J. Miller, Ph.D.
Founder and President of Boulder Psychotherapists' Guild, Inc.
learn more about the Guild, click here
In 1994, a group of Boulder psychotherapists began discussing
how they might 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 undermined 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 of the
Guild 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 have the resources
needed 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.
Dr. Miller realized that he could establish an organization that
would accomplish the goal of promoting psychotherapy and educating
consumers about the advantages of treatment outside of managed
care. He founded the Boulder Psychotherapists’ Guild, Inc.
and invested his funds to establish the organization. Fifty-five
other therapists joined and provided dues, ideas, and encouragement.
A group of four 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
The Guild is based on the principles of ethical marketing—providing
consumers with accurate information about the potential benefits
of psychotherapy so that they are able to make an informed decision
about entering therapy. The Guild serves consumers by supplying
information about psychotherapy and how to locate a therapist;
serves referral sources by providing information about how to
locate services or therapists; and serves 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. It
has been a success and has served as a model for similar organizations
around the country. It now has 78 members, and is recognized in
the Boulder Community as the leading referral source for licensed
psychotherapists. It has been described in a professional journal
and a Wall Street Journal article . The Guild has created a model
program 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. Consumers are increasingly paying out-of-pocket for
their therapy. The Guild therapists make therapy more affordable
by offering a discount for self-pay clients. Some 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, most of the Guild therapists work with
insurance and managed care companies even as they remain committed
to the mission of the Guild.
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