Keeping Tabs: A Manifesto for Teletherapy

In May of 2024, I joined the workshop, Keeping Tabs, with other NY based mental health professionals and researchers to reflect on the new dynamics and challenges in digital therapeutic practice. Organized by Data & Society Research Institute in collaboration with Marcus Britain Fleming (Psychotherapist | Bandwidth Care) and Romy Gad El Rab (Psychiatrist), our work produced this manifesto outlining the hopes and demands of platforms, providers, and therapists engaging in teletherapy.

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Keeping Tabs: A Manifesto for Teletherapy

With the move to teletherapy and platform therapy, the ways people are seeking and providing care are changing. The following are hopes and demands for the future of teletherapy; for platforms, providers, and therapists, created by teletherapists.

1. Transparency

As teletherapy platforms continue to grow and profit from increased demand, we expect more transparency from the public and private organizations that employ us. We refuse to be exploited and will only work for organizations that use transparent and ethical marketing algorithms, scheduling systems, and pay structures.

2. Community

Teletherapists need to support and advocate for each other. The rise of teletherapy has further isolated clinicians from each other, making it harder for therapists to network, confer, and organize. We envision teletherapists unionizing to ensure fair labor policies and consensus around best practices moving forward.

3. Reinbursement

Just because we do “altruistic” or “important” work, doesn’t mean we should do it for free. Online therapy providers - including trainees - should receive a living wage and equitable pay across all teletherapy platforms and insurances. Though mental health work can be a “calling”, it’s also a job that requires a highly sharpened set of skills. If our work is important, pay us so we can survive doing it.

4. Accessibility

Technology offers the possibility of going to therapy anytime anywhere. Unfortunately, governments and licensing agencies have put restrictions on the potential for therapists to meet our clients wherever they are at. We demand an update to these outdated policies; one that is in step with the burgeoning demand for teletherapy.

5. Self Care

Teletherapy is demanding work. To combat the collective burnout of teletherapists, we propose more resources for therapists to find rest, comfort, and connection to self.

6. Critical Reflexivity

We demand critical reflexivity and call all therapists and providers to consider how their beliefs, assumptions, prejudices, and behaviors may impact telepractice. We must be critically aware of how the mental health industrial complex is built on centuries of systemic violence, oppression, and prejudice. Teletherapy is not immune from these histories. Therapists of the future must advocate for the fair and equitable treatment of all patients. Moreover, we must see our work as part of larger abolitionist and decolonization efforts in our increasingly networked world. All mental health is connected.

7. Value in the Human

As technology proliferates and language models progress, we want to work with Artificial Intelligence (AI) and not against it. Clinicians should be valued over chatbots. Software can never replace the soft skills, life experience, and training of teletherapists.

8. End Gamification (therapy is not dating)

Therapy is serious work. We should not be “matched“ by a swipe, or swapped at a click of a button. Endings in therapy are meaningful and should be explored. Therapeutic relationships should be honored and prioritized above the “better-faster-cheaper” goals of many therapy platforms.

9. Ethical Guidelines

We need a clear set of ethical guidelines for telepractice. Teletherapy platforms must be held accountable. Patient data should not be sold to third parties and terms and conditions should be acceptable and clear to all. We want to end unnecessary surveillance and make relationships with insurance providers clearer. We need regulations to protect patients and providers in new and expansive mental health milieus.

10. Resources

Though teletherapy can offer great flexibility for all, therapists still require access to workspaces and affordable/free therapy rooms in public health clinics. We also need shared resources, increased training, telehealth certifications, and the provision of tele-supervision to maintain standards. Continuing education must focus on how teletherapy changes the nature of mental health care; and how clinicians can harness teletherapy to support our patients and ourselves in new ways.

11. Honoring Support Outside the Mental Health Industrial Complex

Community mental health models have existed outside of the mental health industrial complex for thousands of years. As teletherapy continues to expand, it poses a threat to regional webs of care work. We must never aggrandize teletherapy, but instead see it as one of many tools available to people around the world. Informed consent and cultural humility must be present when offering teletherapy to any community, group, family, or individual.

“Ultimately, professionals all agreed that teletherapy, platform therapy, and virtual care are here to stay. They want to shape how they do it.”

- “Doing the Work” by Livia Garofalo

This artifact was born from the May 2024 ‘Keeping Tabs: A Workshop for Teletherapists’, led by Marcus Brittain Fleming LCSW and Dr. Romy Gad el Rab MBBS, hosted by Livia Garofalo, Suisui Wang, and Hannah Zevain, co-authored by participants Dr. Candice Crawford LMHC ACS, Cheryl Taruc LCSW, Samuel Fogarty MHC-LP M.A. Ed.M. Veda Kamra LMSW, and Yesel Yoon Ph.D. With thanks to Iretiolu Akinrinade, Tunika Onnekikami, Rigoberto Lara Guzmán and Data & Society Research Institute.

The workshop was made possible with support by the Internet Society Foundation.