn’t qualify for city or county services but didn’t have enough to pay $150 or even $100 out of pocket. This was before the Affordable Care Act came into play (2013), so there were many more people who were uninsured at that point as opposed to now where it feels like there are many more people who are under-insured.

What I found was that I would get these phone calls and there would be people who I really wanted to work with and I couldn’t fit them into my schedule. There was no good place to refer them to, so they had to be sent back into the wilderness. I was picking up the phone and calling therapists, asking if these people could be seen at a lower rate. It didn’t make sense to me that there wasn’t a resource, especially since the internet was here, in all our lives.”

On obstacles faced in the first two years of Open Path: 

“In the beginning I assumed that word-of-mouth would spread like wildfire and that would be all the advertising we would need. That certainly wasn’t the case. It takes time and we’re really grateful now. I think about 50% of the new clients we get are coming to us by word-of-mouth. It’s picking up. But in the beginning that was certainly the hardest part: how do we get the word out with zero dollars? There are huge start-ups today that do text-based therapy — I don’t really consider that therapy — but they have 26, 27 million dollars in investor funding so they can paper New York City subways with ads. We have probably double the number of therapists that those organizations have but we don’t have an advertising budget. We’re quite hampered in that way. But it’s really exciting to be cultivating and nourishing a “little-engine-that-could story.” Every year we’re a little bit stronger than the year before, and that feels right.”

On why therapists sign up for Open Path Collective, and how they benefit:

“When I would lower my fee for someone as private practitioner, there was the mutual benefit of providing the service for someone and then receiving this altruistic boost — that I’m doing something good for somebody else. That’s really important and an essential part of what we do as professionals, ethically. But that’s a one-on-one type thing. We’ve really tried to communicate to our Open Path therapists that because you are offering lower-fee therapy in San Francisco, through Open Path someone can receive lower-fee therapy in Miami, and that means someone’s getting that in Nebraska, and on and on. This is the idea of the collective: therapists are not lone individuals having a one-on-one relationship. Every therapist in Open Path Psychotherapy Collective has a hand in the treatment of the 11,000 individuals so far who have been connected. To me, that’s been especially meaningful as a practitioner, because it adds richness to the work I’m doing with the one low-fee client I’m seeing.”

View all episodes of The Thoughtful Counselor