The Delinquents
Last time I went to a therapy industry event I went to join a group developing a Wellbeing Charter for people working in psychological therapies, an initative aimed to soften the commodification blow to the NHS. I normally last ten minutes in such environments before the existentials hit, so to disguise my likely regression into a more primitive state I wore a skirt and coordinated make up rather than adopt a fur and dragging a club with my extended forearms.
Thirty minutes in and hair was starting to grow on my palms. Shiny young folk promoting Cognitive Behavioural Therapy apps and guided self-help courses, wellbeing at work industry reps, private contractors delivering welfare assessments, private employment agencies and clinical psychologists measuring the impact of resilience manuals. We’re not in Kansas now, Toto. As I am about to click my heals a retired Doctor called Chris with immense humanity and an enviable capacity for building relationships somehow manages to bundle me into a windowless room to listen to a presentation on the link between work, welfare and mental health. An MP on a podium apparently unencumbered by actual facts about his own government’s introduction of the Universal Disaster of Universal Credit appeared to be unaware that being on welfare doesn’t mean you’re not in work, as a solid majority of NHS workers can testify.
As the discussions start about how we are going to build support for a Wellbeing Charter I realise that, for some, this is primarily a question of learning how to present the ‘business case’ and learn the creative accounting required to match targets and outputs with actually helping people. As someone who has spent most of their working life as a trade unionist I would like to suggest that the entire experience of industrial relations is that whatever financial argument you present to protect psychological therapies actually doing it requires genuine political will on both sides. To simply adopt a business school logic creates just an efficiency logic, underlined as I sit next to a rep from a digital CBT provider talking about how the clinicians they employ value the flexibility of working on a zero hours contract. I stare enviously at her matching beige outfit and wonder if she can tell that my hair is matted and full of moss and twigs. In the early years of the gig economy, she had not consciously connected the growth of precarious work with the growing number of people working in mental health services who didn't want to get out of bed in the morning. I feel my toe nails start to split open my shoes and dig holes into the hotel carpet.
As me and Chris sit and listen to a senior official from one of the big NHS associations bark random performance metrics I realise that Anton Obholzer is sitting behind us. Anton is a man mountain of epic political and psychoanalytic experience who has been a key institutional player in the Tavistock tradition combined with a rare degree of compassion. I even made my mum read his books about working in healthcare so she’d stop asking me if I’d met a nice man working in mental health. Anton is sitting with his head in his hands and I wondered tearfully at what must be going through his mind as he listens to a panel of experts talk about ‘going forward’. I say a small prayer of gratitude that Anton is just there holding in his head the knowledge that there is a really important political fight to be had but that it’s not happening in this particular room anytime soon.
Then a man from Sheffield speaks up - an NHS mental health service manager there with is team and reminds the audience of some actual facts. That he can afford to train 2-3 Psychological Wellbeing Practitioners per year to provide 80% of his service. Despite getting over 800 applicants for the training, because PWPs don't earn enough to live on and provide care that they are not trained to deliver they leave fast. This didn't make any difference to the young man on the podium but it made an enormous difference to those of us in the back row reminding us that it has always been the case that real politics exist between those of us on the frontline.
What we didn’t know in 2015 at this event was that a decade later, after years of loss-making contracts delivering online CBT for the NHS, the key digital therapy signatory to the Wellbeing Charter would now be the largest provider of AI diagnostic and self-help tools to the NHS. Their re-imagining built on the back of a decade of recorded NHS sessions. We didn’t see it at the time but UberTherapy started way before we knew what an LLM was.
Some time later after I’d done some research into the therapy sector I asked Anton if he would meet me, seeking institutional approval for Surviving Work that was starting to annoy some of the key players in therapy. Therapy is a sector full of people who have had past professional lives so its typical that a conversation with a psychoanalyst can take an unexpected turn. On a table I noticed a book about South African vernacular furniture, a familiar voluminous book of careful observation of previously unknown craftsmen, just like my own parents’ research. We ended up having a conversation about craft and design and he gave me a copy of his book to give to my mum and dad. In the way that you never know what can come out of therapy, when I gave my dad Anton’s book he had to sit down as it turned out that my father had been looking for Anton for several decades to learn about his research and get a copy of his book that had fallen out of print. For my father Anton was a mythical figure in furniture history who, like my parents, used the new technologies of their times to photograph and record the stories of these cultural objects that until that point had virtually no value in the commercial world. In psychoanalysis there are no coincidences, just links that have yet to be made.
At the end of the discussion, I remembered my pitch to Anton that I needed his help in opening doors to the institutions of psychoanalysis to engage with my book – the first of my rude short books Surviving Work in Health: Helpful stuff for people on the frontline. I gave him a copy and told him to brace himself as it is based on a delinquent energy that despite nine years of psychoanalysis I was unable to shift. In a dry psychoanalytic tone he said the following words.
“Your work does indeed have a delinquency required to challenge us, I hope that you don’t feel you ever need to change that.’
This one sentence of therapy haiku changed my life. As short as a tweet, but offering the deep backstory of understanding that is offered within therapy he invited me to think that there is a place for my delinquent mind and its rude books.
One of the key ideas in UberTherapy is the idea that it represents a profound attack on the deep thinking that underpins therapy. That through the appification, platformization, digitalization and commodification therapy plays on our desires to circumnavigate the deep, to exist in an algorithmically curated denial of the usefulness of other people. Part of this attack on thinking enlists our failing trust in our institutions, including the institutions of therapy, that have become so denigrated by the political and ideological battles within mental health that we are no longer prepared to fight for them. As the institutions of therapy fall, either through failure to govern themselves or being sold out to deliver better cognitions and behaviours, our institutional memories are reprogrammed to forget the traditions of therapy that came before (although a cracking book about the Tavistock tradition provide a bread crumb trail back, by two gentle folk Margaret Waddell and Sebastian Kraemer).
As the greats of psychoanalytic thinking retire or are blacklisted on NHS trainings, their ideas remain within many of us. Over the next few weeks I’ll be writing a series of love letters to the psychoanalytic ideas that have helped me think about the rise of UberTherapy.
The Unconscious at Work, edited by Anton Obholzer and Vega Zagier Roberts - includes writings by some of the greats in applied psychoanalysis (including the gentle man of psychoanalysis Michael Halton) that spell out why psychanalysis is useful in the workplace. It focuses on health sector work and made me cry with relief when I read it, as it reminded me that it’s a lot to carry when you really look at the systems within which you work.
Workplace Intelligence is another ahead-of-time book by Anton in that it is essentially a series of blogs about key concepts used in psychoanalytic consultancy in workplaces. It has mercifully short chapters on anxiety and the unconscious at work, each section is just a few pages with an example from the therapy or organisational world to understand what psychoanalysis looks like in practice. No references, no manifesto’s or professional codes - a psychoanalysis at work literacy guide that is actually useful. These writings remain starkly relevant to the future of work and therapy.
You can buy a copy of UberTherapy: The new business of mental health by BUP here
@survivingwork.bsky.social @survivingwk
@UberTherapy.bsky.social @ubertherapies