More people than ever are accessing psychotherapy and counseling remotely in the United States, especially since the COVID-19 pandemic. Teletherapy has allowed clients and therapists to connect across physical distance, often to the benefit of those seeking mental health support. Therapists themselves have to contend with these changes, not only adjusting their practice to the virtual space, but also adapting to new ways of how their labor is structured. 

In Doing the Work: Therapeutic Labor, Teletherapy, and the Platformization of Mental Health Care, Livia Garofalo examines the changing realities for mental health professionals in the US as therapeutic labor is restructured by teletherapy services and digital platforms. While therapy platform companies provide opportunities for therapists to find patients, diminish administrative load, and earn additional income, providers have also increasingly been recruited into labor arrangements that mirror those of other gigified sectors like service and delivery work. By looking at experiences of mental health providers shifting their work to telehealth and different therapy platforms, Garofalo examines how this reconfiguration affects therapists’ practice, professional expectations, structures of compensation — and therapy itself. 

This report argues that the changing conditions of therapeutic labor — the economic, technological, and professional arrangements of online therapy via platforms — are redefining therapeutic work: how mental health providers make a living, how they understand and give meaning to their professional identity, and how they relate to their clients. Focusing on providers who practice teletherapy and work for digital platforms, the report examines the fundamental tensions that emerge when a profession with clinical expertise, licensing, and training standards meets virtual mediation, the dynamics of platformization, machine learning augmentation, productivity incentives, and algorithmic management. Doing the Work challenges popular narratives about teletherapy services and digital platforms, and who they serve.

This report is an output from a project funded by the Internet Society Foundation.