The Enshitification of Telehealth Therapy
Telehealth therapy began as a promise of access and care—but Big Tech has slowly turned it into another algorithmic marketplace. This is the enshitification of mental health care: when healing and connection become data. The writer and technologist Cory Doctorow coined the term enshittification to describe how digital platforms begin by serving users, then exploit them, and eventually cannibalize themselves for profit. It’s a perfect lens for understanding what’s happened to telehealth therapy.
Stage One: The Promise
When telehealth first arrived, it felt like liberation.
Suddenly, therapy wasn’t confined to office hours or geography.
Single parents could see a therapist during nap time.
Rural clients no longer had to drive two hours for care.
People who’d never set foot in a therapy room could finally say, “I think I need help.”
It was a revolution built on compassion and technology.
Therapists, too, found new freedom—fewer commutes, more flexibility, less burnout.
For a while, it worked.
But like most things that begin in service of people,
it didn’t take long for corporations to smell opportunity.
Stage Two: The Capture
Enter the platforms.
Suddenly, “therapy” became a platform.
And like all platforms, its real product wasn’t people—it was data.
The marketing language was irresistible:
Affordable. Accessible. Immediate.
Help, anytime, anywhere.
But the business model was simple: scale first, care later.
Stage Three: The Rot
Then comes the final stage—
when the platform turns on everyone.
The therapists burn out,
buried under unmanageable caseloads and reduced rates.
The clients burn out,
ghosted by providers who can’t keep up.
And the platform, bloated and unaccountable,
feeds on the data left behind.
Mental health becomes a brand.
Therapy becomes “content.”
Your pain becomes an asset class.
We are now in the third stage of telehealth’s enshitification.
The same industry that promised access has become extractive.
The same systems built to heal are now quietly monetizing distress.
It’s not that telehealth itself is bad—
it’s that Big Tech can’t resist turning medicine into metrics.
And when mental health becomes a product,
the client stops being a person and becomes a “user.”
What Gets Lost
What’s lost isn’t just privacy or profit margins—
it’s presence.
Therapy was never meant to be efficient.
It’s not a productivity hack or a customer service transaction.
It’s two humans sitting in the messy, sacred work of truth.
It’s slow. It’s awkward. It’s holy.
But when we let algorithms mediate that space,
we lose the pause.
We lose the humanness.
We lose the inefficiency that makes real healing possible.
What We Can Rebuild
The antidote to enshitification isn’t nostalgia—
it’s rehumanization.
Telehealth can still be good.
But only if it’s small, relational, transparent, and human-scaled.
Therapy should not be designed by venture capital.
It should be designed by therapists and communities.
Imagine telehealth that feels more like a call home than a login.
Where your therapist isn’t bound by scripts or quotas.
Where the interface disappears and presence returns.
Imagine platforms owned by practitioners,
not shareholders—
built for healing, not harvesting.
That’s not utopian—
it’s necessary.
Because the opposite is already here.
Closing
Every generation builds a tool that saves them
and then forgets who it was built for.
Telehealth began as a bridge.
It became a business.
Now it’s becoming a machine.
The work ahead is simple, but not easy:
to remember that therapy is not technology—
it’s relationship.
We don’t need more access to disconnection.
We need more access to each other.
Returning to What Matters — Sacred Work: Therapy & Counseling
At Sacred Work, Katie and I practice a version of therapy that refuses the logic of enshitification. We’re not a platform. We’re not a pipeline. We’re not a dashboard full of metrics.
We are two humans sitting with other humans
—in a room, or through a screen when needed—
honoring the slow, relational work that healing actually requires.
We don’t see clients as “users.”
We don’t believe care should be optimized or gamified.
And we don’t think the most meaningful parts of therapy can be captured by an algorithm.
Our work is small on purpose.
Human on purpose.
Built on connection, presence, and dignity.
For some people, telehealth with us is enough—especially when life is full, or distance makes in-person care impossible. But whenever possible, we return to the room, because that’s where therapy remembers itself. That’s where the noise falls away and what’s true can finally breathe.
If you’re looking for therapy that feels personal, grounded, and unmediated by corporate incentives, we’d love to meet you. No pressure, no rush—just a conversation to see whether it feels right.
