Therapists At Mental Health Startup Resilience Lab Vote To Unionize

Therapists at mental health startup Resilience Lab voted to unionize on Wednesday, one of the first successful unionization efforts at a digital health company.

The move comes after growing concerns among employees after the company fired 12 therapists, changed the way the rest were paid and introduced third-party software to track patient progress, according to five current and former employees who asked for anonymity due to fear of retaliation. The petition to hold the union election and the firings were first reported by Gothamist.

The New York-based startup, founded in 2019 by chief clinical officer Christine Carville and her husband, CEO Marc Goldberg, claimed the “largest and most diverse collective of New York-based therapists.” As the company grew, employees say it placed increased emphasis on technology and software and began hiring former executives from WeWork, Uber and Airbnb, in the lead up to a $15 million Series A funding round led by Viewside Capital Partners and Morningside in November.

After publishing a story on the company’s venture financing, Forbes learned Resilience Lab had, three days prior, fired 12 of its 200 therapists, giving them one week to transition 271 patients, according to documents reviewed by Forbes. Three administrative employees were also fired, according to current and former employees involved in union organizing. They also said a majority of the terminated employees had marginalized identities, including people of color, queer people, trans people and people with disabilities.

Carville and Goldberg did not respond to multiple requests for comment via email and phone calls to the Resilience Lab office for this story.

Resilience Lab employees elected to be represented by District Council 37 AFSCME, a union that generally represents public sector employees in New York, by a vote of 79 in favor, 13 against, according to Kayla Blado, a spokesperson for the National Labor Relations Board, which was overseeing the election. Blado confirmed 15 ballots were challenged and weren’t counted.

In 2022, around 1.2 million healthcare workers were members of unions, accounting for 13 percent of the total healthcare workforce – down half a percent from the prior year, according to the U.S. Bureau of Labor Statistics.

“Now the work begins to secure a contract for our new members – the first in the country for a telehealth company,” Henry Garrido, executive director of District Council 37 said in a statement. “All workers deserve the support of a union, whether they conduct their business online or face-to-face.”

Up until four months ago, current and former employees say Resilience Lab offered the prospect of a stable, salaried job in what can be an exploitative training period for early career therapists. In order to become a fully licensed therapist, people with master’s degrees in mental health counseling or social work must first complete thousands of hours of supervised clinical training, which is one of the problems Carville and Goldberg had previously told Forbes they were trying to solve.

Resilience Lab hired therapists under supervision in an arrangement where they’d receive a percentage of the fee from their patient sessions. If they hit 100 patient sessions for several months in a row, the company offered the possibility of reaching what it called “resident” status – a salaried job of $67,000 with benefits and bonus potential, according to employees and documents reviewed by Forbes. That was attractive, as the median salary for a social worker is $50,390 per year or $24.23 per hour, according to the U.S. Bureau of Labor Statistics.

In June, Resilience Lab announced it was partnering with a Boston-based startup called Mirah to deploy “measurement-based care,” described in a press release as “the practice of basing clinical care on client data collected throughout treatment.” Patients started to receive weekly assessments to complete outside of their sessions with therapists.

There was pushback from a group of therapists who said the way the company implemented the software was “unethical,” according to a letter signed by more than 60 employees that was sent to Resilience Lab management in July. The group wrote they were concerned that such frequent assessments and the idea that “progress” in therapy was linear could be harmful to patients. The letter also asked for more details about what patient data was being collected and how it would be used.

In August, Resilience Lab announced new hires from other tech startups in a push to expand operations. Patrick Morselli, the former head of global expansion at WeWork, came on as chief operating officer. John Hamby, a former regional manager of community engagement at Uber, was named general manager, and Alyssa Lin, a former director of portfolio strategy for Airbnb Luxe, came on as head of growth. Goldberg had previously told Forbes the company had “no interest in building Lyft or Uber for therapy.”

In mid-October, therapists were presented with a new contract. The “resident” position with the salary of $67,000 was eliminated. In its place, all therapists would receive a base salary of $1,300 per month – $15,600 per year – plus 15% of the patient session fee for the first 49 sessions each month. The percentage share for therapists increased above 50 sessions.

When the company announced its series A funding the following month, the press release hyped its software products: an online training program for therapists, “proprietary software infrastructure” for billing, reimbursement and tracking patient outcomes, and its client matching software.

Current and former employees say the focus on technology and software was yet another blow to the morale of the company’s mental healthcare workers. “They were not transparent that this was a mental health tech platform in the hiring process until recently,” Tanya Tripi-Weiss, one of the fired therapists who is on the union organizing committee, told Forbes. “Up until recently, we were engaged as though this was a larger-sized private practice in New York City.”

Another former employee described it as a bait-and-switch: “I think they were using all of the clinicians as essentially guinea pigs so they could figure out what worked [with the technology].”

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