How Can Therapists Do Pro-Bono Work Without Risk of Burnout?

Pro-bono work significantly enhances access to mental health services for those who might otherwise be excluded. For many therapists, providing such services offers personal satisfaction and a sense of contributing to social justice.

The National Association of Social Workers Code of Ethics encourages social workers to "volunteer some portion of their professional skills with no expectation of significant financial return" (NASW, 2021). Many others, including the American Counseling Association and the American Psychological Association, have similar wording, reflecting an ethical commitment to improving access to mental health care, particularly for underserved populations and those facing financial hardship. (APA.org; counseling.org).

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The Debate Over Pro-Bono Services Due to Risk of Burnout

While the notion of pro bono work can be a powerful way to give back to the community, it also raises complex issues about professional expectations and personal capacity. Our field has a lack of guidelines for this particular topic, which leads to debate within the field, as many struggle to meet this need due to feeling overworked and financially stressed.

"Providing free or low-cost therapy sessions indefinitely, with no structure, can cause therapists feeling resentful and potentially experiencing burnout," said Jennifer Blanche, PsyD, a licensed psychologist and host of the Therapist Burnout Podcast.

This concern is particularly relevant for therapists from marginalized communities—such as queer women of color—who often experience increased pressure to meet the needs of their clients (McFarland & Hlubocky, 2021). This pressure can lead to what is known as a "double burden," where the demands of personal and professional responsibilities intersect, leading to greater stress and potential burnout (Seedat & Rondon, 2021).

Because those with higher and more complex caseloads are more likely to burn out, this adds to the debate over how to provide these services safely (McFarland & Hlubocky, 2021). However, the ethical obligation to contribute to the public good does not necessarily require therapists to offer free services exclusively. "While our codes mention the importance of pro bono services, these are more of an ideal to strive towards," she says. "Therapists often feel obligated, based on clinical lore about ethical codes, not in reality about our ethical duties," Blanche mentions.

Alternative Forms of Pro-Bono Work

The high risk of burnout in our field highlights the need for sustainable models of pro bono work that do not exacerbate existing pressures on therapists. "We know that one of the biggest contributors to burnout is financial constraints, it's important that we consider the implications of such a practice," reports Blanche.

Some argue that requiring therapists to offer free services imposes undue burdens, particularly on those already facing economic or personal hardships. It is crucial to recognize that being able to give pro-bono work is often a privilege, as therapists who have higher socioeconomic status and fewer personal constraints are more readily able to engage in such work (Seedat & Rondon, 2021).

"Therapists often feel compelled to reduce the cost of their one-on-one therapy sessions, which can put them at an economic disadvantage," Blanche reports. Megan Cornish, LICSW, agrees: "I notice that there is kind of this vague sense of guilt that makes therapists underprice their services in the name of charity, which is not helpful to therapist or to the community in the way the code of ethics intended." Instead, she recommends "charging your full value and donating intentionally one or two slots".

But, many in the mental health field are unable to offer free sessions, due to lack of control over their caseloads, financial strain, or working in places other than private practice. Therefore, rather than adhering strictly to the traditional notion of offering free therapy sessions, there are numerous ways therapists can contribute to the public good while acknowledging their personal and professional limitations. Here are several alternatives that therapists might consider:

1. Sliding scale: Offering services on a sliding scale can make therapy more accessible to those with financial constraints, such as those who are uninsured or underinsured.

Johanna, a licensed clinical social worker, runs a nonprofit clinic in Florida for underinsured communities. "We have a sliding scale method that works well for us, while allowing us to meet the need for our clients."

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2. Accepting insurance: By participating in insurance panels, therapists can increase access to those in need.

Krista, a licensed professional counselor in New York, accepts one insurance panel. "This allows me to reach those who need my services, while recognizing that I would be unable to maintain my business if I only accepted insurance. It's a nice balance."

3. Advocating and policy work: Advocating for policy changes and engaging in policy work can be considered a form of pro bono work. By working to improve policies that enhance access to resources and services for underserved populations, they contribute to the public good by helping to address broader social issues.

Malaysia, a social worker in Ohio, dedicates time to advocate for policy changes. "I meet with stakeholders, help with campaigns, and find other ways to promote change for our community."

4. Having a virtual practice and/or multi-state licensing: Expanding access through virtual therapy or obtaining licenses in multiple states can help reach clients in rural or underserved areas. Furthermore, offering online groups can help meet the need for those in underserved areas while giving therapists an opportunity to offer pro-bono or reduced fees. This approach enhances accessibility and supports clients who may otherwise have limited options, especially when therapists focus on typically underserved regions or states (Butzner & Cuffee 2021).

Cody, a licensed social worker in Georgia, became licensed in neighboring states like Alabama and Mississippi during the pandemic. "I focus on working with Queer sex workers, so I know there is a need for culturally competent therapy in many of these areas. This helped me expand my reach to provide group and 1:1 therapy to those who need support."

5. Supervising and mentorship: Teaching, mentoring, and supervising new graduates are recognized by many licensing boards as forms of pro-bono work. These activities help support the professional development of others and contribute to the field (counseling.org). Furthermore, serving on boards of directors or committees can be an influential way to donate time.

Peter, a licensed psychologist in Illinois, supervises interns, and offers sliding scale slots for them. "It works well, because they need the hours, and are unable to charge due to being unlicensed. In turn, I provide low-cost supervision for their hours. This helps us to meet the needs of the students as well as the population we serve."

6. Educational and public outreach: Writing blog posts, engaging in public speaking, publishing books, and sharing information on podcasts or social media can provide valuable resources and education to the public. This form of pro-bono work offers guidance and support without the need for direct client interaction.