The emerging therapeutic landscape

This blog is the third part of a report written for CTUK The Financial Landscape free to download here.

In the UK 11.7 million people live in relative low income, 2 million officially in minimum wage jobs and 5 million working people earning less than a living wage. The growth of the ‘gig economy’ and widespread use of insecure work such as zero hours contracts and self-employment is the current battle line in employment relations with sustained attempts, driven by trade unions and industrial relations networks such as the Institute for Employment Rights, to rethink regulation based on a model of direct and traditional employment relationships.

The counselling and psychotherapy employment landscape will continue to be shaped heavily by the emergence of digital services, including within IAPT itself, and digital employers. We can anticipate the emergence of large and new digital providers and online platforms as key ‘employers’ for counsellors and psychotherapists.

One aspect of remote working is the link to work intensification – a model of targets and performance management already introduced through the IAPT model but significant for digital workers evidenced in research about call centres and teleworkers, a type of work organisation now much more clearly relevant to counsellors and psychotherapists. This restructuring of work raises with it issues of confidentiality, data protection and surveillance which will need to be managed both at individual and professional levels.

As the pandemic continues the issues around the safety of face to face work and the clear financial pressures for those working in private practice to return to this way of working remain in tension. Although therapy work is not alone in the difficulties of measuring and minimising the risks there does need to be an acknowledgement of the competing interests at play. Particularly with such a high level of self-employment and insecure hours of work, even if the hourly rate is relatively high, the lack of consistent income along with minimal state support in relation to sickness or absence is going to hit this sector hard.

As the financial crisis and large scale job losses start to emerge the impact on the profession will be a double blow. The hit will be both in terms of paid jobs within the sector but also on family incomes where paid work outside of counselling and psychotherapy has subsidised working without sustainable pay. In the survey approximately 16% of respondents said they did not claim  benefits because of family support which highlights the impact of job loss both direct and indirect of the pandemic and 30% earned the majority of their income outside of their therapeutic work.

One of the consequences of the Covid-19 pandemic has been the exposure of inequalities right across our society where occupation, wages and working conditions are often mapped onto class, race, sex and geography. The crisis has disproportionately affected the most vulnerable groups both in terms of health risk but also finances. The Trussell Trust recorded a rise of one third in use of food banks – although we do not know how many people have had to regularly use food banks we do know that there have been 2.4 million referrals in 2020. Most graphically in the current housing crisis where an estimated 400,000 eviction notices will be served this year affecting a disproportionate number of low paid and part time workers and areas of the UK where there are already higher levels of deprivation.

The pandemic has exposed the possibility that in a period of crisis, a financial logic promoted by actors with the greatest financial interests will come to dominate the healthcare sector . Within the therapeutic professions this is signalled by the rapid emergence of digitalized services and the related ‘Uberization’ of mental health services. This fast changing mental health and wellbeing landscape means that the discussions about wages and working conditions within counselling and psychotherapy have to be more informed and explicit in order for us to navigate what is likely to be a deepening of existing professional splits.

Working at this intersection of work and vocation requires taking a view beyond our own disciplines or professional positions and engaging in debates about the future of therapy as a profoundly political project. It means seeking workforce data and clarity about the hard industrial facts of employment law, the professional debates about skills and ethics and the social science research about the future regulation of work in an emerging system of digitalization and algorithmic management. It is only through this interdisciplinary lens that the specific professional prospects for counsellors and psychotherapists can be understood and navigated.

It is widely understood that this will be a two-tier recovery where existing inequalities are exposed and deepened. It is not a coincidence that the CTUK has carried out this survey because of its interest in the inequalities within the profession that are at play here. More importantly CTUK offers a space for counsellors and psychotherapists to raise these difficult issues, such as income and professional standing, in a way that attempts to find consensus and joint platforms for campaigning and relating to the institutions of mental health. It is this everyday work of organising and relating to people within the profession that is a matter of profound importance as we navigate through the pandemic and attempt to carve out a sustainable basis for counselling and psychotherapy in practice.

To download the CTUK report click here.

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