Running start… to a great career: Offering pro bono services

Without the free group therapy sessions Gary Howell, PsyD, offers every other week, trans and gender diverse adolescents and their parents in Tampa, Florida, might not get the help they need. Many simply can’t afford to pay, says Howell, chief psychologist at the Center for Psychological Growth.

While this pro bono work eats into his billable hours, says Howell, “this is my way of giving back.” In fact, he’s so committed to it he has created a nonprofit called the Institute for LGBT Health and Wellbeing so he can accept donations and develop a drop-in center, summer camp and other resources.

Pro bono work helps patients, but it can help psychologists, too, says Kim Baranowski, PhD, who provides pro bono forensic evaluations of asylum-seekers at the Mount Sinai Human Rights Program in New York. Pro bono work can lead to the widening of professional networks, new employment opportunities, development of advocacy competencies and more, she notes. The training and experience a position like hers requires enhances clinical skills and marketability. And pro bono work allows practitioners to “keep doing the work we love while also doing the work that pays the bills,” she says. Plus, APA encourages psychologists to contribute at least some of their time for little or no payment.

If you’re considering pro bono work, consider these tips:

Write things down. Use written agreements, so you and clients have a shared understanding of how much pro bono service you’re willing to give, suggests Nichole Sage, PsyD, a member of the Oregon Psychological Association’s Ethics Committee. “It’s important to have that upfront, so there are no surprises,” says Sage, a psychologist at the Children’s Program in Portland.

Treat pro bono and paid work the same. Don’t get sloppy just because you’re not billing the client or an insurer, says Howell. For example, informed consent and proper documentation of treatment and progress are still required.

Consider “low bono” services. Some worry that clients who don’t pay for therapy won’t be as committed to it. While that hasn’t happened with Howell’s trans youth, he recalls that patients at his internship site who paid as little as a $1 per session were far less likely to cancel at the last minute than those who paid nothing. And while Sage has found no research to back the link with lower commitment, she notes that free services may be problematic for certain clients, such as those trying to overcome dependency. “There may be other ways to help them be self-sufficient,” she says.

Be ethical. Be mindful of insurers’ rules, so you don’t inadvertently run afoul of them, says Sage. Routinely waiving co-pays may be a no-no, for example. In addition to checking with payers, Sage suggests consulting with your state psychological association’s ethics committee.

“Thinking about pro bono work service provision can be daunting when you’re just trying to get your career started,” says Baranowski. “But there’s a way for every single clinician to find some space in their life to do this work.”

For more information, read a review of ethical issues Sage co-authored in the Oregon Psychologist (PDF, 4.03MB).

This column is geared toward early career psychologists working in practice settings. "Running start ... to a great career" features topics typically not covered in graduate school and includes tips and advice from psychologists.