Who do you think you are?
In the last six weeks I have broken four smartphones. The first one broke on the publication date of UberTherapy so hardly an unconscious communication that I’m ambivalent about whether to stay on the grid. My most recent phone is classic mum-material – cheap as chips combined with my refusal to download any apps or use QR codes and my dramatic inability to read anything at all without glasses – I know what I look like. My attempt to consciously choose what technologies are integrated into my home life were further frustrated by the thuggish sales techniques of Google, because I won’t sign up to having an AI companion. It means that I literally can no longer switch off my own phone unless I accept the invitation to get help, either from said AI companion or a teenager.
It doesn’t help that those of us who have been banging on and writing actual books about the impact of platformization turn out to be right about the algorithmic harms of AI surveillance now that anyone using Microsoft Teams can be uberized by their manager. It also doesn’t change the fact that in a world where code is law my laying out of the business model behind UberTherapy means that I am neither visible or viable algorithmically speaking, reduced in the attention market to just another flabby ol’ middle aged woman who doesn’t know how to play the discoverability game. Conversational chatbots and GPL-1s are mother’s little helper in a world where we are forced to audition for a place in our own professional and political lives.
Oh the pure raging indignity of the middle-age.
Last week one of the largest networks of psychotherapists in the US – the Psychotherapy Action Network (PsiAN) - produced the missing data link in the UberTherapy story, about how it is that even in private practice, you can’t escape the self-sustaining nature of the platform capitalism business model. As in the UK, the use of online platforms to market, manage, schedule and record data about private practice is on the increase in the US and probably unsurprisingly in the platform economy size matters. It means we’re starting to see ‘free’ and subscription practice management tools dominating the sector, and the sorry back story that some of the key players are owned by private medical insurance companies. In PsiAN’s report 81% of therapists are concerned about protection of patient data while 85% say they would not use PMCs if they were owned by private insurance companies, which uncomfortably most of them actually are.
In the US private therapy sector, the growing use of practice management platforms are designed to uberize therapy by introducing ‘mega group practices’ or platformization of independent practitioners. Literally, by signing up to PMCs therapists become platform workers by stealth – independent contractors with none of the benefits of working within an actual group practice. This then introduces a system of lack of transparency about who you’re working for and what you will get paid. Not yet dynamic pricing as the big Uber legal cases now expose but only a small step away from this – where despite the claims to higher earnings using PMCs, 50% earned the same or less than independent practice and 84% were not informed about fee-splitting arrangements before joining. The narrative of independent practice twisted into a model of UberTherapists without the brand name.
No, you didn’t know this before PsiAN did the research.
Yes, it now means that therapists in private practice can no longer say that UberTherapy is nothing to do with them.
In doing this interdisciplinary research into the business models behind UberTherapy, PsiAN walks the lines between professional identity, politics and basic AI-literacy in trying to open up debates about digital therapy in a broad church of professionals. It also has to deal with the anxiety that this previously unknown risk to therapeutic work is now being presented to the profession, and the push back this often involves. In the professions we defend ourselves by shutting down conversations before they’ve really started, rolling out the usual suspects to dampen our enthusiasm for learning something that is complex and new.
I don’t doubt that PsiAN’s research will be remembered down the line as the seminal starting point in the debates about the platformization of private practice, but right now it’s the same brilliant middle aged women pushing water up an attention-market hill. That we’ve seen a problem, explained it in clear and accessible language and so bought it into the lives of people who didn’t know it was their problem and now, as if by magic, we start to be gaslit into thinking maybe we are the problem?
In the AI therapy debates it’s tempting to go down the safe route of generational spits where the next generations are ‘transactional’ and don’t understand those of us who have been slogging away in the real to build a better world. For them apparently. The other trope to resist is that the majority middle-aged white women working in therapy have bad politics and rich husbands and so experience complete system failure to raise their own consciousness. It’s hard not to fall into the denigration of all sides of the age-old generational, class and race divides within the professions, when I’ve been in all the movies so long and so often that I have become intolerant to anything described as new.
Our institutions, invite us to think we’ve seen it all and continue to hold circular debates in our echo chambers about how things are just as they used to be, just with a digital veneer in the professional court of Versailles. Success is earned and maintained in its current form, nothing revolutionary to see here. The institutions of therapy are circling their wagons to defend themselves from facts about the new business of mental health and the realization that they too didn’t see it coming. And in this shutting down of the diverse actors and conversations required to see what is on the horizon they render themselves unable to see any of us for who we really are.
As you would expect, it’s not that those of us of a psychoanalytic persuasion aren’t able to think about why we’re so defended against seeing reality. Rolling out more of the psychoanalytic greats, David Armstrong, Michael Rustin and William Halton, in their edited book Social Defences Against Anxiety they give a framework for understanding what stops us thinking about therapeutic labour. Interwoven across the book they think about therapists’ anxieties and their subsequent defences and propose three dynamic and interrelated types of anxiety; task- related anxiety (anxiety in relation to the job and concrete work tasks), persecutory anxiety (anxiety in relation to institutional and organizational context and management cultures) and existential anxiety (anxiety in relation to maintaining ethical and professional standards).
Task-related anxiety within UberTherapy is just obvious given the nature of the work and its intensification. The aptly named persecutory anxiety relates to the anxieties around the performance management systems, increasingly themselves platforms used by the private medical insurance sector to monitor and regulate what therapy can and cannot be done in the private sector. UberTherapy intensifies the grinding feelings of persecution around micromanagement and intolerance of under-performance that in the UK was put in place in the NHS creating an industrial cul-de-sac which continually degrades the nature of the therapeutic work across the whole sector.
But hold onto your pitch forks people, just because you understand something doesn’t mean that we’re at a stage where therapists are able to collectively do anything about it. We might well be able to see the problem at some point in 2026 but the hard slog of developing our capacity to tolerate other people in the industrial politics of UberTherapy is quite another journey we are only now starting.
This last year has been a period of deep grief for many of us and it was in 2025 that I came to live in the shadows and wonder who I really am. Despite being ancient psychically speaking there is no protection from the reality that I have never been in this place before. Over the last six months as UberTherapy came into life, my survival instincts kicked in and I reconnected with and met new minds from different disciplines, generations and backgrounds and consciously started to hold conversations that despite being intentional in helping see the digital future, are not boxed in by what I think I know. I take time to talk and think with others who are not like me, a practice that forms my North star in the disorienting landscape I now call Angerland. A practice that allows me to start again to ask both you and me the question - who do you think you are?
In 2026 Surviving Work will carry out a series of online discussions about the Stories of UberTherapy that lie ahead.
Join us at the online launch of Asylum Magazine’s special issue on AI and mental health on 19th December 2025 6-7pm.
Register here to receive the joining link: http://bit.ly/Asylumlaunch-Winter25
You can buy a copy of UberTherapy: The new business of mental health by BUP here
@survivingwork.bsky.social @survivingwk
@UberTherapy.bsky.social @ubertherapies