We’re not in Kansas anymore

16 Nov

In 2023 despite a history of legal action in the USA taken by the Federal Trade Commission and repeated consumer data breaches, a US digital therapy platform announced the formation of a new state wide service for teenagers, let’s call it TeenTextSpace. Teens experiencing distress can message a ‘therapist’ any time through an app plus have one 30 minute virtual session each month. Therapy for all, no need to wait, on demand 24/7, actual words and emojis. The therapy unicorn that is being offered here has a compelling business case. No more waiting lists, no more diagnosis or complex co-morbidity just consumers consuming therapy on an app. No obligation to concede a fact of life that nothing of the deep and meaningful ever comes simply on demand.

The rise of the digital therapy sector is an American story of neoliberal economics and comparative employment relations gets little traction here in the UK which is an own goal if you’re interested in therapy on either side of the consumption model. In 2025 a recorded conversation took place between three women about the uberization of therapeutic work in the US and UK, a sobering story about what is about to happen in the UK therapy sector. Drawing on the experience of the Psychotherapy Action Network’s (PsiAN) experience of being sued in 2018 by a digital therapy platform for $40m for asking the question is text based support actually therapy and the recent National Union of Healthcare Workers’ hunger strike in the US of Kaiser Permanente workers in response to the uberization of mental health services in California.

Why therapy went so wrong in California

https://youtu.be/jwKdhVQkAWA?list=PLzwr5JGnZR_yzyZPPzqfkPG0vMQqz91Pc

What is an UberTherapist?

https://youtu.be/3CPGRaKkgqM?list=PLzwr5JGnZR_yzyZPPzqfkPG0vMQqz91Pc

What’s the cost of the convenience of UberTherapy?

https://youtu.be/Dvb9rsRIabE?list=PLzwr5JGnZR_yzyZPPzqfkPG0vMQqz91Pc

There are no self- reporting questionnaires that allow us to think about UberTherapy precisely because the metrics of recovery were created to capture industrially useful information and to avoid, by design, critical thinking. It means that to go deep into what the problem is with UberTherapy requires what Nora Bateson calls ‘information of another order’ that symbolizes the warm data of experience. Drawing on our personal and embodied experiences as a route to raising consciousness, is a deeply feminist basis for research. It is a positioning that values the subjectivity of the author, that values experience and recognizes the difference that lived experience makes to the accuracy and legitimacy of the argument. That is why UberTherapy is also a love letter to the political and intellectual work that understands the value of talking from experience. It is in this spirit that I have included in my book UberTherapy the exceptional thinkers and practitioners who have changed me, including these American women who have profoundly shaped my understanding of what lies ahead.

The setting of this conversation is not accidental. In 2019, Maria Albertsen established National Counsellors Day as a platform for addressing social and political issues within the therapy sector as part of her creation of the largest network of counsellors and therapists in the UK. She talked about unwaged and low waged work and the hidden class system in therapy at a time when it could clear a room. Even if you never knew her, if you have skin in the therapy game you took a hit when Maria died at the young age of 44 in November 2024. She had a rare political instinct, a deep understanding of the underbelly of the therapy business and an acceptance of our sharp edges required to survive that. Her death represents a profound collective loss as we had come to rely on her activist’s hunger for an alternative to the uberIzation of the therapy profession. I loved Maria, and miss her ability to make me cry with laughter.

One of the greatest threats to therapy is the attack on our capacities on both sides of the therapeutic relationship to talk of the inconvenient truths of our lives. As the algorithmic silencing of lived experience deepens the voices of those who hold up our sectors of care are routinely erased, and it is in this way that there has never been a more important moment to defend each other’s ability to say what is on our minds.

Watch the conversation between Linda, Garie and Elizabeth go here

Watch National Counsellors Day 2025 recordings go to Onlinevents here

Garie Connell, LCSW, is a Licensed Clinical Social Worker serving as a Medical Social Worker in Pediatrics and High Risk Infant Follow-Up at Kaiser Permanente Woodland Hills Hospital in Southern California. She is a current member and former union steward of the National Union of Healthcare Workers (NUHW), which recently secured a historic four-year contract with Kaiser following a six-month unfair labor practice strike, that included a hunger strike of therapists in the US for the first time. She writes a great blog here.

Linda Michaels, PsyD, MBA is a psychologist with a private practice in Chicago. She is Chair and Co-Founder of the Psychotherapy Action Network (PsiAN), a grassroots nonprofit organization that advocates for improved access and awareness of psychotherapy. She is the author and editor of the book Advancing Psychotherapy for the Next Generation, the most important book to read about what lies ahead for the UK therapy sector.

Elizabeth Cotton is a writer and educator in the field of industrial relations and mental health and is Associate Professor for Responsible Business at the University of Leicester. She has trained and worked as a psychotherapist in the UK’s NHS and has had lots of therapy. She comes from a trade union background, working as head of education for a global union federation in the extractive industries and founded Surviving Work which explores whether it’s possible to do that. Her book UberTherapy: The new business of mental health is published by Bristol University Press in 2025.

You can buy a copy of UberTherapy: The new business of mental health by BUP here

@survivingwork.bsky.social @survivingwk

@UberTherapy.bsky.social @ubertherapies

Elizabeth Cotton

We’re not in Kansas anymore

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