Whether with a private therapist on Zoom, through an app that daily reminds us to log our emotions, or in a back-and-forth with a chatbot, teletherapy is often proffered as a catch-all salve for our current mental healthcare crises. Remote treatment is touted as an efficient way to reach more patients in a time of extreme difficulty, an intimate intervention that can scale.
During the on-and-off mandated social distancing that has marked the past 18 months of the pandemic, teletherapy has shed its status as a minor form of care to become, at times, the only thing on offer. The popularity of remote therapeutic sessions has soared in the US and the “users” we once called patients are increasingly comfortable with and, in some cases, even prefer such practices.
Having a therapist see a patient on Zoom or condensing treatment to self-tracking and AI interfaces may be recent innovations, but the broad notion that technology and distanced processes will solve our woes is nothing new. We have been turning to forms of technology to deliver mental heath services for more than 100 years. From 19th-century written cures delivered by post and ad hoc telephone hotlines, to the ongoing elusive work to create an AI shrink, there have been numerous mediated, networked and remote relationships used in attempts to fix longstanding problems with therapeutic provision. Those problems, while they’ve obviously evolved over time, have also stayed relatively the same: good care is expensive, in short supply and cannot nearly meet an overwhelming demand.
While versions of teletherapy have emerged over and over again during the past century on medium after medium, it is also accurate to say that it has finally arrived. The corporate health industry has taken notice. Online therapy companies such as Talkspace are being traded publicly on Nasdaq. Amazon has continued to push its Halo wearable tech, which uses a built-in microphone to perform machine listening, with nudges to users to be more “positive”. And white-collar workers in the US are treated to a barrage of company-sponsored reminders to use the mindfulness and wellness apps bundled in their benefits.
Corporate teletherapy apps promise convenience and efficacy – metrics positioned at the centre of these interventions ever since the invention of the telephone. Privacy, confidentiality and the therapeutic relationship itself all come second.
Too frequently on these platforms the aim becomes simply “mental fitness”. Fitness is always fitness for something: corporate teletherapy frequently deploys the logic that it’s all done in the service of people working better, harder and, yes, more efficiently. Some apps even offer therapy without the therapist: either in chatbot form or as a type of self-tracking. The patient is meant to click, scroll and type their way to a better state of mind at the expense of deeper, open-ended work and systemic solutions.
For the practitioner, corporate teletherapy presents care work in gig economy form, exacerbating longstanding issues with clinician burnout. If patients are promised on-demand texting and are enticed with the promise of shorter sessions, all of that additional labour is performed by overburdened workers dislocated from a traditional intimacy with their patients. Before the pandemic, psychologists and social workers were increasingly economically precarious; and over the past year, 10% of mental healthcare workers in the UK earned nothing, according to one survey of practitioners across the sector. Others are turning to corporate platforms for a living, earning lower fees than they would in private practice. For patients, this reduction isn’t passed on: fees stay roughly the same as those in private practice, despite claims to the contrary and the radical shift in the nature of the therapeutic experience.
Yet, since a mainstream emergence in the 1960s, remote treatment has been justified by a promise of democratisation. Simply, such treatments can go where traditional mental health treatment can’t or won’t, levelling the vast disparities in access to help. Augmenting therapy with silicon, or telephone cables before that, is supposed to have – somehow, miraculously – also changed the number of clinicians available, protected those in the field and lowered fees, while increasing access to care and destigmatising it. Sometimes this does work: while largely these initiatives have been based in single communities, or are used in pre-existing therapeutic relationships, some have indeed scaled and radically altered our care landscape, as in the widespread adoption of suicide hotlines.
But, in the middle of what has been called the “Uberisation of mental health”, making mental healthcare remote, Zoomed or clicked does not instantly open it up to everyone. If it did, we would have had therapy for all a long time ago.
Hannah Zeavin is a history and English teacher at University of California, Berkeley, and author of The Distance Cure: A History of Teletherapy
In the UK, the charity Mind is available on 0300 123 3393 and Childline on 0800 1111. In the US, Mental Health America is available on 800-273-8255. In Australia, support is available at Beyond Blue on 1300 22 4636, Lifeline on 13 11 14, and at MensLine on 1300 789 978