The Catchup

‍Tucked away in that dark space called responsible business, there has been an important challenge to UberTherapy in a complaint made by the BBC against Health Assured, the dominant employee (and student) assistance programme (EAP) provider in the UK. You know the drill, large US tech company, offering a large platform for short term support for employees, mainly public sector workers, based on a standardised model of solution-focussed cognitive behavioural therapy. A call centre model of non -clinical triage, repeated standardised questionnaires and an offering of six sessions of CBT designed to operationalize economic activity. A return on investment (ROI) offering individual solutions to systemic workplace problems.  

In 2024 the BBC’s File on 4 programme investigated EAPs focussing on Health Assured. It took a whole team of BBC journalists, and someone like me prepared to go on record to call it as a system of ‘attrition by design’, the ROI being the ironic reduction in your chances of getting therapy. What followed this investigation was the BBC submitting a complaint to the professional body that accredited Health Assured’s services. Since this was published by the BBC the complaint had enough traction for the professional body to suspend the company and investigate issues around the quality of therapy provided. Following this the EAP Association ruled the company is in breach of its Ethical Code of Practice and duly notified the two professional bodies that accredit Health Assured as a therapeutic provider. Surprising then that in the debates about the future of therapy nobody really want’s to talk about the uberization of therapy.

It is true to say that the growth in EAPs is a very British story. With the advent of private medical insurance and work related healthcare, we are seeing a rapid growth in both US and UK based EAPs. Many are small and medium locally based services, populated by the very many experienced therapists leaving the NHS and unable to sustain a living in private practice. On a good socially responsible day, the EAP sector potentially offers an industrial fault line given the competition for highly qualified staff that demands competition between EAPs could encourage improved contracts and conditions of work for therapists.

The problem is that since Covid we have seen a dramatic and sustained fall in the hourly rates of pay for therapists. In a recent report about the EAP sector by a professional body, not a word about the EAPA ruling, just a bleak record of the catastrophic erosion of hourly rates of pay in the sector minus a clear explanation as to why.  What is being evaded is a debate about current industry standard of £40 per hour, a hurried compromise naively supported as a minimum rate for online therapy in the pandemic, but inevitably now the best you can hope for. And as 32% of EAP therapists now earn £31-35 the trajectory towards even lower rates of pay reveals itself.

The problem with ignoring the Health Assured investigation is that it tries to understand the EAP business without understanding the current and future business model behind it. In the UK for the big online therapy platforms a therapist earns on average £18 per hour if they are not willing to intensify caseloads to over 40 hours a week. In other platforms there is a growing uberization through 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 consumers and therapists, between therapist and the platform. Platform pay involves a disorienting absence of hard facts in the grey market of self- employment and gig work, reinforced by the absence of solid regulation for platform workers. Over time, whether you work for an online EAP or an on demand therapy platform, we will all be subject to the consequences of algorithmic control. As we watch the roll out of platformization by the institutions of therapy, at some point we will have to ask whose interests does the £40 rate serve?

If you’re a therapist in private practice it will have started to dawn on you that you’re competing within an uberized model of therapy including both low paid platform therapists and AI automation. The competition is not the seven people in your local area who are also in private practice, the competition is around hourly rates and wage theft, the security of the therapeutic relationship, and people's expectations around the short term nature of the work. As the key commentators on the ‘AI Con’ show us, the technologies which will continue to be developed over the next three years represent a genuine threat to human therapeutic practice.

I recently heard a phrase from a politically ancient and psychically militant therapist, talking about life long campaigning in the therapy sector - “We have to hold our vexation at the catchup”. When I heard these words I spat coffee all over my computer, a £100 repair bill well spent as it introduced the soundtrack for defending therapy.

UberTherapy was written for therapists to take to their supervision groups and ask, why are we not talking about this? To talk to their professional bodies and say, here's a book it asks why you’re OK with an industry rate of £40 and falling. You might not agree with it or like it, but let's start there. The real question is not “what do you think about AI?”, but how do we stop it uberising and automating our profession? If that's not enough to incentivize you to catchup I don't know what is.

How to catchup:

Join our discussion about UberTherapy hosted by The Relational School online 5th June 7-8.30pm here

Listen to Linda Michaels from the Psychotherapy Action Network in the US talk to Justin Karter for Mad in America here

Listen to the File on Four programme Investigating EAPs here

Read UberTherapy here

Read Surviving Work’s submission to the PCPB looking at AI and digitalization of therapeutic labour here

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@survivingwork.bsky.social @survivingwk

@UberTherapy.bsky.social @ubertherapies