“I am going to do what I can to show you how I arrived at this opinion about the room and the money”
IN THE ESSAY A Room of One's Own, Virginia Woolf famously claims the right to a room, to work, and to money. The essay was published in October 1929, right when global markets were crashing and women's rights to creative labor were the least of society's concerns. The problems of gender, class, and financial woes were perceived as entirely unrelated to each other by some of her audience.
I have often wondered about the essay in the virtual room of my own therapist, who is also a woman. Whose room is this? Is it mine, hers, ours? Woolf's room is not a therapy office, her money is not a private practice rate, and her work is not the treatment of patients. But what she is talking about, as a woman and a writer, is the right to have the necessary conditions to “do the work.” She is claiming public recognition (and private freedom) to do what she desires and does best, without intrusion, exploitation, or dismissal. Aware of the class privileges that are required to lead a creatively and financially remunerative professional life, she is quite simply demanding what her male counterparts seem to have without needing to ask.
Woolf is fundamentally inquiring about time, space, money, labor, and yes, gender.
More recently, Woolf's demands have come to my mind during my research with mental health professionals to understand how they grapple with teletherapy rooms (think Zoom, Doxy.me), and especially ones mediated by therapy platforms (think Betterhelp or Talkspace). The resulting report, “Doing the Work,” examines how the meaning of therapy is changing for clients and clinicians.
As I interviewed providers who worked for therapy platforms in the US, I realized many of Woolf's questions echoed those of my interlocutors. Mostly identifying as women, these providers
were asking themselves, “At a time of virtual therapy and platformization, how do I hold rooms of my own that are safe, ethical, and accessible to my patients? How do I manage life and work within and outside them? What is the monetary value of my therapeutic labor?”
In short, they too were probing the significance of the (therapy) room and the money.
Teletherapy—mental health care at a distance—has reframed the relationship we have to the therapeutic encounter. In virtual rooms, we interact and see differently. Both parties might be in their own environment, revealing their backgrounds while being visible only from the waist up. Other times, the parties might not even see each other: They are connected by message or voice.
Some teletherapy is done via a communication service that simply connects provider and client, like Zoom. But many therapists now use mental health tech platforms, which not only connect them to their patients but also handle scheduling, insurance, payments, and messaging, while enforcing certain corporate policies and taking a portion of the therapist's fee. On these platforms, the therapeutic encounter is mediated by the conveniences and promises of technology and powered by algorithmic efficiency.
Those seeking help can find a therapist in a matter of minutes on their phones through an app, have a session in a comfortable place of their choosing, and change therapist if they are not satisfied. Those providing services, on the other hand, can ease or bypass the endless battles with health insurance and bureaucracy, have a flexible schedule that gets populated for them, and sign up for additional “gigs” alongside other clinical and familial responsibilities. The ultimate promise is one of unencumbered work that supposedly (finally!) realizes Woolf's vision of being without intrusion or dismissal.
Thanks to these platforms, mental health care is at last being delivered in ways that have not been possible before. (The former CEO of the food service company Door Dash is now the CEO of mental health tech company Headspace—so the term “delivery” is apt).
Yet, as Woolf warned, the problem about the room, the money, and the work remains.
As I learned in my research, many providers felt like the medium of teletherapy wasn't the issue, however challenging virtual therapy rooms might be. Rather, the problem was the labor arrangement, which, in the words of one therapist, can be eerily like that of an Uber driver (except “therapy is not the same thing as driving a car,” as they pointed out). Choosing your own hours, working as an independent contractor, seeing clients whenever you want, fitting one task between other responsibilities, and getting “matched” in seconds: This Uberization is not confined to the United States, nor to psychological services.
As Hannah Zeavin writes, distanced care has been present since the beginning of psychoanalysis. Freud was writing letters to treat his patients, anonymous hotlines have long helped those who want to be heard but not seen, and therapists have always negotiated how to serve those who cannot come to their office.
What is new is the configuration of platform therapy and broader issues of gendered labor, professionalization, and technology. The logics of tech corporate power are overlayed onto the feminization of the profession. Pandemic-era care responsibilities are joined with platforms that demand perpetual attention via notifications.
The tradeoffs, for clients and providers alike, are in some cases worth it. Scheduling a session from a room of one's own home has opened possibilities for new forms of access, intimacy, and disclosure and interesting renegotiations of interpersonal power. Patient and therapist are now meeting in a third virtual space. Some therapists I talked to genuinely preferred this format and were grateful for the flexibility it afforded.
But in other instances, these trade-offs—of time and money—were not as advantageous. Rita, an early-career therapist of color trying to expand her practice and income, described her frustration when working for one of the large mental health tech companies:
I joined some forums specifically for clinicians of color to see what folks thought about the platform. I felt it exploited therapists that might be in my position, it takes advantage of that need for clinicians. [The platforms] say, we'll do this for you, but we're also not going to compensate you equitably in a way you deserve or that is in alignment with your degree and your expertise.
As Rita suggests, it is the (largely feminized) therapeutic labor being compensated as low as $30 per session that allows the profitability of some of these entities. Going public tends to make the thirst for short-term profits stronger. One of the largest platforms, Talkspace, became a publicly traded company on the stock market in 2021. Some mental health companies have also been scrutinized because of selling client data to advertisers, as recent examples and Federal Trade Commission fines have shown. Gender, race, class, and the health of financial markets are not that disconnected after all; Virginia was onto to something.
Researchers have found that teletherapy in many instances reinforces existing inequalities in the access to mental health care. In conversations with therapists of all credentials, walks of life, and specializations, I found that some of these unequal reinforcements are also occurring for providers. Therapists who have a private practice or are more seasoned can dabble in platforms to try them out despite their skepticism. Younger practitioners like Rita who are eager to work and feel the weight of their student loans might instead be pressured to rely on platform income entirely. According to an American Psychological Association survey from 2021, women and providers of color were experiencing higher levels of burnout and overwork compared to their colleagues. Platforms' recruitment targets this exhaustion to offer promises of more convenient and remunerative arrangements.
As colleague Suisui Wang and I describe in an upcoming publication, women providers are working what we call the “digital double shift.” Digital therapy work does not automatically entail being free from the other forms of unpaid gendered labor that women disproportionately perform—housekeeping, caring for children or elders, or providing emotional support.
“My husband went to work, and I had the kids all day. Then I had to schedule my stuff in the evening so I could have confidentiality and separate space for my sessions. It was a lot to juggle,” Christa, a provider with small children, revealed about trying to find a physical and virtual room of her own to practice in.
Time and space are figures of therapeutic speech, in addition to cornerstones of psychological functioning and human relation. Clients often hear that sessions are “their time to use,” that they have a right to take “space,” a place of simultaneous containment and freedom. Therapists' dedicated, expert, compensated attention is provided at a specific time, in a 45-to-60-minute block, and in an appropriate space, a therapy office.
Platformization—the process by which services, labor, and skills become delivered and packaged through a platform—compresses and augments these variables. Therapy can be done anywhere (although it is still bound by state licensures) and anytime (although it relies on the availability of the provider and client). The result is the intrusion of corporate jargon (“customizing care” while “hitting targets”), video sessions with compensated-by-word messages, and around-the-clock texts from distressed patients combined with platform notifications about productivity.
Of course, not all platforms are created equal; there are examples of virtuous companies that compensate providers what they deserve and strive to provide ethical care. But promises of 24/7 availability and of a therapist on demand, always a text away, muddle the important clinical and personal boundaries of time and space, for both practitioner and client.
The seemingly infinite availability of therapists—the right one just around the swiped corner—leads many clients to switch in the middle of treatment or before the relationship even starts. This rotation is especially challenging for therapists practicing more psychodynamic approaches that require longer and deeper
I joined some forums specifically for clinicians of color to see what folks thought about the platform. I felt it exploited therapists that might be in my position, it takes advantage of that need for clinicians. [The platforms] say, well do this for you, but we're also not going to compensate you equitably in a way you deserve or that is in alignment with your degree and your expertise.
engagement. On some platforms, the therapy room still has a (digital) door, but it is now much easier to enter and exit it. At times, providers are not compensated for cancellations or no-shows, or do not know how to get back in touch with someone who ghosted them, to use app parlance. “It's like a revolving door,” Brian said, as he noted all the patients that dropped him as a provider with no explanation.
Dislocated and in place, simultaneous and asynchronous, focused and dispersive, these therapeutic rooms of (almost) one's own are something new.
While advertising infinite availability and boundless communication with mental health providers (or even an AI substitute), platform therapy cannot solve the mental health crisis, as much as it might promise to. Yet, it is important to pay attention to its emerging dynamics. It is posing significant questions about human connection that go well beyond ones about psychotherapeutic treatment.
In the last five years, we have grown accustomed to—and in some cases, even preferred—various forms of half-presence. Of course, there is an easy commentary about the uncanny nature of all this: The fantasies and hauntings of this 21st century allow for infinite connective possibilities. These possibilities coexist with increasingly isolated realities and massive collective struggles. We can be in constant digital communication with people while retreating from interactions in the flesh and watching live-streamed violence, near and far.
These struggles make rooms of our own—shared with trusted interlocutors and ourselves, virtual and physical—more critical now than ever. Reclaiming them against intrusions, exploitations, and surveillance feels not only important, but crucial to our sanity. Time and space are axes of healing because they are a function of full presence. Anytime, anywhere is not how we live. Fully accepting being here now might be a source of suffering, but also creates possibilities for imagination and resistance.
Perhaps then, in addition to Woolf's 1929 questions, nearly a hundred years later we might find ourselves still asking about purpose, work, and our times: What are people seeking through therapy now? What happens to human relationships when a platform and its algorithmic convolutions are present? Which rooms should we be in, and who is there with us?
Livia Garofalo, PhD, MPH, is a cultural and medical anthropologist. She is a researcher at Data & Society Research Institute.
First published online March 2025
Garofalo, Livia. “Doing the Work.” Therapeutic Labor, Teletherapy, and the Platformization of Mental Health Care. Data & Society Research Institute, 2024. datasociety.net/library/doing-the-work
By looking at experiences of mental health providers shifting their work to telehealth and different therapy platforms, the report examines how this reconfiguration affects therapists' practice, professional expectations, and structures of compensation. You can also listen to a Data & Society podcast conversation about platform therapy and the report with guests Linda Micheals, PsyD, MBA, chair and cofounder of the Psychotherapy Action Network (PsiAN), Melody Li, founder of Inclusive Therapists, and Mei Wa Kwong, JD, the executive director for the Center for Connected Health Policy.
Psychotherapy Action Network
PsiAN is an advocacy group aiming to provide resources to the public concerning the benefits of therapies of depth, insight and relationship, and to empower people to become advocates for themselves and these therapies. PsiAN also issues position papers and other public-facing statements that promote effective mental health treatments and policies for clients and providers alike.
Inclusive Therapists
Inclusive Therapists is a social justice and liberation-oriented mental health directory, community, and resource hub for both mental health providers and clients.
Therapist Worker Cooperatives
therapistworkercoops.info
Website providing information, resources, and models for therapist worker cooperatives as alternative to large mental health tech platforms.
Privacy Not Included: Mental Health Apps
foundation.mozilla.org/en/privacynotincluded/categories/mental-health-apps
Guide from the Mozilla Foundation investigating mental health and prayer apps, rating them in terms of privacy, security, and AI use and providing tips for how to protect your data.
Therapists in Tech - Company Transparency Project
therapistsintech.com/companies
Therapists in Tech (TnT) is a nonprofit community of mental health professionals and students who work in, or are interested in, applying their background and knowledge to digital health. They have an underway company transparency project where different mental health companies are reviewed.