Online Mental Health and the Future of Therapeutic Labor

RESEARCH QUESTION 

The research asks how the work of mental health professionals is changing as they increasingly provide services through online digital platforms, and how such shifts impact therapeutic expertise, therapeutic labor, and professional practice. 

The project aims to understand how the work of mental healthcare professionals is changing as it moves to teletherapy and online mental health platforms, and to shed light on new directions in therapeutic labour. Specifically, the research traces: (1) the dynamics of delegating care work between human therapists and technological systems, including artificial intelligence agents; (2) the labour conditions of mental health professionals, particularly the issue of professional autonomy in online practice regarding caseload management and clinical approach; and (3) the institutional and bureaucratic pressures, incentives, and power dynamics embedded in these changes to the work. 

WHY IS THIS RESEARCH IMPORTANT? 

The massive growth of platforms promises to expand access to mental health care by virtually connecting patients to therapists, unburdening providers from administrative work, substituting AI for provider labor, and providing therapists with a consistent client base.  

Telehealth has the potential to reduce barriers to care, especially for communities with limited access to services, people with disabilities, and older adults. Teletherapy, in particular, can offer a more immediate and sometimes private space for the creation of a trusted and intimate relationship between patient and provider.  

However, the growing availability of telehealth has also been accompanied by increased fragmentation and intensification of work for those who provide these services. At the same time, telehealth services that require robust data and video connections can exacerbate inequities in access to care for communities without a reliable, high-speed Internet connection. The widespread adoption of telehealth has also been complicated by issues related to insurance reimbursement, medical licensing mechanisms, and public policy. These obstacles have all impacted service delivery for patients and the labour of care for providers. 

If the existing patterns of platformitization—where a digital intermediary steps into an industry to provide marketing, data management, and connection of “vendors” to “customers”—hold for mental health care, there are real risks for labour conditions for providers. This study closes the gap in the knowledge about labour conditions among mental health care providers who practice on digital platforms, so that new regulations will be informed by empirical data and can create humane, sustainable, and equitable conditions for this critical group. 

The research also gives a chance to ask how platforms can be designed in a way that actually delivers on the promise of democratized access to mental healthcare in a way that is humane to those who engage in the labour of care. 

METHODOLOGY  

The research follows a qualitative approach using focus groups, time diaries and media analysis as data collection methodology.  

Focus groups will be held with clinic-paid or self-employed providers who practice online and/or use direct-to-consumer mental health platforms. The focus groups involve discussion and storytelling amongst participants, which allows them to capture the participants’ reflections on their experiences in their own words.  

A subset of these providers are asked to keep a “time diary” to track how they spend their time over the course of three working days. The goal of this is to document, across a range of online platforms, what a provider’s day is like in terms of demands for patient care and administration and how that differs—if at all—from the classic, in-person, office-based schedule. The research also collects data from websites, job postings, discussion boards, popular writing and other publicly available materials that outline the expected labour arrangements between platforms and providers. 

In terms of analysis, grounded theory is used to structure the iterative development of themes as they emerge from the focus groups and media content.