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Ghosting, Therapeutic Tinder and Uberisation: it’s time to talk about your online therapy
2024-03-14
By Dr Elizabeth Cotton
Dr Elizabeth Cotton, Associate Professor in Responsible Business, is about to launch her new book on the business of mental health. Here, she discusses the online phenomenon of digital therapy in time for University Mental Health Day.
Mental health week is an increasingly uncomfortable place to be when you’re a therapist. Far from the top tips and positive psychology of social media messaging the ‘Uberisation’ of the therapy sector can be, well, depressing stuff. Less time to talk about your feelings, more time to talk about whether your therapist earns enough to live and, with an estimated 4% of therapists routinely accessing foodbanks, it’s a legitimate question.
The demand for therapy has never been higher, with rates of depression doubling since the COVID pandemic began and a recent report from the Resolution Foundation underlining the rise in youth mental health problems and its impact on their employability (REF). Strategies of “speaking up”, mindfulness sessions at work, and national “happiness” campaigns have been used to promote wellbeing at work, but as the recession hits, the risks of disclosing mental health problems at work become apparent to everyone born outside of the Royal family.
Over the past decade or so, mental health services in England have been undergoing a process of marketisation and digitalisation where services are effectively treated as commodities marketed through online platforms, changing the model of care to on-demand and pay-as-you-go. This business model promotes a therapeutic model, prioritising short-term and solution-focused cognitive behavioural therapy (CBT), which although can be useful techniques, move us away from the long-term deep work that most therapists are trained to do. One of the debates is whether therapy needs to adapt to short-term and cheap interventions given the financial crisis, and indeed psychotherapy has a history of adaptation, but it raises a question whether something is always better than nothing.
The new business of mental health has the additional problem of making therapeutic jobs more precarious, similar to the effect of ride-hailing apps on taxi drivers. Therapists increasingly find themselves working self-employed in the gig economy, paid by the hour at low rates and with poor professional protections. Increasingly your therapist will be algorithmically managed – nudged and budged into work intensification through higher rates per caseload and performance targets for recovery.
The reason why this matters is probably obvious; when your therapist is working with large case loads and on low wages, their capacities to manage your distress are likely to be reduced. Add to this the cost of living crisis where therapists are most likely to cut their costs by not having their own supervision and therapy (the gold standard of professional care), which means therapists are taking a direct hit both financially and psychologically.
The growing platformisation of therapy work has consequences for the nature of the therapeutic relationship, where the ability to swipe right or ‘ghost’ your therapist has led to a culture of ‘therapeutic Tinder’. Through the appification and interface of social media, digital therapy takes on the disposable etiquette of therapeutic Tinder, including eyes across a virtual room, facial recognition technology and wearable technologies to seamlessly curate the perfect response. Indeed, therapy no longer requires a real or virtual consulting room, and is now something that can be done on the bus or in the work toilets.
It’s hard to imagine how these therapists might establish sufficient intimacy in a context of threats of bad reviews shared on TikTok and Reddit. And it is in this way that the design premise of therapeutic Tinder redefines the therapy problem as one of convenience. If it can be done anytime from anywhere by any one of the tens of thousands of therapists on a platform, then the problem of relating has been solved… except it hasn’t because it changes the nature of the relationship where short-term connections replace a model of dependence and containment, required to do the deep work of therapy.
In the post-pandemic world, mental health services will continue to be shaped heavily by the emergence of digital services and digital employers. We can anticipate the growth of large and new digital providers and online platforms in the private sector and NHS mental health services. It means that we have to engage with the Uberisation of therapy and find ways to protect both the digital therapist and their clients from the risks associated with going online. The Digital Therapy Project is a group of researchers, practitioners and academics from UK and US research institutions and professional networks of therapists looking at how people are using digital tools for their mental health. As part of this project, we are exploring what therapy websites such as MuchBetterHelp might look like, including the need for a human and workers’ rights basis for therapists, developing an ‘AI Health and Safety’ code for practitioners and consumer protections for people accessing therapy online.
Elizabeth Cotton’s new book UberTherapy: The new business of mental health will be published by Bristol University Press in 2024.