Hilda “The minute therapists start talking about organising people raise antitrust concerns but it’s really upside down because the real power isn’t actually with clinicians, it’s with massive insurance companies…..we hear about the workforce shortage, the therapy shortage, but it’s actually a market failure….I think that’s where the shift is going to come because when you frame something like reimbursement rates as an individual contract issues therapists have very little power but when you connect it to how patients can’t access care, even when they’re insured…because of the inefficiency of the system and the insurance companies have all the power you can’t actually access care when you need it. So connecting it to patient access and making it a public issue that’s where I think we’re going to build real leverage….”
James “When we took legal action against Uber and Orla cabs in the Netherlands about data access and algorithmic transparency that was one of the defences they used to say that this was an abuse of rights and anti-competitive behaviour. That we were interfering with the competitive force of drivers completing against each other by collecting this data. It’s a very old argument, 150 years old as a restraint on trade argument and it was quite amazing seeing that being used in 2025.”
If you want to understand the one two three’s of the platformization playbook look at Kaiser Permanente in the US. Kaiser is a consortium of healthcare providers and one of the largest nonprofit healthcare plans in the US. It’s big, with 12 million members making $9.3bn last year and employing thousands of healthcare workers, including therapists or ‘behavioural health’ workers. You might know their name from the hunger strike of therapists in their long running disputes and protracted legal mobilizations used to bring Kaiser back to the table. It wasn’t enough that they forced Kaiser to pay legal settlements for the datafication and gamification of healthcare to the tune of $billions – since fines are now a permanent cost heading as the world tries to unpick the legal gaming associated with platform regulation.
Over the last 16 months Kaiser has put back on the table the ‘terrible three’s’ of introducing AI technologies through ambient recording and scribing ‘services’ as well as algorithmic screening of patients seeking care combined with the traditional uberization strategy of proposing clinical staff layoffs and outsourcing, while at the same time uberizing professional discretion and autonomy by limiting both the decision making opportunities and options for clinicians. The uberization playbook seen across the professions.
In the US a series of important collective legal and regulatory mobilizations in therapy have emerged through the National Union of Healthcare Workers (NUHW) and Psychotherapy Action Network (PsiAN) - organizing organizations that are doing the work.
They are the first to understand down-coding and the subsequent gold rush for automation of therapy. This year Alma, one of the largest clinical practice management platforms in the US, unilaterally announced that therapists in private practice with clients who have private medical insurance with Aetna will see what has become known as ‘down-coding’ of therapists’ capacities, their session times reduced and a subsequent 40% cut in pay. Although Alma is not owned by Aetna, it’s business model relies on being a contractor to the large private medical insurance companies who determine the parameters of therapeutic practice. In the same week Aetna announced its new service, Mental Health On Demand, offering single session therapy with non-clinical staff or, marketed as the emerging preference of consumers, an AI agent who will respond within 13 seconds. The cuts at Alma represent a loss of income for therapists ranging from a drop of $4800 a year for 5 Aetna sessions a week to $14400 for 15 sessions. Private providers now determine what counts as therapy.
Instead of wondering whether Claude was useful they made formal complaints to the San Francisco Supervisors about what AI roll out means across the private medical insurance sector, by the big players at Kaiser Permanente, mapped out in all its granular glory in the testimonies at this hearing from NUHW members and Linda Michaels from PsiAN.
They also engage in legal campaigns aiming to protect consumers including attempts to secure state level regulation in California - most recently the campaign to install Regulation SB 903 - demanding explicit consumer consent for recording therapy sessions and no penalties for clients who say no. It demands that clinicians not AI Agents carry out triage or make clinical decisions. It is one of the first union campaigns to stop AI mental health providers from sharing or selling private data to make even more money.
If you want to understand the playbook of how automation is taking place across the therapy sector Stories of UberTherapy is a series of six recorded conversations with therapists, social justice activists, trade unionists and progressive tech campaigners to ask if a MuchBetter.Help is possible. In Episode 4: Do you have to marry a rich man to be a therapist? with James Farrar (Worker Info Exchange) & Hilda Poulson (National Union of Healthcare Workers) and Linda Michaels (Psychotherapy Action Network) and me, Elizabeth Cotton, we demystify the one-two-three’s of uberization and learn the lessons of organizing Uber drivers and the Kaiser Permanente hunger strike.
The good news is that under platform capitalism people do organise by necessity. Multiple groups and networks are being created both within and outside of our professional silos and all of them potentially are worth relating to. So if you’re an UberTherapist wondering how to make friends here are some suggestions. You won’t be gamed or have your biometric data sold on to the big data daddy in the sky, instead you’ll be encouraged to join a group of like minded people to remember how very much other people are not a waste of time.
How to make friends
Listen to our podcast series Stories of UberTherapy here
Join our network of UberTherapists here
Read UberTherapy: The New Business of Mental Health here
Join our mailing list to follow our work organizing a MuchBetter.Help here.
Join the Psychotherapy Action Network that actually understands how to navigate UberTherapy. International & UK membership welcome and highly recommended here.
Follow the groundbreaking organizing work of the National Union of Healthcare Workers to understand the future of organising therapists in the UK
Join The Relational School my favourite politicised space for therapists here
Listen to the gnarly good Therapists Unchained podcast from Sivie Suckerman the US here
Join the mailing list for those groups that are leading the way in social justice activism such as Healing Justice London.
Join the mailing list for those groups actively organizing platform workers such as Worker Info Exchange.
By a long shot the best substack on platformization is Ben Wray’s The Gig Economy Project subscribe here.
Join a union. Join more than one union. Psychotherapy & Counselling Union, Unite & Unison’s mental health nursing and applied psychology sections.
Come to UberTherapy discussion event at Psychotherapy & Counselling Union online event on 9th December 7-8pm GMT open to everyone working in mental health. Register here
Surviving Work will be piloting, designing and publishing useful information and workplace tools for therapists as part of The Digital Therapy Project. If you would like to be involved in this project you can keep in touch details below.
If you’re an UberTherapist do this:
Listen to our podcast series Stories of UberTherapy here
Join our network of UberTherapists here
Read UberTherapy: The New Business of Mental Health here
Follow the story of MuchBetter.Help here