Once upon a time in talking therapies
Once upon a time NHS Talking Therapies was an ambitious and beautiful ideal of universal access to free therapy. Once upon a time it was a badge of honour to be an NHS therapist working in what we used to call IAPT – Increased Access to Psychological Therapies. This is not meant as an attack on the many good therapists working in what remains of our public service, I salute you for staying in your places to defend the possibility of getting therapy in the NHS. It is thanks to you that we can say that something good can come of the interaction between an empathic and experienced NHS therapist and someone who wants help based on need rather than capacity to pay. But although IAPT was always a patchy service and in some places you can still get solid care I have come to believe that this is despite rather than because of the IAPT system. As the business model shifts in therapy and the uberization process reaches its digital turn, the chance of accessing actual therapy in the public sector is becoming increasingly remote, in every sense of that word.
The origins of UberTherapy is a story of the ambitious campaign to set up a system of widely accessible publicly funded therapy in the UK in the early 2000s. In and of itself a great idea, but over fifteen years later it is legitimate to ask if we set ourselves up for failure because of its political and financial foundations. Ubertherapy: The New Business of Mental Health is not just about online therapy platforms, it’s also a story about decreasing access to free therapy and replacing it with a system of psychic pilates where you get what you can pay for. It is a story of what happens when a model of ‘retail therapy’ comes to dominate, shifting the model to one of e-commerce where consumer choice replaces patient needs. What happened in the NHS is the backstory of how it came to be that UberTherapy drove us like a juggernaut into a future of datafication of patient data, platformization, AI diagnostics and the digiceutical sector and into a series of therapeutic cul-de-sacs.
It means that whether you consider NHS Talking Therapies to be real therapy or not is ultimately unimportant because according to the rules of UberTherapy, whether it is consumed in the NHS or in the private sector, the business model is no longer about therapy. I do not wish to be conspiratorial but if you wanted to denigrate public mental health to the point that we are not prepared to fight for it, this would be one way to do it.
Listen to the story of how UberTherapy came into being in a conversation with the delightful Ravi Amruth and Michelle Sudbury of Two Lost Souls : Full podcast here.
1. Whether it’s conscious or not there’s a lot of shaming and blaming in the therapy world, including the therapist. Listen here.
2. It’s not about therapy any more, its about snaffling up NHS data and entering UberTherapy where size matters. Listen here.
3. We’re not stupid people but there is an attack on our thinking about what is happening in digital therapy. Listen here.
4. If we’re not able to be attentive because we’re busy getting people off the books we are projecting our anxieties into our clients. Listen here.
5. Digital Therapy is now a sector of e-commerce and we are just consumers, changing the nature of the relationship into therapeutic tinder. Listen here.
6. In the realm of UberTherapy consumer power will come to dominate in determining the good, bad and the ugly of algorithmic harms in therapy. Listen here.
You can buy a copy of UberTherapy: The new business of mental health by BUP here
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