That all makes a lot of sense. I wonder if those issues could be alleviated by contracting a sufficiently large outside firm to manage therapy services, thus at least creating some separation and objectivity for individual therapists.
My wife has been using an approach called "Design Therapy" (www.designtherapy.org) that uses design thinking methods for self/couples development. This allows mental health challenges to be approached outside of a "disease treatment" frame. I appreciate the approach.
