Empowerment, agency, and control. Impact, self-esteem, and social connections. A sense of meaning, a sense of purpose, a sense of contributing — and with all that, a feeling of reward.

All are elements in the psychological impact of volunteering.

And all are critical pieces of Volunteers in Psychotherapy, a West Hartford, Connecticut, program that offers pure talk-therapy sessions in exchange for voluntary service in the community. The longstanding, forward-pushing nonprofit was designed as a corrective to the usual medicalized approach to mental healthcare, which too often strips the autonomy of patients and too often prioritizes pharmaceuticals over in-depth therapy. Many people can’t afford mental healthcare out of pocket; when it is covered by health plans, privacy is compromised by regular reports to insurance companies.

No empowerment. No agency. No control.

“There are a lot of us out there who could use a little straightening, [but] most of us can’t afford it,” remarked a client of VIP in an excerpt from 13 interviews quoted anonymously in psychologist Robert Hubbell’s 2006 dissertation profiling the nonprofit program.

Remarked another: “This fits beautifully into the idea of a better world, where something you can do to improve your community helps you help yourself if you’re going through tough times. I think it’s a beautiful concept, incredibly beautiful concept.”

That very concept — providing psychotherapy for nearly anyone who does nearly any kind of volunteering nearly anywhere in the community — is the brainchild of psychologist Richard Shulman, who founded VIP 22 years ago and runs it to this day.

Richard Shulman (courtesy Richard Shulman)

The aim, from the start, was manifold: to provide sessions for those who might not otherwise be able to afford it; to equalize the relationship between therapists and clients; to humanize the care being given, framing each person’s struggles as problems, not illnesses; to emphasize privacy; to restore control, allowing clients to choose the duration of the therapy and the type of volunteering; and, in so doing, to encourage a sense of purpose and connection with the world.

“You’re willing to go do some help, do good work, in the community? You pick what it is,” Shulman said. “You have complete privacy about it.”

That’s another critical element. In VIP’s “clinic without walls,” the sessions are independent of insurance companies, which have no oversight and no stake in them. The therapists don’t inform anyone of the arrangements. The clients don’t tell the organizations where they volunteer that they’re using their service hours in exchange for therapy (unless they choose to). At the homeless shelters or soup kitchens or other agencies or efforts they serve, they aren’t patients. They aren’t charity cases. They’re simply there as helpers, agents for change bringing what they can to those in need.

In so doing, they help themselves.

On its website, ctvip.org, VIP states its case succinctly: “People helping people helping people.” There’s a sense of equity to the motto, a balance to it. And with that balance, Shulman said recently, a reminder that “this is not an authoritarian, perfect person helping out a damaged, psychiatrically disabled person. It’s two human beings sitting down to try and make sense of problems. And in the meantime,” he said, “they are doing these good works.”

How good works work for the good

“Good works”: It’s a concept that spans history and the globe, both a philosophical catchphrase and a religious call to action. In Christianity, good works are outward acts of faith that help the needy as Jesus did and prep the soul for salvation. In Islam, good deeds please Allah and work to erase the bad. In Judaism, the mitzvah is a commandment, a duty, to give and act with empathy.

And in the ancient texts of Hinduism, good works offer positive results for the doer:

Now as a man is like this or like that,
according as he acts and according as he behaves, so will he be;
a man of good acts will become good, a man of bad acts, bad;
he becomes pure by pure deeds, bad by bad deeds.

But how do “good works” work? What does giving do for people — including those who don’t normally feel they have much to give?

As it turns out, a lot: In studies from around the world, the links between volunteering and mental and emotional well-being are many and widely confirmed. Although everyone is different, and all volunteering is not alike — just as all jobs and workplaces are not alike, with some more positive than others — the overwhelming upshot of voluntary service is positive. Research points to a range of benefits.

First, and most broadly, is the sensation known as the “warm glow” — a byproduct of giving explored at length by economic theorist James Andreoni in 1989 and expounded upon by psychologists, moral philosophers, and economists in all the decades since. In simplest terms, doing something for others can make the doer feel good. The result, said UK researcher Ricky Lawton, is “a beneficial, warm feeling, well-being, warm-glow effect” that can motivate the doer to do even more.

But why? What’s at play, exactly? Breaking down the reasons, researchers from around the world have associated volunteering with higher life satisfaction. Lower blood pressure. Lower depression. Greater happiness. Better self-esteem. It’s good for older people. It’s good for younger people. It’s good for younger people with disabilities, giving them self-confidence and a sense of social inclusion.

“The more hours of volunteer work, the greater a person’s happiness, life satisfaction, self-esteem, sense of mastery, and physical health, and the lower his or her depression,” declared a 2001 paper on Volunteer Work and Well-Being. “These effects of volunteerism hold even after individuals’ participation in other voluntary groups and their prior levels of personal wellbeing have been controlled.”

One more thing: It’s good for cognition. In a 2017 paper examining 29 European countries, the authors noted volunteers’ increased “physical and cognitive activity, which protects against functional decline and dementia in old age” and cited neuroscience research showing “the release of the caregiving-related hormones oxytocin and progesterone, which have the capacity to regulate stress and inflammation. From an empirical point of view,” they add, “evidence for a positive association between volunteering and health has been found in different age groups in countries such as Canada, Germany, Israel, Spain, Taiwan, the United Kingdom and the United States.”

In 2019, a British survey from the National Council for Voluntary Organizations (NCVO) documented the self-reported effects of volunteering on volunteers. Wide in its scope and meticulous in its breakdown, Time Well Spent: A National Survey on The Volunteer Experience asked more than 10,000 respondents to gauge the impact of voluntary experiences.

The association with psychological benefits was indisputable: “Over three-quarters of volunteers (77%) reported that volunteering improved their mental health and wellbeing. This benefit was more widespread than physical health benefits (53%),” it stated. Other numbers from the breakdown of positives: 93%cited “enjoyment” as a benefit; 90% “feel like they make a difference”; nearly 90% said they met new people; more than three quarters of younger adults said volunteering made them feel less isolated.

In an email, survey co-author Joy Dobbs stressed the “neutral” phrasings of the survey, “so we can be confident that it is a robust finding.” Furthermore, she said, “this proportion was similar for all demographic groups (that is volunteers of different ages, genders, ethnic groups, etc.). Most previous research has concentrated on the mental health benefits for older people, with some suggesting that positive effects are only felt among those over 40, whereas our findings suggest that all age groups perceive benefits to mental health through volunteering.”

The “virtuous cycle” of volunteering

Given the complexity of human psychology and human relationships, those benefits — as obvious and everyday as they sound — can be hard to unpack.

“There are a lot of theoretical reasons why something like volunteering would contribute to those feelings of self-efficacy and being needed — and kind of being a part of something bigger than yourself. Which we know are all important to psychological, emotional well-being,” said Rachel Casiday, a medical anthropologist now based at Samford University in Birmingham, Alabama. Beyond the theoretical, she said, “There is some effect of, in some cases, volunteering helping people to enjoy better mental health.”

Casiday explored the two-way street of benefits — their effects on the giver, and on the recipient — in her paper from 2015, Volunteering and Health: What Impact Does It Really Have?  The review is broad in its definition of health (physical as well as mental) and narrow in its definition of volunteering (no compensation whatsoever, so work exchanged for therapy technically wouldn’t count). But its conclusions offer a window into what, precisely, volunteering can provide to all involved: It was “shown to decrease mortality and to improve self-rated health, mental health, life satisfaction, social interaction, healthy behaviours and coping ability.”

Complicating all of this, as researchers have pointed out, is the chicken-and-egg conundrum of volunteering’s effects. Ricky Lawton tackled the “reverse causality” issue in his 2021 paper, Does Volunteering Make Us Happier, or Are Happier People More Likely to Volunteer?

Ricky Lawton (courtesy Ricky Lawton)

The answer: both. Wherever your happiness baseline is, volunteering will usually make you happier. And the happier you are, the likelier it is you’ll volunteer. So rolls “the knock-on effect of more volunteering in a virtuous cycle,” writes Lawton, currently director of research and analysis at Simetrica-Jacobs, a consultancy firm specializing in well-being and social value.

In a video call from the UK, he spoke of this feedback loop: “The more you do it, the more benefits you gain — and the more likely it is that you’ll continue at a certain point.” When volunteering, he said, “You get a massive boost of the good that you’re doing, but there’s also the social interaction, and the community cohesion that’s created. There are lots of different motivations for volunteering, but what elements of volunteering are most beneficial is having agency.”

There it is again. Agency. A chance for someone to go out, do good, and make a place for themselves in the process.

Overwhelmingly, volunteers themselves agree. Responding to call-outs by Mad in America across social media, commenters described the effects of volunteering on their own lives and mindsets. The majority were positive in their characterizations of the mental-health implications; the majority of those were enthusiastically so, citing many of the same benefits in much the same terminology that researchers have noted all along.

First, self-esteem:

“Since I was fairly unfulfilled in my paid job, it gave me a sense of worth and accomplishment that was lacking,” said Lynn Beiermeister on Facebook, detailing her work over the years with her daughter’s ballet school and her high school alumni association. “It did wonders for my self-esteem. . . As one who has clinical depression these activities did more for my emotional health than any of the medications I’ve taken.”

Then there’s impact:

“Volunteering absolutely bolsters my mental health, supports my wanting to make a difference and my wish to leave the world a better place because I was here — a kind of a pay back for what I’ve taken,” said Deborah York Reiter, also on Facebook, unspooling a huge list of past and upcoming volunteer stints with La Leche League, suicide prevention, rocking babies in the ICU, and more. “My mother used to say, ‘When are you going to do something you get paid for?’ I hope I will always have the ability to volunteer.”

With that comes social connections:

“To volunteer brings the friendship of the kindest people that you will ever meet, the volunteers,” said Anne Campbell, who spent 25 years as a psychotherapist out of the UK and many more volunteering. She often suggested volunteering to clients who were lonely and adrift, feeling aimless and needing direction.

Which leads to meaning:

“It gives you a sense of purpose,” replied Elaine Chaput on Quora.

And that, in turn, cycles back to self-esteem:

“Working with a group of people with the same intentions gives you a feeling of self worth, you’re offering your services to help with something very important,” Chaput said. “It gives everyone hope that something good will come.”

Maintaining their privacy, and their dignity

The voices of VIP in Hubbell’s dissertation echo such sentiments. Volunteer work, said one client, “made me part of the community. I didn’t feel so isolated. And, that is exactly what I want. I want to be someplace and I want to be part of that community.” In another quote, a client said the act of volunteering “helps me to sort so much out. When I go to do the volunteer work I’m able to give more of myself in a different mindset. I feel that I am healthier in terms of volunteering.”

Speaking on a Zoom call last month, Shulman characterized the effect of volunteering in those same, everyday terms. “It has them doing things that make them feel good about themselves.” Does it give them agency? Empowerment? Meaning? “All those things,” he said. “And also, I think, it helps to prove to themselves that they have something to offer other people.”

At VIP, four hours of volunteering “pays” for each hour of therapy. Alternatively, clients can pay for a session with three hours plus $15; two hours plus $30; or an hour plus $45. Around 95% of people choose to pay nothing. It’s not a bartering arrangement, Shulman emphasized, as clients aren’t volunteering directly for VIP. Instead, they’re contributing their time to hospices, hospitals, shelters, nursing homes, tax-assistance programs, literacy programs. They’re coaching kids’ sports teams and cleaning up public parks. They’re pitching in with Habitat for Humanity and nonprofit health clinics that aid those in need. The list goes on.

And the therapy isn’t a handout. Funded by VIP’s grants and private donations, which cover its expenses, the therapists are getting paid $55 per hour. That’s far less than the going rates — which can push into hundreds per hour — but also not pro bono.

“This is more of a human scale,” Shulman said. Again, the clients don’t feel like charity cases. “They’re not taking advantage of somebody’s time. But it’s a fair exchange.” As a client observed in Hubbell’s dissertation: If something costs $150 and it’s for fifty minutes, each minute really has to count.” With VIP therapy, by contrast, “I didn’t have to weigh each moment and say, ‘is this really worth it?’”

Populations served by VIP include the unhoused, the unemployed, the working poor, immigrants, and others in need — including survivors of the psychiatric system. According to Shulman, VIP’s emphasis on autonomy, along with its opposition to involuntary hospitalization and other “counterproductive and destructive” practices, “have led to us always attracting numbers of people who’ve previously been hospitalized… and who are seeking a place to talk about their lives.” Right now, three of the people he’s seeing regularly have such histories, “and none were at all happy with how they were treated.” He counsels more such clients episodically.

The nonprofit also sees a small number of professionals who prefer to keep their therapy away from the eyes of insurance, Shulman added. But the bulk are under-employed or unemployed, folks who otherwise have no access to therapy “but have any number of life problems they’re seeking to address.”

Currently, VIP employs six therapists at varied locations. New therapists are vetted carefully for their approach and asked to “recreate” a session anonymously that’s then analyzed “with a fine-tooth comb,” Shulman said. Before therapy starts with a given client, a “reverse release of information” is signed that flips the usual agreement on its head: Basically, the therapists agree not to tell anyone anything, but the clients can speak with anyone they like.

There are no intrusions from any insurance company. No misunderstandings about informed consent. No evaluations written up and sent off for assessment. No suggestion that anything that passes between a therapist and a client is anything but sealed between them.

That’s one reason no clients were interviewed for this story, as VIP declined to reach out on this reporter’s behalf. Hubbell, having interviewed people for his dissertation and quoted them with the promise of total anonymity and locked-tight privacy, also declined. Efforts to find current or former clients via social media and other avenues yielded no response.

Privacy, in other words, is imperative: “We felt so strongly that this is the warp and woof of what therapy discussions are about . . . If somebody is going to be talking to you about the most private, and sometimes the most shameful, or the most anxiety-producing topics in their lives, they have to be in charge.”

At VIP, they are.

“We go back to a system that gives civil rights, and their autonomy” back to clients. “They maintain their privacy,” Shulman said. “They maintain their dignity.”

Calling the shots 

Robert Hubbell was a doctoral student at Antioch University New England when he first approached Richard Shulman about a possible dissertation, having read of VIP’s work a few years earlier. He went into his study and its baker’s dozen of client interviews wholly intrigued by the ideas underpinning Volunteers in Psychotherapy — and curious to hear about their experiences. For years now he’s directed psychology-intern training for Albany Medical College, its campus down the street from the grassy spot where he sat last month to discuss the nature of pain and power of giving.

The way he sees it, it all boils down to how we live.

“When people struggle with anxiety or depression in personal issues, it’s not so much that they’re struggling — that all of their suffering is bound up in the emotional experience they’re having,” he said. “It’s the way that we slowly become shaped by that suffering and start to restrict our lives.” Someone with anxiety or depression may become more and more isolated, the feedback loop causing a different sort of cycle.

“By getting out and volunteering, being engaged, I think we do 40 percent of the work right there,” he said.

In his paper, Hubbell repeatedly noted the effects of agency — once again — on VIP clients, both in their community-service work and the control they exercised in determining their own care. They felt they had a place in the world; they felt empowered; they felt they had a choice. “I can call the shots in a way,” observed one such client. “I can call up [therapist] and say, well I need an appointment this week, I have this many volunteer hours, and have them documented by my people at [advocacy group]. And, I feel more in control of myself in the situation, more in balance between me and the therapist.”

From the beginning, all of this was part of Shulman’s goal with VIP, which he envisioned as a corrective to managed care, the prevailing disease model, and the problems he witnessed in his time working a poor person’s clinic at Hartford Hospital. In his early years — after a B.A. with Wesleyan, he attended the University of Michigan, then earned his Ph.D. at the University of Toledo in 1984 — the approach was more humanistic, less diagnostic, more nuanced. Students and faculty would meet each Friday morning to discuss new people being evaluated and seen in therapy. “And it was all about making sense of them as a human being.”  Medication, back then, was seen as “ancillary.”

But as the years passed, politics and rivalry between factions of psychiatrists and psychologists led to “a massive consolidation of power” that then led to a more ideologically driven, medical-paradigm approach that embraced the idea of biologically based disease. Editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) only solidified this, assigning new labels that soon became the norm.  Patients who might have received therapy a few years earlier were affixed with those labels and re-routed to meds. Insurers became reluctant to pay for talk sessions, Shulman recalled, and started requiring periodic reports.

There had to be a better way, he thought — a way to help people through difficult life passages without depriving them of their privacy and control. There had to be a way to provide therapy — real, affordable, unrushed, non-medicalized sessions in which one person talked and another person listened without the quick dogleg into drugs. And there had to be a way to provide them at low cost to the client without resorting to managed care.

Consulting with a pair of like-minded psychologist-friends, he brainstormed the possibilities: What would work better than the current approach? What clinic could they set up that would work better? What sort of outside-the-box model would provide both the privacy and the control? How could it avoid the pitfalls of the insurance-run, medication-centered paradigm, instead giving people access to private talk therapy that they could afford? The wealthy have always been able to avoid the prying eyes of managed care by bankrolling their own therapy. But what of those without means?

“We all say, ‘The unexamined life is not worth living,’” Shulman said, quoting Socrates. “But then the issue is, who’s going to pay for the examination of that life?”

Confronting the labels and lies of the medical model

Volunteerism as payment wasn’t an entirely new concept in the world of psychology, Shulman said, noting the anecdotal accounts of therapists who gave clients a discount — perhaps after losing a job, or losing insurance — in exchange for service in the community. In his dissertation, Hubbell cited two mental-health projects that utilized volunteering, one a community-service intervention, the other an in-kind arrangement for pastoral counseling detailed in a 1977 paper. But VIP isn’t an intervention. Nor is it church-run.

In 1999, the program opened its decentralized doors with Shulman in charge; those psychologist friends became board members. In the years since, with yet more editions of the DSM and yet more intrusions of managed care, its model remains as outside-the-box as ever.

Len Dupille (courtesy Len Dupille)

“It’s counter-cultural within the mental-health field right now to perform long-term, intensive psychotherapy,” said psychologist Len Dupille, board chair of VIP. Volunteers in Psychotherapy “definitely makes that more available for people in the Hartford region than they otherwise would have access to.”

Clients decide when to start therapy, how long to pursue it, and when to leave; the longest-running have been with VIP for around eight years. Some folks come and go, taking breaks and bouncing back according to their preferences and the chapters in their lives. It’s entirely up to them. Without someone stamping them with diagnoses — saying who they are, and what they need — they can determine both for themselves.

“I did not want an insurance company or any other person having documentation as to what I was going for or place the therapist in a position to label me,” said a client in Hubbell’s dissertation. “And that was very important because I feel I’m unlabeled, and because I don’t have a label.”

VIP shuns labels. “Instead,” Shulman said, “we just treat people as human beings.”

In conversation last month, as in scads of interviews and essays over the years, Shulman went on at length about the medical model’s established shortcomings and outright lies.  He served for years on an institutional review board — a research-ethics committee at Hartford Hospital — and saw firsthand the stacks of evidence against the biological model of psychological distress, he said.

“All of those researchers admit that we have never found any biological substrate, no biological markers, for these constructed entities.” Meaning all of those labels affixed to people in the mental-health system — “schizophrenia, bipolar disorder, you name it. Whereas in the rest of medicine they spend their time explicating the underlying tissue pathology so that they can come up with therapeutics and more accurately address the underlying lesion or malfunctioning in the body, in psychiatry that has never been demonstrated. And instead, what happens is all sorts of verbiage is used to mislead people to believe that these are quasi-medical disorders.”

It all reminds him of that old adage: “If you’ve got a shiny new hammer, everything starts looking like a nail.” The true goal of a psychotherapist is not to put people into boxes, he said, but to grasp “the picture that people are painting of their lives and various factors that influence them. It’s a very individualistic consultation that you’re doing that has to do with them. And it doesn’t have to do with telling them what box they belong in. . . . In psychiatry, the whole story only becomes clearer and clearer the more you know the person.”

Not a cure-all, and “not shitting roses”

That long-form exploration of a person’s life and thinking takes time — and that means money. Normally, people with limited funds and subpar or no insurance can’t afford long-term psychotherapy: Too often there’s a limit of three, or six, or some other finite number of sessions before the health plan maxes out. For people trying to articulate and understand some of the most fraught issues in their lives, that sense of hurry doesn’t help.

As a participant told Hubbell, the VIP approach “is more geared towards actual therapy versus in and out, you  know, ‘You’ve got four sessions and this is going to solve all your problems’  . . . I don’t feel as rushed.”

In another comment, a client spoke of the mental-health needs of the underserved: “I think poor people should be able to get therapeutic help as easily as someone who has insurance and money because the poor people, like I am, are really close to the edge all the time, being homeless, being hungry,  not having any clothes, transportation, and um, so I feel that this is an opportunity for me that could I never even been hoped for [sic], having a therapist that will accept volunteer hours instead of cash or insurance.”

That said, the volunteering-as-pay arrangement isn’t always perfect. For all of its benefits, some participants referred to certain complications in the VIP payment structure, including the need to find and document so many hours of service gigs. Volunteering for mental health’s sake itself isn’t always perfect, either, a point made by the Hubbell interviewee who replied to a question with this succinct rejoinder: “I knew you had some dream that these guys are, ‘Oh man, I’m volunteering, it’s just so fulfilling… I’m shitting roses here.’ But it’s not really.”

Indeed, not all volunteers report mental-health benefits. And not all volunteering is alike, a fact born out even in research that trumpets its powers. According to Lawton’s paper, for instance, volunteering in sports is better for well-being than volunteering in arts and culture; volunteering frequently is better than volunteering occasionally. And in a 2018 paper published in BMC Public Health, “other-oriented” volunteering — that is, performing public service for humanitarian reasons — is declared better in reducing depression than “self-oriented” volunteering, which is done for personal betterment.

Volunteers, like all workers in all contexts, benefit from reasonable expectations and a healthy environment. When those are lacking, the “warm glow” is, too. That lack can occur, said Rachel Casiday, “particularly for volunteers who don’t seem to be as well supported, or well trained, in things like setting boundaries and having a kind of a mentor . . . Burnout and stress can be an issue.”

Respondents on social media also described the downsides. “Honestly, volunteering was really bad for my mental health,” said Grace Allan on Quora, where she described a toxic atmosphere with coworkers and supervisors who failed to accept her. “They appreciated their other volunteers but they didn’t really want a depressed and disabled person working with them. . . My mental health got worse and worse. I felt humiliated by the ostracization, the bullying almost, the pressure to stop being weird. I quit in the end because I couldn’t take it anymore.”

That was her worst experience working for a charity. Other experiences weren’t much better, she said. As a result, “Volunteering makes me feel depressed, anxious, worthless and a total freak. I wouldn’t do it again.”

On a Reddit board devoted to volunteering, moderator and therapist Jayne Cravens cautioned against painting too cheery a portrait of its efficacy in improving mental health. As a manager of volunteers and a volunteer herself, she’s familiar with both pros and cons — and even created a web page in an effort to present more realistic expectations.

“Volunteering can make you feel great,” she said. “It can also make you feel even worse.”

Her worry: “Volunteering is oversold as a panacea for depression and a source for better well-being, and because of that, many people start volunteering with an expectation that it’s going to help relieve their depression, anxiety, loneliness. And then they’re stunned, frustrated, even angered, when it not only doesn’t do those things, but makes things seem worse.”

“We’re both listening”

Still, for the majority of people, both the research and the personal accounts suggest that volunteering can nudge a lot of folks along the path to recovery. Maybe it’s not a cure-all. But for many, it helps.

As a VIP client explained in Hubbell’s dissertation, volunteering “enlivened me as a human being. It’s been terribly therapeutic. That’s a fine few words to put together. ‘Incredibly therapeutic’ would be the right thing to say.” Other voices spoke of volunteering as a new way to engage with life — maybe even redefine it — with passion and purpose. One described her disability and job loss as a “dislocation of my own identity” and volunteering, in turn, as her way forward.

What works for one person might not work for another; this is another philosophy underpinning VIP. In his interview, Shulman repeatedly underscored the independence and power of clients in not simply paying for their care and choosing its duration, but in the stories they tell, the metaphors they use, the community service they do, and the paths they choose to follow toward well-being.

If volunteering works, it works. To the person benefiting, the whys barely matter.

“Subconsciously, you keep doing it because it feels good,” Lawton said. “More importantly, you don’t stop — because you enjoy doing it, and you get something out of it, and you sleep better at night.”

The research does its best to break down the reasons why a certain brand of volunteering might help a certain aspect of someone’s health, Casiday said: “If you’re volunteering in doing something outdoors and environmental, you would probably expect the health effects of that to be related to the physical activity. . . If you’re doing something that involves social interactions with somebody — in that case, is it the fact of the social interaction, or the fact that you’re volunteering, that’s good for you?” It’s hard to say definitively. “But I don’t think that negates the point that volunteering can be beneficial.”

The same is true of therapy. Someone might glean something from a session that the therapist never anticipated. Sitting at a picnic table on the grass last month, Hubbell chewed on this for a bit.

People don’t care about psychological theory, he said. They take away from therapy whatever they need in the moment, whatever might prove helpful to their lives. “I always tell colleagues and trainees: ‘Theory is for you. It’s nothing to do with the patient. It’s irrelevant to the patient’s treatment. It’s just for you to be organized.’” To the client, he said, “It doesn’t mean shit.”

What matters instead is the chance to talk and feel heard — to hash out their backstories and trauma and find some guidance, maybe, in how to frame it. Maybe it’s some comment the therapist made. Maybe it’s a recollection from childhood that suddenly makes sense. What comes to the fore in such conversations is obvious enough, Shulman said: “It becomes clear that these aren’t medical issues.”

They’re life issues. Pain issues. “And we’re both listening.”

He described the key to therapy as an ear keenly trained for nuance, always listening for some shrouded truth in the tales being told in session. “And that’s the way human beings are, especially — now I’m going to use a very technical psychiatric term — especially when people have been knocked ass over teakettle by things that have happened in their life.” Therapy, he said, “is just a discussion about those things.”

Dupille agreed. “Listening is, I think, the core, or the foundation of good therapy — being able to listen carefully, being able to listen in a nonjudgmental way, having a sense of empathy and compassion for another person’s difficulties . . . There’s a lot of subtlety in that, and I think there’s also a kind of knowing when to share something that you’re picking up on seeing, too. Because the client might not be ready to pick up on that and see that yet.”

Moving forward, spreading the word

With the onset of COVID, the usual VIP arrangement was put on hold. Due to the risks of in-person volunteering, the program has simply asked new clients to establish a connection with a charity where they might work in the future. “And they can build up a debt with us until things are safe, with the understanding that they’ll sort of gradually pay off that debt afterwards,” Shulman said.

The therapy itself, meanwhile, has gone completely virtual — which seems to work well enough for established clients, as the total number of sessions is “way up.” But new-client numbers, normally around 50 each year, are down.  Newcomers are “frightened about their worst conception of what it might mean for another human being to really get close to them and understand great deals of their private life. And I think that’s much harder to do over the phone” or Zoom, Shulman said.

But Volunteers in Psychotherapy presses ahead, still pushing its emphasis on drug-free talk therapy and the affordability of its sessions. A sense of mission has always driven Shulman as he gives talks, reaches out to graduate programs, and promotes the VIP concept in the hopes of inspiring variants. An “export initiative,” funded with grant money and delineated on its website, offers aid for those interested in developing their own “independent nonprofit psychotherapy service, either substantially recreating what VIP has done since 1999, or borrowing from and adapting a VIP-like approach.”

Although some efforts have taken cues from VIP — at one point, following a 2002 New York Times story, Shulman fielded about 100 calls from people looking to pick his brain — no full-on affiliates have cropped up in the years since its founding.

Why remains a bit of a mystery, although he suspects therapists are reluctant to ditch the current model for something with lower pay. Given how hard they worked for their higher degree and how much it cost, most would rather “grin and bear it,” he said. Making their peace with managed care is a compromise. And they may well hate that compromise. “But I don’t think many people have the fire in their belly.”

Granted, certain programs do share a sense of kinship and commitment with Volunteers in Psychotherapy: the Greenwoods counseling and referrals service in Litchfield, Conn., for one, connects those in need with affordable therapy. But by and large, VIP remains an outlier.

“It’s hard, I think, to find psychologists and mental-health professionals in other areas who are willing to carry this the way that Rich has carried it here in the Hartford area,” Dupille said. “Because it really does take dedication and commitment. You’re swimming against the stream.” He added: “A lot of psychologists — how should I say this? I’m just gonna be honest — for a lot of them, they wouldn’t want to give up their private practice and just dedicate themselves to the tireless work it would take to create and support an agency. . . . That’s been the stumbling block.”

And yet, in conversations over the years, Shulman and his colleagues with VIP have been constantly struck by the “oh, wow” responses from those who hear of it for the first time. “Uniformly, my impression is people recognize what a nice little [system] this is,” he said.

For example, Ricky Lawton. When VIP was described to him in the interview, his reply was immediate. “That’s brilliant,” he said, adding: “That’s great, because you’ve got the double benefit of giving people therapy, and sort of the well-being benefits of volunteering — and the uplift there.”

Expanding the ranks of volunteers

As the scholar who analyzed the chicken-and-egg question behind happiness and volunteering, Lawton sees the significance of both components — and he also sees the importance, moving forward, in encouraging the populations most in need to volunteer. Self-selection among voluntary workers inevitably skews the ranks toward those who feel a little better about themselves, who have better life satisfaction and, yes, greater happiness. But as his research showed, that doesn’t mean those with less wouldn’t profit. The opposite is true.

”People who maybe do have high levels of anxiety or mental-health issues at various stages of their life — those are probably people who are not going to select into volunteering,” he said. “And yet they would benefit more.”

Other demographic groups are similarly under-represented in volunteering and, researchers say, might also benefit from outreach and changes in policy that recognize both the potential health benefits and the need to diversify the usual corps of people who show up to donate their time. Most of them, Lawton pointed out, tend to skew whiter and older.

Joy Dobbs, one of the UK survey authors, said its most important new finding “is the benefit of volunteering on mental health and well-being for younger people. To promote or improve mental health, policy makers should be considering encouragement and interventions for volunteering among young people, in the way that they have done so for a while for older people.”

Over the last decade or so, she noted, the UK has moved toward “social prescribing,” in which patients with long term physical and/or mental health conditions, including those who are socially isolated, can be referred to a range of local, non-clinical services, often run by the voluntary sector, to meet people, take up interests and, if well enough, undertake volunteering activities.”

Rachel Casiday (courtesy Rachel Casiday)

Rachel Casiday, for her part, hesitates to generalize too much about volunteering and policies that might push for same. A committed volunteer herself, she donates time as a birth doula for an organization that provides services for those who can’t afford it. But volunteering is such a wide tent. There are so many factors at play — the type of work being done, the reasons for doing it, whether or not someone’s donated effort is displacing someone else’s opportunity to work for pay.

“If we’re advocates for volunteering — and I think there’s lots of reasons to be advocates for volunteering — I think I want to be mindful” of all of that, she said. And she’s wary of any implication that volunteering should substitute across the board for mental-health services. Complement them, yes. Replace them, no.

Despite all of those provisos, “There do appear to be significant benefits from volunteering when the volunteering is well managed and well-resourced — and so this can be considered, where appropriate, as a component of an overall approach to promoting mental–wellbeing in the community.” That requires money — and that’s where policy-makers might help.

“Good volunteering programs,” she said, “actually require a lot of resources.”

Knowing you’ve got something good to offer

The way Richard Shulman sees it, everyone has a story to tell. His job is to help them tell it.

“In therapy there’s often some kind of central, gnawing questions that the person can’t even articulate — but that’s a lot of what the work is about.” In a way, he continued, “This is more like literature than it is medicine. . . . This is the human condition. And we are imperfect. And in fact, a big part of it is that we have to recognize as shrinks, too, that we have our own particular life that we’ve lived, and it leads to our own biases, and our own blindnesses.”

He always felt he had good training, and always advocated for a more humane, less medicalized approach to understanding those labeled psychotic or schizophrenic. Early on in his career, if someone walked in looking for help and talked about hearing voices, their experience wasn’t automatically stamped as a biological disorder. “The point was, ‘Okay, maybe let’s hear what the voices have to say.’” If someone spoke of their dreams or nightmares, therapists would zero in on their content and meaning, he said — “So why wouldn’t we similarly listen and try to make sense from a human perspective? If someone, for instance, tells you that they’re Jesus Christ . . . . The more they talk about it, you start to think maybe they’re saying they are being crucified, or maybe they’re being maltreated — or they have something good to offer.”

Something good to offer: No matter someone’s struggles in life, their course through society, their time in the healthcare system, or the stickiness of the labels slapped on to define them, everyone wants to give something. To be a part of something. To feel connected. Isn’t that what it means to be human, after all?

“Yeah,” Casiday said. “I think so. Definitely.”

“Yeah,” Lawton agreed. “Completely.”

He contrasted it with an idea too often expressed — that “every man is an island.” That, he said, is “a reductionist and simplistic view of the selfish individual.” And it’s wrong.

Dupille described it this way: If being human means suffering and stumbling, it also means moving beyond that and pushing for the good. “We all struggle. We all lose our way at times.” The critical point, he said, is “recognizing the person’s capacity — their potential — to grow and make positive change and to move beyond. Not necessarily to get to a happiness-ever-after, or a pain-free life, but to get to a place and achieve a greater sense of well-being.”

For the volunteers themselves, this is the gist of it.

“Giving is the best feeling in the world,” said Tess Lecuyer on Facebook, “and giving of yourself makes everyone wealthy. . . It is an unbelievably satisfying experience.” Beiermeister agreed.  “Giving of oneself is the best pill . . . I don’t really understand people who don’t give back or pay it forward,” she said.

“To me, that’s what being human is.”

12 COMMENTS

  1. Thanks Amy.

    This is a wonderful article. He sounds like a wonderful human and seems
    to understand the complexities of life which will be most beneficial to those
    around him. A great program indeed.
    Privacy and keeping people away from BS theories and beliefs and biases is of utmost importance.

  2. Stunning to see no replies. I thought this was one of the better articles on MIA recently. And I’ve personally always derived greater satisfaction and meaning from volunteer gigs than paid positions!

    “Dupille described it this way: If being human means suffering and stumbling, it also means moving beyond that and pushing for the good. “We all struggle. We all lose our way at times.” The critical point, he said, is “recognizing the person’s capacity — their potential — to grow and make positive change and to move beyond. Not necessarily to get to a happiness-ever-after, or a pain-free life, but to get to a place and achieve a greater sense of well-being.””

    This is a gem!

  3. Before I went to therapy in my 40s for childhood abuse, I volunteered for almost 30 yrs so by the time I arrived for therapy, I was already mostly integrated because all those I helped along the way, inadvertently also gave me parts of themselves for me to heal! I found myself in therapy comparing the exact implicit memory to a real memory from my volunteer about how I learned who I am truly!
    Empathy, Altruistic, and Connection are three words I would use to explain my volunteer background.

    thank you for putting it so beautifully.

  4. I wanted to end. The despair was so deep that only the grave distracted me from that abyss, as if a grave were a level up from that intolerable pit. Death can seem an almost thrilling liberation, a freedom that is hypnotically compelling. Irresistable as a lover. I felt myself swooning towards that suitor. As you do before you die, my hands got busy doing mindless tidying up, my fingers, the brainless jerking of dissected frog’s legs. Voila! Before my eyes my fingers had scribbled a postcard to a place I had never been to before. An archaeology establishment. I was volunteering, apparently…wrote the fingers.
    A dazed amount of days later and I received a phonecall. The quacking, staticky voice on the other end said I was desperately needed. Please, please could I come immediately to the archaeology base? I ended the call by saying “yes”.

    I figured I had confusingly just said “yes” to a different sort grave, a graver mistake. On the journey by bus I wondered if I would be properly interviewed. I wondered if the staff would see through the porous veneer of my trustworthiness and reliability, seeing through the performance of my eddification to the absolute mess I was in. I wondered if I would tell them I was having a nervous breakdown.
    This, I did do. Or my lips did it for me. But I was not ushered into a side office for awkward pauses and tissues. Instead I was swiftly led by an energetic archaeologist down a long dank corridor of shelves. All the shelves were bent under the weight of hundreds of muddy buckets.
    “Can you wash?”, asked the archaeologist.
    “Yes”, I said, self consciously closing my armpits.
    “Good, because we are in a crisis and need the contents of all these buckets washed in two weeks, can you wash broken pottery?”
    “Of course”, I replied, having not washed my home coffee cups for months.
    “Can you wash animal bones?”, she inquired, smiling.
    “Not sure, but I can give it a whirl”, I mumbled.
    “Can you wash human bones?” she asked, lifting a lid.
    “Never done it before”, I said.
    “Great, it is really easy, you just use a toothbrush and washing up tub like the sort you’ll have in your kitchen at home, do you think you can handle it?” asked the archaeologist.
    “Okay”.

    Within the span of one week I was sitting on a floor with a basin of muddy water between my knees, a toothbrush in one hand, and an ancient human skull in the other. And as I brushed off the besmirchings of mud from the skull’s teeth and cheek bones and forehead and filled the eye sockets with water scoops that trickled like tears, and I watched them plink ripples over the reflection of my living, breathing face, I felt the ghost of the person, whose skull I was baptising, soothe me and heal me and tell me not to kill myself.

  5. Ignoring my therapist’s bad advice to “quit all your activities and concentrate on the meds,” and doing a LOT of volunteering instead, did help me survive and escape today’s insane “mental health” system. As a matter of fact, I’m quite certain that repeatedly discussing my many volunteer activities with my psychiatrist is part of why he eventually concluded that my therapist had misdiagnosed me, so he weaned me off his drugs.

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