WWhether with a private therapist at Zoom, through an app that reminds us daily to record our emotions, or in an information exchange with a chatbot, teletherapy is often offered as a blanket balm for our current mental health crises. . Remote treatment is touted as an effective way to reach more patients at a time of extreme difficulty, an intimate intervention that can scale.
During the intermittent mandatory social distancing that has marked the last 18 months of the pandemic, teletherapy has lost its status as a minor form of attention to become, at times, the only thing on offer. The popularity of distance therapy sessions has shot up in the The US and the “users” we once called patients are more and more comfortable with and, in some cases, even prefer such practices.
Having a therapist see a patient with Zoom or a condensation treatment in AI and auto-tracking interfaces may be recent innovations, but the broad notion that remote technology and processes will solve our problems is nothing new. We have been turning to forms of technology to provide mental health services for over 100 years. From 19th century written cures delivered by post and ad hoc telephone hotlines, to the elusive work in progress to create an artificial intelligence psychiatrist, numerous mediated, networked, and remote relationships have been used to attempt to solve long-standing problems with therapeutic provision. Those issues, while obviously evolving over time, have also remained relatively the same: good care is expensive, in short supply, and can barely meet overwhelming demand.
While versions of teletherapy have cropped up time and again over the past century in one medium after another, it is also correct to say that it has finally arrived. The corporate healthcare industry has taken notice. Online therapy companies like Talkspace are listed on Nasdaq. Amazon has continued to push its Halo wearable technology, which uses a built-in microphone. to listen to the machine, pushing users to be more “positive”. And white-collar workers in the US receive a series of company-sponsored reminders to use the mindfulness and wellness apps included in their benefits.
Corporate teletherapy applications promise convenience and efficacy: metrics positioned at the center of these interventions from the Telephone invention. Privacy, confidentiality and the therapeutic relationship itself occupy a secondary place.
Too often on these platforms the goal becomes simply “mental fitness.” Fitness is always fitness by something: corporate teletherapy often implements the logic that everything is done in the service of people who work better, harder and, yes, more efficiently. Some apps even offer therapy without the therapist: either in the form of a chatbot or as a type of automatic follow-up. The patient is supposed to click, scroll, and type on their way to a better state of mind at the expense of deeper and more open work and systemic solutions.
For the practitioner, corporate teletherapy presents caring work in the form of the gig economy, exacerbating long-standing problems with clinical exhaustion. If patients are promised on-demand texting and lured in with the promise of shorter sessions, all that extra work is done by overburdened workers who have dislocated from traditional intimacy with their patients. Before the pandemic, psychologists and social workers were increasingly financially precarious; and in the last year, 10% of mental health workers in the United Kingdom won nothing, according to a survey of professionals from across the sector. Others are turning to corporate platforms for a living, earning lower fees than in private practice. For patients, this reduction is not passed on: the fees remain roughly the same as in private practice, despite claims to the contrary and the radical change in the nature of the therapeutic experience.
However, since a widespread emergence in the 1960s, remote treatment has been justified for a promise of democratization. Simply put, these treatments can go where traditional mental health treatments cannot or will not, leveling out large disparities in access to help. Increasing therapy with silicon, or phone wires before that, is supposed to somehow miraculously also change the number of doctors available, protect those in the field, and reduce fees, while also increasing access to attention and destigmatized it. Sometimes this works: While these initiatives have largely been based on individual communities, or used in pre-existing therapeutic relationships, some have in fact scaled and radically altered our landscape of care, such as the widespread adoption of suicide hotlines.
But, in the midst of what has been called the “Uberization of mental health”, Making mental health care remote, zooming, or one-click doesn’t instantly open it up for everyone. If so, we would have had therapy for everyone a long time ago.
Hannah Zeavin is a professor of history and English at the University of California, Berkeley, and the author of The Distance Cure: A History of Teletherapy.
In the UK, charity Mind is available at 0300 123 3393 and Childline on 0800 1111. In the USA, Mental Health America is available at 800-273-8255. In Australia, support is available at Beyond the blue at 1300 22 4636, Life line on 13 11 14, and on MensLine at 1300789978
George is Digismak’s reported cum editor with 13 years of experience in Journalism