Mental health workers at Resilience Lab, a Manhattan startup that matches people with therapists who provide remote counseling, is likely to be the first in the booming teletherapy sector to unionize.
Employees at the company filed a petition this month with the National Labor Relations Board to vote on joining DC 37, the city’s largest municipal employee union and one that represents public hospital workers. DC 37 officials say it is the first telehealth company in the country to organize.
The filing comes after the company fired a dozen mental health therapists in mid-November, giving the 271 clients they worked with a few days’ notice that their care would be disrupted – a move that critics of the company said violated mental health best practices. Ethical guidelines from the American Counseling Association and the American Psychological Association note that ending a patient-client relationship should be done with enough time to process clients’ complex emotional responses, make sure they aren’t being harmed and review their treatment goals and progress. The layoffs came days before the company announced raising a $15 million venture investment round.
Company officials have declined to answer questions about why the 12 therapists were dismissed. CEO and co-founder Marc Goldberg said patients were allowed to continue seeing their therapists outside of the Resilience platform.
In a statement, Goldberg said unionization would hurt the company’s development and was not needed. “While we respect our colleagues’ rights to seek union representation or vote against joining, we do not believe this model provides the necessary flexibility for the current stage of development of Resilience Lab to continue providing the best possible treatment for our clients and support for our clinicians,” he said.
Talk therapy, once offered primarily by nonprofit agencies or clinicians with brick-and-mortar private practices, has increasingly moved into the tech startup world in recent years. One of the largest companies, BetterHelp, has been around since 2013. Other companies have followed, and the COVID-19 pandemic further increased the acceptance of teletherapy among both patients and practitioners. Last year, startups offering digital mental-health services raised $4.8 billion in investment funding, The Wall Street Journal reported.
These companies can help therapists build up their own practices or supplement income from other jobs. But they can also have significant downsides: Low pay at some companies can push therapists to take on larger caseloads and spread themselves thin — mirroring some of the labor conundrums seen in the tech-fueled gig economy.
Resilience Lab, founded in 2019, sought to set itself apart from competitors in the increasingly crowded teletherapy space. The company claims that half of its 230 or so therapists identify as people of color or part of the LGBTQ community, which could appeal to a more diverse client base.
At a time when the country is facing a shortage of mental health professionals, Resilience Lab has also made a point of allowing new therapists who are not yet licensed to go into private practice to work under clinical supervision. That way they can accumulate the hours of counseling they need to earn full licensure. BetterHelp, for example, requires its approximately 30,000 therapists to be licensed.
About a half-dozen current and former Resilience Lab employees who spoke to Gothamist said they were drawn in by the opportunity to build a client base and the company’s message of inclusivity. But some are now criticizing the company for hiring executives from outside of the health care field. Union organizers also say a new employment contract will mean pay cuts for some therapists, and criticized management decisions that some believe were not in patients’ best interests – including the firings and a patient assessment tool that management tried to introduce over the summer.
“[Resilience Lab] was sold to us as a group private practice that sounded very inclusive… and it’s become a mental health tech startup,” said a Resilience Lab employee who sits on the union organizing committee and spoke on the condition of anonymity out of fear of retaliation by management. “A group private practice wouldn’t hire people from Uber to tell therapists how to do their jobs.”
Goldberg, the CEO, said the company has recruited executives from both the tech and health care industries. His wife, co-founder Christine Carville, is the company’s chief clinical officer and a licensed therapist.
After the November firings, one supervisor at the company quit over the move. In a lengthy memo that was shared with Gothamist, he cited the company’s failure to give therapists and patients more time to transition and how the move violated the profession’s ethical guidelines.
At least one of the therapists who was fired, Tanya Tripi-Weiss, remains on the union organizing committee. She said she was already considering leaving the company over the new contract when she was let go in the November action.
“The people I’m working to help unionize, they deserve a lot better than what they’re getting,” Tripi-Weiss said.
Apart from the recent layoffs of the therapists, another sticking point for some workers is an initiative at Resilience Lab to measure patient progress through a new assessment tool. The company has argued the tool will allow therapists to receive feedback from patients and improve outcomes. But a letter to management signed by 60 employees countered that the patient surveys were not “trauma-informed and do not meaningfully assess clients’ individual goals.”
On Dec. 14, Michele Moorman, Resilience Lab’s vice president of people, sent an email about that employee letter to Jason Greer, a labor relations consultant who states that he specializes in “union avoidance.” The email was shared with Gothamist. Resilience Lab did not respond to a question about its relationship with Greer.
Casey Pierce, an assistant professor at the University of Michigan’s School of Information, has studied how the work of mental health professionals has been affected by the rise of teletherapy companies. She noted that many therapists opt to work for these companies because of the flexibility they offer — but some end up feeling pressured to take on larger caseloads than they can handle in order to make the gig worthwhile.
“One of the biggest issues that seems to come up is that you’re rewarded for taking on more clients, but then you don’t always feel that you have the capacity to do so,” Pierce said.
Her research finds that not all teletherapy companies have the same model, however. Some are designed primarily to link insurance companies with their networks of therapists and allow therapists to retain most or all of the fees they earn per session.
Like BetterHelp, Resilience Lab’s pay scale incentivizes therapists to take on as many clients as possible — although Resilience Lab sets itself apart by also offering a base salary.
Resilience Lab has set its base pay at $1,300 per month, according to a contract released in October, which was shared with Gothamist. Therapists then earn a percentage of the fee that patients or their insurers pay for each session — starting at 15% for the first 49 sessions they conduct each month, and going up incrementally after that.
Why it may be hard to unionize teletherapy
At most teletherapy companies, the mental health professionals are independent contractors, not employees, Pierce said. That classification means it would likely be difficult to replicate Resilience Lab’s union drive elsewhere in the industry.
This issue has come up in other parts of the gig economy, such as ride-sharing and delivery services, said James Parrott, director of economic and fiscal policies at the New School’s Center for New York City Affairs. Some companies have argued that organizing by independent contractors is a violation of antitrust laws.
“They ostensibly are independent business people and coming together to deal with a third party like their ostensible employer is sometimes construed as anti-competitive behavior,” Parrott said.
But he noted that delivery workers in New York City have created a political alliance without forming a union and have been successful at changing local laws around their industry. DC 37 says it hopes to set a standard for the telehealth field – which encompasses a range of different types of companies and patient care.
“Workers’ rights are stronger and better protected when we bargain collectively,” said Henry Garrido, DC 37’s executive director, in a statement. “We intend to secure a strong contract for Resilience Lab that sets a high bar across the telehealth industry.”