Has Therapy Become Too Capitalistic? with Paul Fugelsang

Paul Fugelsang (00:00):

It's amazing how often we find that therapists are unprepared to talk about money with clients, and it sort of shows the power of money and it shows that it still has a taboo quality to it. In this culture at Open Path, what we try to express to the therapist is that the money is part of the therapeutic relationship. That what a client pays you is an integral part of that relationship and that when you talk about money, you talk about it as if it's part of the relationship.

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Michael Fulwiler (00:27):

This is Heard Business School where we sit down with private practice owners and industry experts to learn about the business of therapy together. I'm your host, Michael Fulwiler. This week I'm joined by Paul Fugelsang, founder and executive director of Open Path Psychotherapy Collective. We dive into Paul's journey in mental health and his mission to make therapy more accessible, Open Path's role, and connecting clients with affordable therapists and Paul's thoughts on balancing business and ethics in therapy. We're proud to partner with Open Path at Heard and I'm grateful for my friendship with Paul. Here is our conversation. Enjoy Paul Fugelsang. Welcome to the show.

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Paul Fugelsang (01:13):

Hey, thanks Michael.

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Michael Fulwiler (01:14):

Did I get that right?

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Paul Fugelsang (01:15):

You got it right.

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Michael Fulwiler (01:18):

Awesome. You're based in Asheville. Are you from Asheville originally?

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Paul Fugelsang (01:22):

No, I'm a New Yorker. I'm from New York and I've been down in Asheville for about 13 years.

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Michael Fulwiler (01:27):

But you went to grad school in Colorado, I saw at Naropa University. Did I say that right?

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Paul Fugelsang (01:33):

Yeah, that's right.

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Michael Fulwiler (01:33):

How did you end up in, that's in Boulder, right? How did you end up there?

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Paul Fugelsang (01:38):

Well, I was dating a woman who was moving out there and I thought I'd go out and see what it was like. I was in my early twenties and living a very fabulous drifting life, which I miss very much, and drifted out to Colorado and she started a grad program at Naropa and I didn't know I wanted to be a therapist at the time and got really into what the stuff that she was studying. She was studying education and started looking at their psychology programs and it was like, oh, of course, this is what I want to study. For those that don't know Naropa, it is a Buddhist inspired university, so my program was called Contemplative Psychotherapy and it was sort of mixing classical western psychoanalytic thought with Eastern mindfulness practices.

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Michael Fulwiler (02:25):

I love that. I'm from Seattle originally, now I live in New England, also moved out here. My wife is from here. I imagine that's probably pretty common. I'm curious, so you go to grad school, what did you do after grad school? I know that you jumped around a bit.

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Paul Fugelsang (02:42):

Yeah, so when grad school ended, I moved back to New York City and started working as a therapist for a juvenile justice organization doing home-based therapy for kids who've been arrested, and there are a bunch of these programs that have popped up of people making an argument to the state or the city that they'll save them a lot of money if they do therapy then if they send kids away to prison. So it was a really wonderful nonprofit and traveled all over the outer reaches of the New York City boroughs doing home-based therapy with kids and their families.

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Michael Fulwiler (03:15):

Was that your kind of first exposure to nonprofit work in the nonprofit world?

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Paul Fugelsang (03:21):

No, not really. I had been working in nonprofits or NGOs. I lived in South America for about three years working for an NGO in my twenties, so I kept finding myself drifting towards nonprofits all the time, but this certainly was a really wonderful nonprofit run by some really wonderful people, and I learned quite a bit in that position.

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Michael Fulwiler (03:42):

That's amazing. At this time, was private practice on your radar or were you pretty invested in the nonprofit world?

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Paul Fugelsang (03:50):

No, I mean I was getting my hours and I certainly wasn't ready on many levels to start a private practice in New York City at that point in my life. But I think, yeah, it was definitely on my radar. I knew it was coming.

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Michael Fulwiler (04:02):

And then I saw you moved to Florida at some point, so was that kind of the next step for you?

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Paul Fugelsang (04:09):

Yeah, for about five years my folks were ill and not doing well, so moved down to Florida to be close to them and help them along into the next life, and that's where I started a private practice.

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Michael Fulwiler (04:24):

And what was that experience like for you starting your practice and kind of getting the business side up and running?

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Paul Fugelsang (04:31):

In retrospect? It was pretty wild. I joined a group practice and I was terrified about making a living and had a baby and didn't know if I could make it work. And at this group practice within four months I was up to 35 clients a week, so it was a little too much too fast. And a mentor of mine said once that when you start a private practice someplace, you have to buckle in because you are exposing yourself to so much unconscious content coming at you all at once. So now when I take on a new client, I'm sort of entering their unconscious and they're entering mine to some extent, and I can do that if I do that a few times a year. It's not too overwhelming, but getting 35 clients in four months, it was quite rigorous and really difficult and sort of led me to feel like, yeah, I don't know if I'm cut out for a 35 client a week caseload.

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Michael Fulwiler (05:30):

So what did you do at that point? Did you cut back on the number of clients you were working with?

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Paul Fugelsang (05:35):

No, I didn't cut back. What happened was, or I did cut back, but not intentionally. My father had died and we moved up to Asheville at that point. This is back in 2012, and by nature of the move, I lost probably two thirds of my clients, but kept a third. At that point, we were working on Skype. Yeah, it's funny how ancient that seems now, but it wasn't that long ago really. And then started building a practice here in Asheville, and that's when Open Path came to me one day.

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Michael Fulwiler (06:05):

Do you mind sharing that story? How Open Path came to you?

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Paul Fugelsang (06:10):

I had a lot of time on my hands when I moved here and spent a lot of time walking my dog, getting to know Asheville and was spinning my wheels thinking about life and therapy and what was coming up next. And then suddenly this idea came to me and the idea was that in some way we were doing it all wrong. And what I mean by that is that in Asheville, and there was one of these in Boulder, these folks had started a nonprofit by renting or buying a Victorian house and then remodeling it and making each of the bedrooms into a therapy office and then seeing people at low fees, which I think is wonderful, but in many ways it was very much a pre-internet business model. And suddenly I started thinking about that model and thinking about the internet and then realizing, oh, the internet can be the waiting room, or the website can be the waiting room where a client enters, and then we can usher the client on to see the therapist who's in private practice. So rather than having one house with five bedrooms, we could have one house with, well, we have 34,000 therapists now, so 34,000 private practice rooms. And of course at the time I never thought it would be this big, but it suddenly made sense that that model felt a little outdated when one considers the possibilities of the website.

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Michael Fulwiler (07:24):

And was the initial idea to make therapy more accessible and available for folks kind of at a lower rate?

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Paul Fugelsang (07:34):

Yeah, that's right. So when I started my private practice in Florida, I'd see a certain number of clients at a pretty low fee. I felt like it was my ethical obligation. And then once those got filled, someone would call and say, Hey, I can only afford $30 a session. And I'd say, I'm sorry, I can't see you for that rate. And they'd say, well, who can see me for that rate? And I'd say, I'm sorry, but you just got to keep calling people and eventually you'll find somebody. And I just thought about how, in a way, how humiliating this is to ask people to do that and how it's not really reflective of the dignity and worth that they hold as people. And seems kind of crazy that there was no website there where a bunch of therapists could say, all right, I'll see you at a much lower rate and take that step out of it for people.

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Michael Fulwiler (08:16):

Most therapists by now are familiar with Open Path Collective, but for folks who are listening who are not familiar, can you explain how Open Path, how it works and what it costs?

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Paul Fugelsang (08:28):

So it's a pretty simple model. We invite therapists to join for no Cost, and they put a profile page up on our website and then we have clients who come through and find a therapist and we'll choose them. The client pays Open Path, a one time lifetime membership fee of $65, and then we connect the therapist and the client and the rate ranges between $30 for student interns, then between 40 and $70 for adults, 80 for couples and family. And the therapist and the client ideally decide on a number together in that range. And then when they do Open Path removes ourselves completely from the relationship. We're not like one of these other companies that's doing fee splitting and taking a percentage of each session. So once we made the connection, we wish them well and we remove ourselves.

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Michael Fulwiler (09:20):

It makes so much sense. I remember when I was at the Gottman Institute probably 20 15, 20 16 learning about Open Path, and I don't know if we spoke and met at that time, but I know that we were part of a partner program I think where if you're a member of Open Path as a therapist, you got a discount on Gottman trainings, but it just makes so much sense. And as a therapist, really there's two big benefits. One being that if you're interested in offering a sliding scale or if you have availability on your caseload, you're able to get clients to fill those spots. But also to your point that if you have clients who are reaching out to you who are looking for more affordable therapy, but your sliding scale spots are full, you can find someone to refer them to. And my sense is that is kind of the current challenge of Open Path today is you have a lot of therapists and it's more now about getting the word out to potential clients about Open Path. Is that correct?

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Paul Fugelsang (10:21):

Yeah, that's right. We have what we think of as our ecosystem where we try to have a really finely tuned balance of therapists who are available and seeing new clients and then clients coming through the door. And when the pandemic hit, our client numbers sort of went through the roof the way they did for many people, and suddenly we were really low on therapists. And so we spent a couple years and spent a lot of money marketing to therapists and got a lot of therapists to come through the door, and now we have too many therapists and not enough clients. I think this is just the nature of the job where we're constantly going to be working on getting that balance right. So right now, yeah, we have a lot of therapists and since the pandemic, there's so many of these health tech companies that have sprung up, so suddenly there's just a lot more people vying for eyes than there ever have been before.

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Michael Fulwiler (11:12):

Do you want to go there, we've talked about this a lot, but I'm curious your take on the emergence of health tech and mental health venture capital, what do you think is the net impact on the field?

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Paul Fugelsang (11:32):

I think that whenever you create an endeavor where the ultimate goal is pleasing shareholders and bringing in the most money that one possibly can, then some element of humanity or soulfulness is going to leave the room. I think it's unavoidable, and I think it's the nature of the beast of capitalism and Open Path. We run as a capitalist business. We don't really have a lot of donation money coming in. It's mostly done through earned revenue through the membership fee and a few other programs that we have. So I'm not excluding ourselves, but what we've tried to do this entire time is not be seduced by the power of money and by the power of numbers and by the power of growth. We've tried to hold on to some level of soulfulness there and really, really concentrate on what is the most effective means of helping people that we can find in this endeavor.

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(12:26):

So that's what we do, that's what we try to do, that's what we strive to do. I have to remind myself constantly if I find myself crunching numbers in a way of going, oh look, this thing, this is a very powerful force capitalism. And then I try to be careful around it because I recognize its power and I recognize its capacities to seduce people and get them to really, really operate in ways that are antithetical to their humanity. So when it comes to these big companies, not to put too much of a blanket over them, however, it often feels like a ruse is happening, like a really transparent ruse where they're saying, we're here to help. We're going to take care of you, we're going to make you better and all the things. And ultimately we know what their primary motivation is. So I'm very distrustful,

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Michael Fulwiler (13:11):

Understandably, and it's a space that we at Heard operate in, right? We're not a care delivery platform. We don't provide therapy services, but we operate within the mental health space. And it's something that I spend a lot of time thinking about how can we be on the side of therapists, but also we have taken venture funding and part of that venture funding is to hire people and grow the team and put dollars into marketing and all those things. But at the end of the day, we're not a nonprofit. We're a venture backed startup and we have obligations to our investors and shareholders as well. And so how do you tow that line between ethics and growth and revenue? And I'm curious about your perspective on that. You mentioned earlier that you felt an ethical obligation as a therapist to make your services accessible, yet being a therapist is expensive. A lot of therapists we know and heard from surveying therapists are just drowning in student loan debt. They have expenses, and so to some degree they need to make money and they should be able to make money and afford the lifestyle that they want to live, but there's also that ethical obligation of making your services affordable. And so where do you see that balance?

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Paul Fugelsang (14:40):

Yeah, it's interesting. I come from a pretty solidly middle class background. I didn't really come from a wealthy family. We had all our needs met out. There wasn't wealth there. And I, as a kid growing up and even as a young adult, I had this vision of therapists that it was old New York and analysts charging hundreds of dollars an hour and doing quite well for themselves. And then once I got into the field, it's like, oh yeah, this is a way to make decent money for sure, and one is not going to become fabulously wealthy doing this work. It just is not that career, and it probably is because it's one of the helping professions and we know how we reward the different professions in this country. It feels like there is a real push for therapists to, in some corners, to play into this game of making the most amount of money they possibly can and recognizing their worth between quotations.

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(15:39):

And I actually have no problems with this. People get to live their lives exactly as they feel they should. I noticed when I was a therapist in private practice that I was totally doing well enough in terms of how much I was making, and then to drop my fee to $40 or $50 a session for a certain number of people, which I still do 20 years in, it feels like, it feels like, oh yeah, I can actually afford to do this. And I do feel like it's my responsibility. I don't think it's other people's responsibility, but I do feel like it's my responsibility to chip in this way

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Michael Fulwiler (16:16):

That makes a lot of sense. I have this belief that it shouldn't be the financial responsibility of making therapy more accessible. That burden should not be on the therapist, it should be on the system that they operate in. And so with that said, we operate in an imperfect system. I think ideally all therapists would take insurance, clients would be able to pay a small copay, therapists would be reimbursed well, and that would work right as long as clients had insurance. That's not the case because insurance companies are for profit and they're not necessarily incentivized to pay therapists more than they do. So there's a misalignment of incentives there. And I think that if there were more state and federal grant programs for therapists to forgive student loans, then that could help as well, that if therapists weren't paying off their loans, they could afford to charge less or have at least a sliding scale or a few spots in their caseload that are less.

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(17:30):

But I think it's not so black and white, which is why I'm glad that we're having this conversation, right? Because the soundbites you hear on social media is you should be charging or you should be charging 200, 2 50, $300 a session. As a therapist, you deserve to be paid that. And that's true if that's the business you want to build and you're seeing 15, 20 clients, the impact that you're going to make on the industry by making therapy not accessible is probably pretty minimal. And there's also people out there who can afford to pay that, but I think if everyone did that, then we'd have a problem. And so it sounds like it's a balance of it's okay to charge a premium fee, and if you're going to do that, that enables you to offer some spots on your caseload for a reduced rate,

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Paul Fugelsang (18:24):

Ideally, if that's what someone has in their values. I'm aware that I'm sort of, and I was raised this way, I'm kind of a collectivist at heart. I just think that it's our responsibility while we're here to help one another out in whatever ways we can. And sometimes that means just being friendly to the person you bump into in the grocery store, but I'm a much happier person when I am living in a collectivist way than I am when I'm living in this hyper capitalistic way. So for me, there's a level of self-interest involved in it. And I would also say to add to it, and I don't mean to be controversial with this, but maybe someone is worth 250 or $300 an hour, but also maybe they're not, and therapists should be asking themselves that questions as well. That question as well, I mean, I've been doing this for 20 years and I feel like I'm just finding my footing as a therapist because it does take a long time. You got to make a lot of mistakes before you really start having an idea of where you are in this world.

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Michael Fulwiler (19:18):

I imagine part of that depends on who you work with as well, the population that you serve. We had a therapist on the show who works with black men, and he shared that he feels like he can't charge more than $150 a session because as a black male, he wouldn't pay that and his friends probably wouldn't pay that. And so he feels like if he charged 200, 2 50, he just wouldn't be able to get clients based on the community that he's in and the population that you work with. So I imagine if you're working with tech executives, for example, and you live in San Francisco or you live in New York City and your clientele or executives and bankers and lawyers, and maybe that can have an impact on what your fee ultimately is.

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Paul Fugelsang (20:00):

Absolutely, yeah. In Nashville, North Carolina, I charge 175 an hour because it feels like an appropriate number given where we are. I once read about this guy who was a therapist in Los Angeles, and you'd have to be working with wealthy clientele to make this work. He charged each client what they made by the hour. If the client made 15 bucks an hour, that's what they paid. If they made 5,000 an hour, that's what they paid.

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Michael Fulwiler (20:24):

I just saw that this morning on Instagram, a therapist I follow Kelly Stevens Private Practice pro, and she actually tagged Open Path Collective, she said for her sliding, I think she has four sliding skills spots on her caseload. What she does is for those clients who are on a sliding scale, she charges them what their hourly rate is in their job. So yeah, if they make $15 an hour, she charges $15.

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Paul Fugelsang (20:48):

Oh, good for Kelly. She's cool. I like Kelly.

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Michael Fulwiler (20:51):

For folks who aren't already working with Open Path, how do you recommend navigating that conversation around what a client can afford? And that was, I saw in the comments of that post, there was questions like, do you ask for a pay stub? Do you just trust their word? How do you navigate that conversation?

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Paul Fugelsang (21:11):

Yeah, that's a great question. It's amazing how often we find that therapists are unprepared to talk about money with clients, and it sort of shows the power of money and it shows that it still has a taboo quality to it. In this culture at Open Path, what we try to express to the therapist is that the money is part of the therapeutic relationship. That what a client pays you is an integral part of that relationship and that when you talk about money, you talk about it as if it's part of the relationship, and when it's one of the first conversations you have with a client, it can be really great way to get things off in a way that is engendering trust and engendering transparency. So what we do is, and it's another service that we offer to the therapist that they don't have to then build into their own practice, is that when a client applies, they'll put a lot of their financial information in there, how much they make their household income, how much debt they have, what their expenses are.

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(22:06):

So when the therapist gets a new client, they can read this information right off the bat, which can help them in that conversation. So if our sliding scale range is between 40 and 70, some therapists will just come in and say, 60 bucks for everyone. That's what we do, or 50 bucks. And if that's their choice, then that's their choice. But what we like to encourage people to do is have a conversation with the client. And when I talk to clients about this, what I say is, in a rate that ranges between 40 and $70, what is a number that you feel like you can afford on a weekly basis or a bimonthly basis depending on their plan for coming in? And just knowing that whatever number you say, I'm not going to be offended or taken aback by it. So you can tell me what number sounds like a number that you can afford, and then I'll let you know whether or not I can work with that. So that's how I do that conversation with people.

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Michael Fulwiler (22:58):

That's really helpful. I love that reframe as talking about money is an opportunity to connect and build rapport versus I'm nervous to talk about it. The client probably feels shame that they can't afford my fee. So you kind of tiptoe around the conversation, but it's really sounds like more of a door for

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Paul Fugelsang (23:15):

Oh, it's a door. Yeah. Yeah, that's a good way to put it.

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Michael Fulwiler (23:18):

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(24:15):

I love that. One kind of thing that I've heard about offering a sliding scale. I'm curious your perspective on it is that some therapists use sliding scale as a crutch because they don't feel like they deserve to charge their full fee. And so before they even get into a conversation about their fee, and if a client can afford their full rate or not, they jump to offering a sliding scale because they feel like I'm not worth a hundred or $150 an hour, so what can you pay? I can offer you a reduced rate, and I'm curious if you've seen that.

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Paul Fugelsang (24:53):

Yeah. Have you ever used a crutch?

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Michael Fulwiler (24:56):

I actually don't think so, no. Have you used a sling? I've had a shoulder injury, but I've never used crutches. No,

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Paul Fugelsang (25:01):

I've used crutches before. They're incredibly helpful tools.

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Michael Fulwiler (25:04):

Right. Okay.

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Paul Fugelsang (25:06):

That's a good thing. Yeah, I mean it could be. Why not,

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(25:08):

Right? I think that if this is where someone is at in their profession and in their development and they don't feel confident charging $150 an hour and they're going to maybe sell themselves a little short by charging $80 an hour, then they can do that. And I think the critical part though is having an eye on what's happening. It's like anything that we do, the more conscious we can be of our patterns and what we're doing, the more we can learn about ourselves and then the more it ensures that that same behavior will be happening 10 years down the road. So I certainly hope that most clinicians entering the world, even if they've gotten their licensure, are working with a supervisor. I've been working with a supervisor for the last 16 years in a supervisory group. We meet every other week and I find it to be still incredibly helpful and we talk about money all the time in there because it's such a big part of what happens. So I would hope that someone who maybe has an idea that they're doing that maybe they're selling themselves short in some way can bring that to supervision and talk about it.

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Michael Fulwiler (26:09):

That's great advice. What about mistakes therapists make when it comes to implementing a sliding scale? I think one of those mistakes could be something we've talked about which is sort of avoiding or tiptoeing around that conversation about money. Is there anything else there that comes to mind?

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Paul Fugelsang (26:28):

To be totally honest, there are so many people out there who have so much knowledge about running private practices, and I'm not one of those people, so I'm sure there are mistakes happening, but I don't feel that qualified to speak to them.

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Michael Fulwiler (26:41):

Well, I appreciate the honesty and the transparency and my response to you is I think that that's also very validating. I think therapists see you as the founder and head of a large nonprofit that has 30,000 plus therapists, and they probably perceive you as this is a person who probably has business training and a business background. And so I think hopefully it normalizes that it's okay. You don't have to have the business background and business training to build something like Open Path. I'm sure you've had a lot of support along the way and have probably taken some missteps or had some lessons. I'm curious on that point, as you look back now at the last 2012, so almost 15 years, is there anything that stands out to you as an important lesson that you've learned, especially for folks who are listening who may be considering starting their own nonprofit and have an idea for a nonprofit that they want to create?

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Paul Fugelsang (27:45):

I was thinking about it this morning. It's kind of astounding to me how naive I was back when I started this. I had no clue at all what I was doing. I don't really know if I have much of a clue about what I'm doing now. Maybe a little bit more of an idea, maybe with a little bit of age comes a little more wisdom or I was the recipient of a lot of grace and fortune and starting Open Path. Like I said, I didn't really know what I was doing. I didn't know a thing about marketing. I didn't know a thing about the field. I did a GoFundMe campaign and the website was going to cost 15 grand, which is kind of a laughable number now. There's so much more expensive than that. And I did a GoFundMe and passed the hat around to friends and family and raised $7,000.

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(28:36):

And then a Friend's Family Trust chipped in another 10,000. So I barely had enough to build the website, but then I built it and zero marketing plan, zero idea. I just thought, oh, this is such a great idea. The word will get out and it's not what happened the first, I launched in April of 2013, and by the summer of 2014, I was really debating how we might just sell it for parts kind of thing because it was not taking off. Like I said, I was the recipient of some fortune. Things started breaking in the right areas for us. We brought on staff and brought on consultants who were so helpful. Lisa Eisenhart, who is our deputy director, came on in 2016 and Lisa has just done so much to really build open path up into something where the t's are crossed on the i's are dotted.

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(29:28):

And the other big thing is timing, because I started it in 2013. It was just before all these therapy companies started popping up. I mean, two years before. And I think had I started it a few years later, it would've gotten lost in the mix. But in 2013, I could cold email a therapist and say, Hey, what do you think about this? And they'd be like, oh yeah, let me open this email and look at this website and sign up. Whereas now it's like we're being inundated with people begging for our attention, and it's just so much harder to come by now. So in terms of my business acumen, there's pretty much zero.

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Michael Fulwiler (30:06):

You're being modest.

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Paul Fugelsang (30:07):

I try to employ common sense when I can. That's about it. Someone was once, what's your five year plan? And I was like, I have no clue what my five year plan is. I was like, we get down

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Michael Fulwiler (30:17):

Question out

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Paul Fugelsang (30:18):

Then. Yeah, I don't know. We get down our hands and knees and we feel ahead for the next stone, and we put it in place, then we crawl forward. And it really feels like the way we've been doing it ever since. And sometimes it's worked and sometimes it's been hard and clunky and we find ourselves in trouble, and then other times it feels like the road is wide open in front of us.

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Michael Fulwiler (30:37):

I think everyone who had a five-year plan in 2019 had to throw that plan out the window. The world changes and life happens. And so to some degree, yes, having a business strategy and a five-year plan can be helpful, but you also never know. Even for me from a marketing perspective, we don't plan the year out in advance because we don't know what's going to happen. Things are going to change. We plan on a quarterly basis, and even that sometimes we need to be flexible and adjust. And so I think leaning into that feels really important here.

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Paul Fugelsang (31:15):

And I think now more than ever in 2015, you could more or less predict what the world was going to look like in 2017. I have no clue what the world's going to like in 2027. It's bonkers

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Michael Fulwiler (31:29):

And the need for therapy isn't going anywhere. So I would think that job security for therapists is pretty good. I think the question moving forward is are people going to pay for therapy if groceries and gas and just things life becomes more expensive, therapy could be an expense that people start to cut. I've heard anecdotally that more people are wanting to use their insurance for therapy and they're not as willing to pay these premium fees, which is a big shift even in the last four or five years where people were willing to pay whatever it took because all of the therapists were full. And so hopefully the need for Open Path and sliding scale will, if anything continue to grow. And it's just at this point about getting the word out to people who are looking for a therapist. That Open Path is a great resource for them. What do you see as the impact of AI and advances in technology on the field?

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Paul Fugelsang (32:41):

Well, I think the thing that I've been thinking about recently, which I'm really curious about, it seems like, oh, within five years there'll be a talking head on a screen that looks exactly like a human that can do therapy with clients and maybe do it a lot better than a lot of therapists make. That feels like a distinct possibility. I was talking to some friends who are a therapist the other day, and we were talking about what happens when a client meets an AI therapist and they feel like there's less capacity for judgment than a human therapist, and therefore they may be inclined to share more and go to more of their deeper, darker, more vulnerable places. And the benefits of that versus the idea that if they are doing those things but that the risks of a human relationship are not in place, how beneficial will that be in terms of feeling better overcoming complexes, et cetera, et cetera? And I don't know the answer to that, but I'm super curious. It sort of feels like maybe the whole thing hinges on that and that perhaps somebody will do this. And the fact that that risk isn't there will be not be consequential at all, it will actually help people a great deal. Of course, I have my own wishes, which is that no, it actually would be very consequential and that the human component of being in relationship with one another is essential for making this work. And I guess that remains to be seen.

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Michael Fulwiler (34:10):

I would say that's already happening from what I've read, people are more comfortable talking to AI than they are to a person. We see people who are developing even romantic feelings with ai, which you've seen the movie Her was, it's like science fiction 10, 15 years ago, and now that's reality too. So I definitely could see that people who feel like they can share without judgment. The other side of that though that I've heard kind of the counter argument to that point is that the thing that AI doesn't do is AI doesn't say the wrong thing. It doesn't forget something about your life. And so what you miss is the misconnection between the therapist and client, which is interesting to think about because that can be an opportunity for repair and rapport building. Actually when your therapist offends you and you tell them about it, that's where your relationship grows and deepens. And that's something with AI that you just,

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Paul Fugelsang (35:15):

Right? So the programmers are going to get ahold of this and they're going to AI intentionally forget details every now and then, and it's like it's shockingly terrible in many, many ways, and it's going to be this really cool, interesting proving ground for the power of the relationship and the human elements you're pointing out of the relationship. And I'm really curious to see what happens because I get it that people are talking to chat GPT and they're sharing thoughts and sharing fears and having these conversations and chat. GPT is doing all of this, what feels like kind of corny building up of the other person, which is not really therapeutic, but is it actually helping the person? Is it actually helping them work with complexes or work with the reality of suffering in life? And maybe it is, but I'm wondering, I tend to wonder if it's just providing a little emotional boost right now. And I am very curious about the long-term effects of it.

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Michael Fulwiler (36:18):

The way that I see it is that it's more of a therapeutic tool than a replacement for therapy. I think about chatting with chat GPT almost as if it's guided journaling or it's similar to maybe listening to a meditation app or something like that where it's kind of guiding you and it's kind of responding to you, but it's not a replacement for think some people are using it in that way. Though

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Paul Fugelsang (36:46):

I'm really into Jung, and I read a lot of Jung, and I was in a yoga class recently and he was talking about this idea which are obstacles, and I was like, oh, are CAIA synonymous with complexes? And I asked Chat GPT, and they're like, no, no, no, you're getting wrong. Here are the differences. And this is so amazingly helpful for understanding these things.

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Michael Fulwiler (37:06):

Yeah, it was interesting. We were at Heard playing  with Chat GPT recently, and we asked a simple question about taxes and accounting for therapy practices. The question that we asked was, can you pay your taxes with a business bank account? And the answer is no. Your tax payments should be made from a personal account because your taxes are a personal expense. But chat, GPT said, yes, you can pay it with a business bank account. And we asked, are you sure? Can you check on that? And it actually fact checked itself, which I thought was interesting. I'd never seen that before. And so I think it also just speaks to the inconsistency and inaccuracy of responses as well. So I think that all should be taken with a grain of salt. I think for therapists listening, I don't think your jobs are going to be taken by AI anytime soon.

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(37:53):

I think you can have confidence in that. I do though believe that there are benefits for therapists of leveraging AI to help streamline and automate some of their administrative processes. I'm curious your perspective on this. When we think about Open Path, for example, the ability to leverage AI to match a client with a therapist without a human interaction could be interesting. And when we think about what if AI can help me to write my progress notes or help develop, just write a first draft of a treatment plan, do you see the benefit of that? Or is your perspective more so? I don't want that as part

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Paul Fugelsang (38:36):

Of my process. It's a little bit more the latter. I think that when I ask myself about the internet and I'm like, if I could, this is a question people ask, especially for those of us who had lives before the internet really took over. If you could snap your fingers and have the internet disappear, would you do that and not disappear? And then we're all in chaos, but just as if it never existed, I would do that in a second. I do it in a heartbeat. I don't think the internet is a net positive for the world, actually. And I really do in a lot of ways miss the pre-internet days of what life was like. So when it comes to chat GPT, it's sort of taking that question to a whole other level. I do have the feeling that I get that it's like not, I mean ai, I mean, I get that it has this incredible potential for solving problems and relieving suffering or reducing suffering and on the fence about what the net gain is going to be here.

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(39:31):

And I have a lot of doubts and I have a lot of skepticism. And I also am kind of in one of those camps of like, whoa, we need to be so careful with this thing. We do not know what we're messing with here. And so when it comes to Open Path and AI, we try doing an AI chat for people who had questions coming on. It just was not very sophisticated. It was super clunky. It was creating way more work than it was solving. So we let go of that. So we're not that into it. And I think the thing about, and this is where again, I have problems with big tech companies and texting in between sessions. I'm a real purist when it comes to psychotherapy and when it comes, I think I see it as an art, and I see it as this gorgeous art form.

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(40:14):

And I think that technology can really only get in the way of that. And I don't think it's necessary to practice this beautiful art form which was given to us, the people who came before us. And so for me, there's a real feeling of being, like I said, a purist and how it's like I just really want to sit in a room with a client for 50 minutes and that I can really do without technology. I don't really need technology for it. That being said, I also have no judgments that people are using technology to do their thing.

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Michael Fulwiler (40:44):

I really appreciate that perspective. And for me personally, as someone, I grew up in the nineties, so I grew up before smartphones and social media, but I grew up with the internet. I work for a tech company. We are fully remote. We're online all day, but when I see my therapist, I see him in person because I value that connection and it's very important to me. Honestly, I can't imagine doing therapy virtually. It just wouldn't be the same experience. You're not in the room together. And that's not to discredit people who prefer virtual therapy or therapists who are only virtual, but for me, it completely changes the human experience of it. And so I can understand what you're saying. Alright, we're coming to the end here. Have a few rapid fire questions. You already answered some of these, but I definitely want to bring them back up. First one is, what is your favorite self-care activity?

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Paul Fugelsang (41:43):

Being with friends.

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Michael Fulwiler (41:45):

I love that relationship component. Totally makes sense. Favorite therapy modality to practice?

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Paul Fugelsang (41:53):

Well, like I said, I was sort of brought into this world in this Buddhist model, and I feel like that will always be my base. And then I've shifted over and like I said, I've gotten really into Jung and jgi and ideas and probably incorporate that into my practice just as much.

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Michael Fulwiler (42:09):

My next one is biggest inspiration.

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Paul Fugelsang (42:12):

As a therapist, I've had so many teachers in my life, people who I've known and people who I haven't known that I've just read. And I feel so incredibly blessed to have had these people come across my path and to be able to learn from them. So I don't think I could answer that question with one name. I've just had so many amazing teachers.

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Michael Fulwiler (42:32):

I love that. Is there a company that you would love for Open Path to partner with that you haven't been able to work with yet?

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Paul Fugelsang (42:45):

Oh gosh. That's an interesting question. Nobody jumps out at me. I really do appreciate all the partners that we have worked with, and we're pretty open when someone comes our way, which happens daily, we definitely give everyone a good look and it feels like there's some sort of workability that we'll explore it.

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Michael Fulwiler (43:02):

Great. Well, you heard that here. If you're listening, interested in working with Open Path, definitely reach out. Final question here. What is one thing that you want therapists who are listening to this to take away from this conversation?

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Paul Fugelsang (43:17):

Yeah, I think just to echo what I said earlier, I do have such a tremendous respect for the frame of psychotherapy. And in some ways I feel the need to protect it because I think that organizations that come in and say, oh yeah, well, let's text every day between sessions. There's a part of me that's like, oh God, we need to have some sort of respect for this thing, which I think is really flawed, but it's also exquisite. And one thing that I so appreciate about therapists and I see this over and over again is that they don't finish grad school and then just stop learning. They're so skilled at continuing to evolve and grow and learn as people and professionals, and they just have such a deep respect for the majority of therapists out there.

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Michael Fulwiler (44:04):

Well said. Thank you so much, Paul. This has been a wide ranging conversation. It's definitely given me a lot to think about as someone who operates in the business of therapy and money and accounting and taxes and all of those things. And so I really, really appreciate it. For folks who are interested in learning more about Open Path Collective, where can they go to do so?

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Paul Fugelsang (44:27):

So it's OpenPathCollective.org.

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Michael Fulwiler (44:30):

Easy to find you on social media, I imagine as well.

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Paul Fugelsang (44:34):

Yeah, we're around. Yeah, you can find Open Path on Instagram and on Facebook. We just left X with no plans on coming back, but we're still hanging in the other places. We'll see how long that lasts before we move, before we cut tail.

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Michael Fulwiler (44:49):

Thank you, Paul. Appreciate you. Thank you. Thanks for listening to this episode of Heard Business School, brought to you by Heard, the financial management platform for therapists. To get the class notes for this week's episode, go to joinheard.com/podcast. And don't forget to subscribe on YouTube, Apple, Spotify, or wherever you listen to podcasts. We'll see you in the next class.