Alliance Collective: A Mental Health Worker Co-op

[Editor's note: The website Prism recently published an article about the Alliance Collective that you can read here. In this interview, we focus on the differences between working in a cooperatively owned and managed mental health care practice, and working in a traditional, capitalist, group practice.]

Transcript

Josh Davis: All right. Well, first off, just thank you guys for taking the time to talk with us today. I was really excited to read about your co-op in Prism. It's a great article, and I had never before heard of a therapy worker cooperative. So maybe you can just introduce yourselves real quick and then get into it about your co-op.

Claudia Maisch: Sure. My name is Claudia and I am a social worker at the co-op. I joined the co-op in February of this year, so I'm the newest member of our collective.

Billy Somerville: And I'm the oldest member of the collective. My name is Billy.

Josh Davis: Right. So in reading about your co-op, I saw that it was a conversion, that it started out — I believe Billy, is that you who started it, initially? And then I was wondering, what was that thought process when you were going from — you'd started your own practice and then were converting it. How long did it take you to decide that that's what you wanted to do? Did you know right off, or is that something that you came to after some time, working as the sole proprietor or something like that?

Billy Somerville: I knew right off the bat that I was not going to make it very long as a solo practitioner. So I need to work with other people, and I was really excited about starting a group practice, and just really could not see myself as a business owner. That just absolutely ran against all of my anarchist ideals. So it was around that time that I was just exploring the question of 'what are other formats for people who are working together, to do so in a way that is non-hierarchical, that doesn't involve an employer-employee relationship?' And it is a little weird that in 2018 I had not yet really heard of a worker cooperative before. I mean, now it makes sense, in hindsight, that there aren't that many of them here on this continent. But yeah, that was kind of a new idea to me that I was real excited to learn about.

Josh Davis: And so once you came across the idea, the model of a worker cooperative, did you — who helped you out with that? Did you reach out to some organizations there in New York or...

Billy Somerville: Yeah, that's exactly right. The first step was, I asked friend of mine if she wanted to come and start working with me so that we could kind of flesh it out ourselves in practice. To see what it would be like to work together in that fashion. So that's Kara, and she's still a member of the collective. She and I just kind of came up with some basic guidelines at the beginning then. Things like full transparency to anything that I had access to, checking account or QuickBooks, that she would have access to. Consensus decision making, no unilateral decisions made by either one of us. And then the other thing that we came up with was that we would earn the same hourly wage, even though I was working full time and she was working part time. We decided that would be a way to kind of put our money where our mouth is, values-wise. And just really start to implement a more egalitarian method of distribution of resources.

So we started doing that together, and it was feeling really good, and then we started investigating the question of how officially convert this into a worker cooperative. Since it was pretty apparent — even though we had this really invigorating dynamic between the two of us — it was still pretty apparent that I was the business owner on paper, and we were trying to figure out what to do with that. What we found out is that in New York State it's actually very difficult to set up any kind of health-related organization in this way. There's just so many rules about who's allowed to co-own with whom. There's a lot of kind of weird nit-picky rules about fee-splitting and kickbacks and all kinds of different statutes that actually affect the structure of a cooperative. So it took us the better part of three years and many thousands of dollars of legal research before we came up with kind of a suitable workaround that allows us to own an entity, which is not the service delivery entity. It's kind of a strange two-entity structure, where we all co-own what's called a management services organization, and then I'm still the owner of the psychology practice.

Josh Davis: So, I read in Prism — I was interested as to — I think the way they put it in that article was that the law does not allow different people, with different types of licenses to co-own a single entity. And I have no idea why that would be the case, but it sounds like you figured out some sort of workaround that is working for you.

Claudia Maisch: If I remember correctly, it's people with different professional licenses can't own a health care practice together. But we all have different licenses and we're still able to own some sort of — it's called a service management organization — together. So a different type of legal entity.

Josh Davis: Yeah. And it's something we kind of have to do pretty often in the co-op world, is shoehorn ourselves into these regulations that were not written with us in mind.

Billy Somerville: At some point if you want to reach out to some friends of ours in Western Massachusetts that just started a therapy worker co-op also, It's called Catalyst Cooperative healing, and they do not have the same kind of strictures that they have to work around. Their structure is actually much more elegant than ours, so you might want to talk to them, to see what that's like.

Josh Davis: Yeah, that's great to know that there's two therapy worker cooperatives now, and hopefully there will be more and more — inspire some other people to start their own.

Claudia, you said you're you're fairly new at the co-op still. Is this your first professional gig, or have you been doing this for awhile? And if so, what's been your experience in the co-op as compared to your other places of employment?

Claudia Maisch: Yeah, this is my second job after graduating from the social work program that I was part of. And I'll say it's a complete 180, it's completely different. I was part of a group practice when I first graduated, that was my first job. And it was very, I would say, very founder-centric. There was one person who owned the practice, and it felt like — at least culturally in the practice — that there were different tiers of therapists. People who were considered higher up on the senior leadership team, there were newer folks who were considered learners, and it was a completely different structure than my experience here at the co-op now. And one of the biggest reasons for the switch, for me, was that I felt very low down on the totem pole, very little trust, very little autonomy over my work at my last job. And all of those things are so different at the co-op.

I feel like trust was not something that I had to earn necessarily. It was something that was kind of given at the forefront of me joining this collective. And my autonomy over my work — I can make more decisions about what felt more sustainable for me in terms of the caseload that I had, the amount of hours I wanted to work, the amount of hours I needed for supervision or for even consultations, which is a type of supervision that we work with here at the practice. I can speak with anyone at the practice for consultation on my clients and my cases. So, I think there's a big shift for me when I was leaving the group practice structure: finding myself at the very bottom, feeling very insecure about myself and my job, and kind of feeling afraid to ask for help; to being in a place where, as a newer member of this team, as a newer therapist in the field, being able to actually get the support I need, be pretty transparent about, and ask for, the things I need and feel like that's going to be heard and trusted in the co-op. And so my experience has been very, very different switching into this model.

Josh Davis: And very positive, it sounds like.

Claudia Maisch: Yeah, very positive.

Josh Davis: Yes. So tell me a little bit more about the co-op. Do you have a storefront, a building of some sort, or are you working remotely, as so many of us are these days? Or how are you set up?

Claudia Maisch: It sounds like things have shifted from when the co-op was newer. It seems like there was maybe a place for you and Juliet — am I right, Billy, where you and Juliet were practicing out of? And then, during the pandemic, things shifted, everyone went remote. And now we're starting conversations around what makes the most sense for us. I think at one point you were thinking of getting a space where the three of us could practice out of, but then our needs changed. One of our members needed to take some leave. Billie is also trying to assess your own situation about what you need, if you're feeling safe to go in person.

And I am actually very, very eager to see folks in person again. And so we had a conversation a couple of weeks ago about what we needed, and what would improve our quality of life, what we needed to feel like we could do this work. And based on all of our needs, I was the one who really wanted to start seeing folks in person, had the capacity to do that. And so we made a decision that I would find some office space. So right now I'm the only therapist seeing folks in person, and I'm just starting that process. But hopefully one day we'll have some space where the three of us can practice, at least, together — and maybe more.

Billy Somerville: Yeah, I feel like that issue of, 'do we have a physical location or not? And where is it? What accommodations can we offer to ourselves, and for clients, in terms of COVID safety, and other matters of accessibillity. That was the thing that was quite complex, that we worked through. And, you know, something that feels a little different about this work envinronment than others I've been in, is that we're just allowed to think about our own needs and voice them. And that can be included in the larger conversation of how we take care of each other. The way I like to think about it is that we are encouraged to really care for ourselves. We take care of each other as a group, and then we're also caring for our clients. But just to be able to think about that, and negotiate the peices in which those measures of care can sometimes conflict with eachother. It is pretty cool how relatively easy the conversations are. How much goodwill there is in the group, to just trust each other and work together for whatever the solution is gonna be for the best [indecipherable]. To me that just feels so different from workplaces I've been in the past, where you get an email from management saying, "This is what's happening." Right? It's like, "oh no!"

Claudia Maisch: Yeah, to be able to have a say in that is a completely different experience too, because I think coming from my graduate program, I also had some internships that I was part of and I remember interns didn't even have a choice. Interns weren't getting paid. Interns weren't really getting health insurance from our university either. But we were asked to go in person, during a pandemic, and we don't really have much say over what we wanted to do, if that felt okay, if that felt necessary, or anything.

And so I've think coming into a practice where we all have the capacity to talk about what we need, and what feels okay, what we're kind of — what we need to make this work sustainable, on one hand, but also what we need to meet our basic needs — I think even just our own health, or our own sustenance at this job. So being able to have those conversations, be part of those conversations, is completely different from all the different positions I've ever held really in the working world.

Josh Davis: And how many members in the collective, currently?

Billy Somerville: We have six total. One is out on a long-term leave, she's taking a full year off of work, which is pretty cool. We're all psyched [indecipherable]. And then another member is out on sick leave. We were just recently able to develop and implement a sick leave policy, that allows her to take the time off that she needs. There are four of us who are actively working in the co-op, three of whom are therapists.

Josh Davis: Okay. And so how does your decision making work? Are you operating on a consensus basis, or have you tried using some other form of decision making?

Billy Somerville: We started when it was just three of us: myself, Kara, and Juliet. They were trying to use a type of voting called 'star voting,' which stands for something. something, something, ranked. [laughs] I should know what that is. And it just seemed so silly. We'd all have our little phones out and we're voting this app that I had found, and we're like, "What are we doing? This is ridiclous!" So we quickly shifted over to consensus, and haven't looked back. It's a great model for a small group, like we are, and it makes sure that nobody gets left out, and makes sure that nobody gets railroaded. It really does invite a lot of thoughtful engagement of whatever the issue is. So that's been working well, in my opinion.

Claudia Maisch: And it doesn't really take a whole lot of time. I mean, some of our decisions need a little bit more thought, but a lot of our decisions are oftentimes just one of our members typing in our WhatsApp chat saying, "I'd like to run this past you. Do you think we can do this?" And it's mostly all thumbs up or thumbs down, and we make our decisions pretty quickly. I think there might be a misconception that consensus means people are arguing over a table for hours and hours, until we get to an answer, but it's actually a lot quicker than that. Seems to be pretty seamless for us. A lot of our decisions take just a few minutes.

Billy Somerville: We have a lot of autonomy over our basic day-to-day stuff that we do. You know, I don't have ask the co-op if I'm allowed to take a half day off and go visit a friend, or something like that. It's not like that. We have a rule about spending, that anything under $50 is completely at your discretion, and above $50 we'd ask. But even then it's such a short conversation. Claudia, you were up in your new office and that you just got, and you were like, "is it okay if I spend $400 on a desk?" and it's like, "yes." [indecipherable].

Claudia Maisch: [nodding] Yeah.

Josh Davis: I would imagine having a group of people with very advanced communication skills probably helps on this front. Having been in some groups where consensus works well, and where it doesn't, I would think that you guys are pretty well situated to work that, especially with a relatively small group now.

Billy Somerville: That's an interesting point. I do think that just knowing about — just caring for one another's feelings — I think probably does help out [indecipherable].

Josh Davis: Yeah, for sure. And it sounds like you have created a good culture of trust among yourselves, which is, in my humble estimation, the single most important factor for any successful cooperative enterprise. Everything else you can have figured out — the finances and the legal stuff — and if there's no trust, none of that matters.

Claudia Maisch: Right.

Josh Davis: So remind me, how long have you been operating now as a co-op?

Billy Somerville: 2018. And then just this past summer we were able to create a legal structure that the State of New York recognizes as a cooperative enterprise. That part wasn't terribly important to us [indecipherable].

Josh Davis: Right. And so you're up to half a dozen now, at least when everybody is there. Do you have any plans for expanding, or are you wanting to add more members to the collective? Or do you feel like you're at a good size? Have you thought about that at all, or is it just go with the flow and see what happens?

Billy Somerville: What do you think, Claudia? Are we gonna expand?

Claudia Maisch: Well, I think there's been talk about maybe bringing on another therapist in the future. But I think what's different about our decisions to expand or not, are we're not interested in making tons and tons of profit, and growing so that we keep making more money. It's not necessarily the the goal of our practice. It's more so, there is a need for mental health care, and we do have the capacity to bring some folks on. It's not necessarily going to make or break our bottom line, necessarily, to have more and more therapists join our practice. I think what we've said in the past is our goal isn't to bring in so much money that we can eventually liquidate the business and walk away. That's not necessarily what we're trying to build. We're trying to build something that's sustainable, and so the more folks we bring in, it actually does make things more sustainable, to an extent. We have more comrades who are working with us, and we're meeting more need in our community. So that definitely are things to consider. I don't know. We've talked about bringing some other folks on in the future, but I don't think that it's necessarily our goal, to be as big as we can be, or as big as a 40 person, or 50 person co-op.

Josh Davis: Have you had other therapists approach you, and be interested in your model, and want to start up their own thing, or join, or...

Billy Somerville: Yes. When people hear how happy we are at work, and the fact that we make a living wage. The way our compensation model works is we all earn $40 an hour. And that's not just clinical hours, but quite literally everything we're doing at work. That's administrative tasks, that's anything and everything we're doing at work. So, when you run the numbers out on that, that comes out to $80-$85,000 a year. That's a very solid yearly income here in New York, very livable. So the folks are attracted to those features and we do get inquiries. We're not looking to add anybody new right away, but having that level of interest make's it easy when the time comes to [indecipherable].

We also do hear from many people who are like, "how would I start one of these where I live?" And there's a bit of a community now of folks who have expressed that kind of interest. We have an email list for folks to kind of talk about their plans, and actually use that for some recruiting. There are some commrades in Chicago, who are getting pretty close to being able to open up their doors next year, and they're currently looking for someone to do administration, bookkeeping, that kind of work. None of them really have those skills, so they're looking for someone to join them to do those tasks.

So there does seem to be a little bit of a movement happening in the mental health world. We are not the first cooperatively owned mental health practice in the U.S., we seem to be the one to able to make it work for some amount of time. The model we're using does seem to have some kind of longevity to it, in a way that maybe other experiments haven't worked out so well.

Josh Davis: That's great to hear that you have other people interested in starting up their own similar cooperatives, and that you've actually done some, at least minimal organizing, even an email list. That's so helpful and good to hear that people are out there on their own sharing the information and the knowledge that you have.

Well, one question that came up — I actually had mentioned the fact this morning in talking to a friend of mine — I live in northwestern Montana, in rural Montana — a recent widower, and I mentioned to him that I would was going to be talking with some some therapists with a worker co-op. And he said, "oh, do they work online?" "I would imagine everybody is nowadays." And his question — and I'll just ask you for that for the sake of everybody — since you are doing online now, have you expanded your clients, like have you taken any clients outside of New York, or are you still very focused in NYC, and would you consider doing that, or...?

Claudia Maisch: So this is less a question of what we would like to do, and more a question about what our licenses allow. So because of licensing laws for social work — it might be a little different for psychology, but I think it's probably just as restrictive — I'm not allowed to practice anywhere outside of New York because I'm licensed in New York. And so I'm not technically allowed to practice with folks who live outside of the state, although during the pandemic, I think some of those regulations were relaxed because of extenuating circumstances. People were moving all over the place. I think as long as you were technically still a resident of New York, we're allowed to practice with you. But I think some of those laws are now kind of reversing and getting back to what the status quo was prior to the pandemic.

Billy Somerville: Yeah, these laws probably aren't really — I mean, most laws — are probably not actually helping the people they're supposed to be serving. The sensible reason for these laws is that if someone needed emergency services, the therapist should be able to [indecipherable] local services. [Indecipherable] so it's a bit of a flimsy reason. There is some agitation to get those laws changed, but right now [indecipherable].

Josh Davis: So you've mentioned that your — both Claudia and Billy, have mentioned that your quality of life, just in terms of your work life, has greatly improved in the cooperative context, as compared to other places that you've worked. What do you think is like — what's the biggest change? What's the most important thing that makes it a better place to work? Is it about that you're getting paid better, or that you are have more trust with your coworkers? Or what do you think is the the biggest draw for you?

Claudia Maisch: That's a very good question. I think all of those things are are important. And maybe for me, what I'm noticing is autonomy has been really, really valuable. I think I just came from a series of jobs where I haven't really had a say over anything that I do, or even my my workload. And I talk to friends who graduated in the same program as I did, and they had to build their caseload so fast that they're getting burnt out before they can even get their feet in the water and see if they like this work, and see if they want to continue with it. They don't really even have a chance to explore that. They're just given 50 clients, 70 clients, and they don't have an option to say, "Can I slow down? Can I get extra support around this? I'm really struggling." And so my autonomy here is I can say how many clients I want. I can build my caseload as quickly or as slowly as I'd like. I think that has been really meaningful for me to be able to explore if this work is sustainable, and how to keep that sustainability for myself. So I think I would say autonomy, although trust and livable wage and all of those things are obviously super important too.

Billy Somerville: For me — I'm not a well-read theorist, by any stretch of the imagination, but when I came across Marx's term alienation, the work in the cooperative seem to be the best antidote for alienation that I have come across. There is an experience here of self expression, of fulfillment, of connection, of vitality. I feel like a full, live, three-dimensional human being in this workplace, in a way that I just never have before. And it's very exciting it's energizing to work at a place like this.

Josh Davis: Yeah. Yeah, that's great. I know for my own sake, once I had experienced the cooperative way of working together, it ruined me for ever going back and working for a boss again. Like, "what do you mean, I don't get to think about what I doing? I don't get to have a say?" And yeah, that's exactly that feeling of alienation. We have to get rid of that.

So you mentioned that you have at least one of the members of the collective who is not a therapist or a counselor. I'm assuming that's an administrative person, right? Does the admin and... How does that work in terms of your decision making? Do you have decisions that are just made by the therapists and the counselors, or is it just kind of everybody is all in the same discussions, regardless?

Billy Somerville: We kind of just handle that practically. Kara is invited to participate in any conversations, and weigh in on anything that needs to be decided. And then she will sometimes duck out when she doesn't feel like her attendance would contribute that much, if that makes sense. She's happy to kind of get around for those things, and obviously wanting to stay apprised of what's being decided. But she'll often just kind of punt to the therapists for that kind of clinical...

Claudia Maisch: Yeah. I think there's clinical conversations that Kara will step back from if she doesn't feel like it's really — I don't know if, she really doesn't want to participate in those kind of decisions, but other decisions for the practice are more so all of us will contribute to it.

Josh Davis: Right. So, what question do you wish that I had asked you during this last 30 minutes that I did not ask you? And then go ahead and answer that question. This is how I cheat on my interview skills, make you come up with the questions and answer them.

Anything important that you feel about the experience that you haven't mentioned yet, or maybe even anything that might be useful for other people looking to do something similar?

Claudia Maisch: I have some thoughts. I'm not sure what question would have prompted this thought, but I'm going to say it anyway. I think as a new therapist, it can be really hard to work in an environment where your boss has your job, your livelihood, in the palm of their hand, and they can kind of hold that over you at any point. Because if you're trying to learn in this field, being a therapist, knowing what to do, not knowing what to do could be a pretty vulnerable experience. The learner can be really vulnerable. And so not feeling so afraid, not feeling so activated by the power dynamics in my relationship with my employer, and my learning. I think those things, being able to relearn learn how to be with other people who are my comrades, who we're all trying to do this work, and do it well, and do it sustainably, and struggle together with some of the hard parts of this job, as a way to build a sense of confidence, a sense of what I bring to the table for my own clients in a way that I think has been really empowering for me as a learner, empowering for me as a therapist, empowering for me as just someone who's just trying to build some authenticity in this work.

And so I've found that my nervous system is so much more relaxed when I'm talking with folks about some of the things that I'm struggling with. I'm not kind of nervous about how I'm saying it, or so overly careful, not trying to be so protective of whether or not I'm going to get fired. Sometimes I can just feel a lot more honest and authentic about my experience, and actually get the support I'm looking for that helps me do this, do this job. And so I think that experience for me has been just such a game changer. And it's been just a really great part of being in this co-op, I think.

Billy Somerville: Amen to that.

Josh Davis: You spend so much time, supporting your clients, and and helping them through their stuff, and then as the support people, you need the support yourself. It seems crazy that you would be working in a situation where you as the support person feel like you don't have the same support that you give to other people.

Billy Somerville: That's so common in our field. The exploitation is just rampant in our field. It's real bad.

So I was thinking about your question, what question do we wish would have been asked. And something you didn't ask is, "What's hard about this?" You know, very easily and very naturally we've been talking about how good this is and how grateful we feel to be in it, because some of the things that are hard about what we do and how we do it. First and foremost is the fact that we still live in capitalism. Even though we have an anti-capitalist project, we have literally seized the means of production, and have kind of created this little model that feels really good and really fair and strong, we still exist in a world that absolutely does not operate that way. And so we do feel a lot of antagonism from outside and from the rest of the world. Including insurance companies, by the way. A lot of our revenue comes from insurance companies and they are just monstrous in their dealings with private providers.

Another another thing that's difficult to navigate is people, rightly, see us as a radical outfit. You know, we talk about our values on our website, and they come to us expecting us to meet certain financial needs. But sometimes we're just not able to, and they're rightly upset when all they can afford for therapy is $20 a session. And sometimes we're just not able to meet that, even though we really, really would want to. Other times we can because our financial situation does fluctuate, and we're just very transparent with folks when they're asking for an affordable fee, we're just very kind of straight up, like, "you know, right now we can't do that." But at other times sometimes we can. So that's tough. That's just kind of painful to sometimes have to turn people away just because of our own need to keep the lights on, and keep paying our own rent. So I think that's one of the hard things just about trying to be very ethical in our dealings with people is that it's emotionally difficult sometimes when we're not able to make it all work. If we lived in the kind of world that we are hoping for, aspiring to, and trying to build together, then people's needs would just be better met across the board, and we wouldn't have to run into these difficult moments like that as often. But the world that we do live in is [indecipherable].

Josh Davis: But you know, that's very admirable of you all to, at least be trying to provide, lower cost services as you are able. I was very impressed with that in the Prism article as well, saying that as you're able you'll offer a sliding scale for people. Because I know, the little community I live in, our average annual income here, or median, is $22,000 a year. And so I'm very familiar with people who are living on very little. And it can be very hard to get those services. So even if you're not able to offer them to everybody all the time, just the fact that you're offering as much as you can to as many people as you can is like — that's at least moving in the right direction there. And hopefully other people pick up on that attitude and do the same. So. Well. Yeah. I can't really think of too much else. Again, I thanks so much for for taking the time. It's been wonderful to talk to you. And, uh. Yeah, the. Thanks.

This transcript has been edited for readability.