Something has happened to the provision of human attention. It used to be distributed through the ordinary infrastructure of social life—through the relationships that accumulated in the slow spaces, the local institutions, the neighbourhoods where proximity produced familiarity over time.
The attention was not free in the sense of requiring no effort. It required the sustained effort of maintaining relationships, of being present to other people in ways that were sometimes inconvenient, of the reciprocity that made the attention mutual rather than transactional. But it was not purchased. It was not a service. It was the texture of social life, available to people who participated in the infrastructure that produced it.
The infrastructure has thinned. The slow spaces have closed or been reorganised around throughput. The neighbourhood has been architecturally structured away from the incidental encounter. The local institutions have contracted or disappeared. The social fabric that once distributed attention through reciprocal relationship has become patchy enough that significant numbers of people find themselves without adequate access to it—without the relationships that provide the sustained, focused attention of someone who knows them well enough to notice what they are not saying.
The market has responded to this absence in the way markets respond to the absence of things people need. It has made the attention available for purchase.
The professional companion is a real and growing category. The life coach who provides focused attention to a person’s circumstances and development. The rent-a-friend service, available in several countries, that provides the social presence of a companion for an occasion or a regular arrangement. The professional cuddler, the social skills coach, the conversation partner hired for practice or for pleasure. These are services that provide, for an agreed fee, something that was previously available through relationship—attention, presence, the experience of being with someone who is focused on you.
The services are not fraudulent. The people who provide them are often genuinely skilled at what they do. The people who use them are often genuinely helped by the access to focused attention that the service provides. The transaction is honest in the sense that both parties understand what it is. The provider is present, attentive, and skilled. The client receives presence and attention. Money changes hands.
What the transaction cannot provide is what makes the attention in a genuine relationship different from the attention in a purchased service. In a genuine relationship, the attention is mutual—the other person is present to you in ways that are not determined by your payment, that extend beyond the session, that accumulate over time into a history that the attention is informed by. The friend who notices you seem distracted today is drawing on a history that allows them to recognise the distraction as a deviation from your usual state. The professional companion who notices the same thing is drawing on their professional skill and the notes from the previous session. Both forms of noticing are real. They are not equivalent.
The distinction is not a criticism of the professional service. It is an observation about what the professionalisation of presence can and cannot provide. It can provide the experience of focused attention. It cannot provide the history, the mutuality, the reciprocity, the knowledge that the other person’s attention is not conditional on your continued payment. These are the things that make a relationship a relationship rather than a service encounter.
Therapy is the professionalisation of presence in its most established and most rigorously developed form. The therapist provides sustained, focused, non-judgmental attention to the client’s inner life, in conditions of privacy and reliability, over a period that allows the relationship to develop enough depth for genuine therapeutic work to occur. The relationship is real. The attention is real. The skill the therapist brings to the attention is real and not easily replicated by untrained presence, however well-intentioned.
The therapy relationship is also unidirectional in a way that distinguishes it from the mutual relationships it is sometimes called on to supplement or replace. The therapist’s inner life is not present in the therapeutic relationship. The client does not know the therapist’s circumstances, anxieties, pleasures, or difficulties. The attention flows in one direction, which is what makes therapy therapeutic—the asymmetry creates conditions of safety and focus that mutual relationship cannot reliably provide. The asymmetry is the feature. It is also the limitation.
The person whose primary experience of sustained, focused attention is the therapy session is experiencing attention under conditions that are specifically unlike the conditions of ordinary relationship. The session ends at the appointed time. The relationship does not extend beyond the therapeutic frame. The attention is not available between sessions in the way the attention of a friend is available—not absolutely or reliably, but as a background condition of the relationship’s existence. The therapy relationship is real and valuable and not a substitute for the mutual relationships that provide the background condition of being known.
When therapy is used not as an adjunct to social life but as a supplement for absent social life—when the person goes to therapy primarily because they have no one else to talk to—the therapy is doing work it was not designed to do. Not poorly, necessarily, but differently from what it was designed for. The therapist becomes the primary source of sustained attention in the person’s life, which places on the therapeutic relationship a weight it was designed to share with the natural relationships the person does not have.
The outcome is not harmful in the short term. In the longer term, it may sustain the conditions that produced the isolation, because the person’s need for attention is met sufficiently to reduce the urgency of seeking it through the riskier, more effortful process of building mutual relationships outside the therapeutic frame.
Social prescribing is the medical term for the practice of referring patients to community activities and social groups as an intervention for conditions—including loneliness and social isolation—that are not primarily amenable to clinical treatment. The general practitioner identifies a patient whose health is affected by social isolation and refers them to a link worker, who connects them to community activities suited to their situation. The activities are real. The link worker is real. The benefit to some patients is real.
The structure of the intervention is worth examining. The person who is socially isolated presents to their GP—a medical professional, in a medical context—and receives a referral to a community activity, via a designated professional whose role is to facilitate the connection. The connection has been medicalised. It has been administered. It has become a clinical task, moving through a clinical pathway, producing a referral that is recorded in the patient’s notes as an intervention for a diagnosed condition.
The community activity to which the person is referred may be excellent. The people who run it may be warm, genuinely interested, and effective at producing the conditions for connection. The person who attends may form relationships that are genuinely sustaining. All of this can occur within the social prescribing framework.
What the framework has done to the seeking of connection is worth noting independently of whether the framework sometimes produces good outcomes. It has turned the search for human contact into a medical task. The person who wants to meet people now has a referral. They have a link worker. They have an appointment with a community activity. They are patients receiving an intervention for a diagnosed deficit. The search for connection, which was once a natural and self-directed activity embedded in the ordinary infrastructure of social life, is now a clinical pathway.
The clinical pathway is the available infrastructure because the natural infrastructure is no longer reliably available. The social prescribing exists because the slow spaces closed, the local institutions contracted, the neighbourhood was architecturally structured away from encounter, the linguistic threshold was not bridged by the gradual familiarity that shared infrastructure once produced. The prescription fills the gap left by the infrastructure’s absence. It fills the gap with a managed, medicalised, professionally facilitated version of what the infrastructure once produced organically.
The managed version is better than nothing. It is not the same as the thing it replaces. The person who makes a friend through a social prescribing referral has made a real friend. The process by which they made the friend has been administered, recorded, evaluated against outcome measures, and reported in a commissioning document. The friendship has been produced by a clinical pathway. The clinical pathway has no mechanism for producing the next friendship, or the one after that, because the infrastructure for the self-sustaining social life that produces ongoing connection without clinical facilitation has not been rebuilt.
The cost of access to focused human attention has increased as the infrastructure that once distributed it freely has thinned. The increase is not uniform. It falls most heavily on the people who are least able to pay it—who cannot afford the life coach or the professional companion or the ongoing therapy, who do not have a GP relationship robust enough to produce a thoughtful social prescription, who live in the areas where the community activities that might receive a referral are sparse or inaccessible.
The professionalisation of presence has made attention available to people who can pay for it and has produced a clinical pathway for people who present to health services with the absence of it. The people who cannot pay for it and do not present to health services—who manage their isolation silently, who do not identify themselves as lonely, who do not seek a referral because the seeking of a referral requires a degree of engagement with systems that itself requires confidence and navigation skills that isolation can erode—these people are not served by either the market or the clinical pathway.
They are served by the infrastructure that once existed and no longer does. The slow space. The local institution. The neighbourhood with its incidental encounters. The street that produced the familiar face. The place where you could sit for three hours without being moved on, with one other person, and the conversation found its way somewhere.
The infrastructure was not free to maintain. It was maintained by the participation of the people who used it, by the civic investment that kept the community centre open, by the commercial logic of the local pub and the independent café that made the slow space economically viable, by the urban design that put people in proximity to each other and to the places where encounter was possible.
The maintenance cost was not paid. The infrastructure deteriorated. The attention it once distributed without transaction is now available through professional services that charge for it, clinical pathways that medicalize it, and community programmes that administer it.
The attention is still there. It has been moved behind a paywall.
The paywall is not always money.
Sometimes it is a referral form.
Sometimes it is a GP appointment.
Sometimes it is just the willingness to present yourself as a person with a deficit requiring professional management.
Some people will not do that.
They would have preferred the conversation.
The one that lasted three hours.
In a place that is no longer there.
The Vorpel Foundation