The Liberation Institute (affectionately known as “Libi”) is a non-profit community mental health agency providing low-cost, sliding scale psychotherapy services to residents of California and Oregon. Libi uses a fee policy that allows clients of any socio-economic status to have access to services. Before the coronavirus pandemic of 2020, Libi served residents of all walks of life who lived in the San Francisco Bay Area. Access to services was only limited by the client’s ability to transport themselves to the clinic.
Within the last year, the scope of Libi’s practice has expanded exponentially to include residents of California and Oregon. This happened when the California Board of Behavioral Sciences (BBS) temporarily authorized service delivery via telehealth. This temporary authorization was due to the concerns of spreading the SARS-CoV-2 virus through personal contact. In response, Libi has been able to expand its services beyond the boundaries of the San Francisco Bay Area to all of California and now Oregon as well. The implications of this expansion are vast since the combined total populations of California and Oregon is roughly 41.9 million people.
One factor that differentiates Libi’s clientele from other agencies is that the clients are not mandated by any law or program to attend sessions. Participation is completely voluntary. And though payment is not required, a suggested donation of $20 is requested for those who can afford it in order to facilitate a sense of investment in the time, energy and process offered by the practicing clinicians. If clients state that they can not afford the $20, they are asked to sign an affidavit attesting to their inability to pay. This is then signed by the director for authorization for services to continue.
Another distinction that sets Libi apart from other agencies is that Libi does not rely on the insurance system for reimbursement for services. Since insurance companies require the use of clinical diagnosis and documentation of progress, Libi is free from the constraints of those requirements and this freedom can feel liberating for those who find diagnosis to be pathologizing and insurance companies to be focused on profits over care.
My role at Libi is to provide professional individual psychotherapy sessions to clients that I am assigned as a PCC trainee. It seems as though we are not required to employ any particular type of modality or intervention beyond using an inclusive approach such as trauma-informed, person-centered expressive arts therapy. According to the Libi website,
“Our inclusive model embraces the full range of diversity across California and most recently including Oregon. From technology executives to economically disadvantaged people. Those who can cont”ribute the higher levels of our sliding scale help to cover the cost of services for those who have less. We receive all who come with equal compassion under our motto “liberation for all” and with the understanding that someone who can pay a little bit more is helping themselves by helping others.”
In terms of the topics that may be unique to residents of California and Oregon, not only are we dealing with the ramifications of a global pandemic which has adversely impacted our mental and physical health, we are facing the impacts of climate change. The novel coronavirus which causes the disease covid-19 has created unprecedented challenges for people who are being faced with not only the threat of acquiring a life-threatening disease (especially for older and immune-compromised people) but also the impacts of family-owned businesses being shut down or having to close to reduce the spread of the virus.
Californians and Oregonians live on the West Coast of the United States and have also been faced with unprecedented impacts of climate change such as drought and large wildfires that have destroyed forests, homes and businesses. One of my supervisors at CIIS postulated that we could collectively qualify for a diagnosis of adjustment disorder due to the many intense stressors we are currently dealing with. Many people are unemployed and trying to meet their children’s educational needs at home through distance learning. Working parents who relied on childcare providers and schools are now trying to stay healthy and balanced while working from home and caring for their children. I am one of those parents.
Politically, we are a people divided. The many complex issues surrounding the political topics of vaccination, gun rights, civil rights, black and native body rights, women’s rights and medical freedom among others have touched the lives of every citizen of the United States. Regardless of the varied identities we hold in terms of our beliefs, sexual orientations, backgrounds, cultures and privileges, we are realizing that we are all connected by this unpredictable novel virus that does not discriminate between black and white, rich or poor, housed or houseless. And the strains of this new virus are mutating, making natural or fabricated immunity almost impossible to achieve.
Some corporations are profiting from this pandemic while people of low socioeconomic status, who are often front line workers, are dealing with the highest amounts of stress among any segment of the population and are struggling to pay their rent and/or mortgages. Front line workers are often people of color, immigrants and other non-dominant identities. Unemployment compensation in California has been fraught with fraud and has been paying minimal amounts to some people, not enough to pay their bills or hire private child care.
How does this translate into clinical terms? When people are stressed beyond their capabilities, this can result in harm to self and others. Substance use and suicidal behavior are on the rise. The need for compassionate, trauma-informed mental health services is greater than ever before. Front line workers deal with the highest degree of stress, encountering not only exposure to the virus, but also taking the risks associated with vicarious trauma by serving the health needs of people who are suffering from forced relocation, illness and deaths of friends, family and loved ones.
However, these crises also provide new opportunities for change, healing, integration, reconciliation and growth. After being socially distanced for almost a year, I have noticed that people are recognizing the deep needs we have for genuine, heartfelt connection with other human beings. I would like to anticipate that there will be a surge of gatherings, community celebrations and festivities when the pandemic is over, much like the end of a World War. It is an amazing time to be entering the field of psychotherapy.