Professional Cannibalism
It doesn’t take much in the debates about living wages in the caring professions to end up sounding like Marie Antoinette. For those of you who don’t work in the therapy world one of the most embarrassing things about the profession is that most therapists at some point have to work unwaged in order to get through their training, get professional accreditation and build their client base. It means years and years of working part time both within the NHS and in the third and private sector for free in order to clock up clinical hours. It sets the bar for earning anything as a therapist very very high, and apparently not high enough to nudge the current average rate above £40 per hour.
In industrial relations research we no longer call this unwaged work, instead the more aggressive term of wage theft, to account for the cost to us of not earning enough to live. The downward pressures on pay rates, the cost of training and registration, the insecure housing and insecure consulting rooms, miniscule professional prospects and the death of our dreams, a lot has been stolen from people working in the caring professions including the likelihood of their ability to care.
Before we implode into a state of professional self-loathing its worth knowing that two things under the heading of uberization have happened that have been a profound attack on therapy.
Firstly there has been a professional uberization in the creation of, big sigh, SCoPEd, the new system of professional standards that has been introduced in the UK quietly and without any real debate within the profession over the last few years. SCoPEd divides therapists into categories A-C, with the majority of trained therapists now hovering somewhere in Category A which, despite its Class-A-ness exists in a growing realm of non-clinical non-therapeutic practice. As such SCoPEd offers a new-not-new system of professional aristocracy which entrenches the same old inequalities of gender, class, private vocational education and race that are on the ascendance across the professions.
In April 2024 I wrote a submission with CTUK to the Professional Standard Agency’s consultation around therapy regulation raising our evidence based on two large financial surveys across the therapy sector in 2021 and 2023. We raised concerns that SCoPEd will further deepen the financial unsustainability of working in the therapy and counselling sector. Only 3% of 2023 survey respondents felt that SCoPEd offered them higher opportunities for paid work and 1% felt it would lead to income increase, rising to 13% responding they anticipated a fall in income. As a result of these financial realities, a high level of 33% (30% in 2020/21) of respondents cannot see a future earning a living as a counsellor or psychotherapist.
Within the psychotherapy and counselling profession there is a two tier system which is based on pre-existing inequalities in terms of class, race, gender and disability both for the clients and their therapists. The SCoPEd framework will entrench those inequalities already inherent in the profession by formalizing a system of unwaged work and presenting disadvantage as a personal and professional failing. Rather than as a result of the professional bodies having created a regulatory and accreditation structure that many existing and future therapists simply cannot afford.
I just want to note that I wrote the first draft of our submission to the PSA overnight to send to Maria Albertsen who ran CTUK with one of those really annoying red exclamation marks. I did that because I got the submission date wrong, underestimating the timeline by a month and neither of us noticed. That was something to do with the fact that as single parents our eyes were literally bleeding. In an increasingly resentful exhaustion I did ask Maria if either of us had the energy to go through the patient listening and mansplaining to consult across our sector. We decided that our own states of mind were so fragile that we should just do the work and send it out as a template for people who were borderline about whether this is worth making a fuss about. I’m just saying that every time we also engage in organizing work it comes at a cost. So I add to my own calculation of wage theft, the cost to my health entailed by the loss of a night’s sleep submitting consultations to policy bodies when you’re a single parent with a 2.5 hour commute to work.
The second part of the uberization of therapy involves platformization outlined in graphic detail in my new book UberTherapy: The New Business of Mental Health. Right now in the UK there is a rapid expansion of online therapy platforms. This is a changing business model – including Business-to-Business (B2B), Business-to-Client (B2C) and hybrid providers including the expansion of the Employee Assistance Programme (EAP) sector and more fundamentally the growth of private medical insurance in the UK.
As therapeutic labour is platformized it becomes intensified, and so it might feel that we have a vibrant therapy sector. But whichever way you cut it platformization brings with it low wages especially for women something to note in a profession with 80% women. For the big B2C platforms a therapist earns on average £18 per hour if they’re not willing to intensify case loads to over 40 hours a week. In other platforms there is a growing uberisation through an emerging system of dynamic pricing and therefore a tiered system of payment. The increasing split between what is charged and what is paid to therapists is reliant on a lack of transparency between client and therapists, between therapist and the platform and all the disorienting absence of hard facts in the grey market of self-employment. Reinforced by the absence of solid regulation for platform workers and the increasing majority of us who are algorithmically managed.
In my 2026 submission to the Commission for the Future of Counselling & Psychotherapy about what needs to happen for the profession to address uberization, I outline the key fault lines of platform regulation that lie ahead for therapists.
The digital shift in the therapy business model opens up the doors to the next decade of responsible business as a matter of competitive advantage. The ‘good business’ debates setting the fault lines of what a better model of digital therapy might look like. But even if we allow ourselves to imagine a MuchBetterHelp it still leaves us with the thorny question of money. Because what we are seeing now is that even the progressive EAPs and the therapist campaigns to move us beyond wage theft into demanding actual money have settled for £40 per hour. An industry rate that ignores the history of industrial relations and collective bargaining in the professions that says if you set the bar too low you’ll spend the rest of your working life defending the indefensible.
The therapy business has form. An old story of systemic underfunding and the intentional failure of public services but also a forever story about gender, class and race. A system of professional regulation something like a 17th century French Court - precariously placed patronage creating a professional aristocracy fussing about their lace cuffs and independent practice while bread runs out. The architecture of the therapy industry is founded on a system of professional cannibalism where bad therapy is blamed on bad therapists and the only way to navigate this is to engage in a form of professional cannibalism. This aristocratic logic distracting us from the reality that we are set up for failure as we eat our own. Deaf to the thud thud thud of the peasants marching past the Petit Trianon.
The de facto acceptance of a £40 industry standard is the new fault line for the future of therapy and for the very many undervalued women who work in it. To open our eyes to the emergence of a labour aristocracy and make a demand for decent wages, whatever our proximity to Versailles.
Hosted by The Relational School on Friday 5 June 7-8.30pm this online event opens up a discussion about the ‘uberization’ of therapeutic practice, the business models behind it and the emerging political fault lines for therapists. Using as its starting point the book UberTherapy: The New Business of Mental Health (Bristol University Press, 2025) the author, Elizabeth Cotton, Jumanah Younis and Claudia Coussins will together explore the narratives and the politics of digital therapy and the collective challenges that lie ahead for therapeutic work in the face of widespread platformization. Thinking about the generational splits in the digital therapy debates for consumers and practitioners, the event will think about whether other people are a waste of time in defending the deep work of therapy and the what next in the story of UberTherapy.
To reserve your place at The Relational School go here
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