Better Than BetterHelp?
What do you get when you combine smartphone technology, a global pandemic, and surging demand for mental health care? App-based therapy services! Companies like BetterHelp and Talkspace currently dominate the field of therapy apps. You may have heard about these platforms on a podcast or come across one of their many ads on social media.
My favorite paid celebrity endorsement features Antoni Porowski from Queer Eye! Now, do we really think Antoni uses BetterHelp? I don’t think so. (Does Beyoncé use L’Oreal?) But I can get on board with a publicity campaign if it helps to normalize therapy. Or if it inspires Antoni’s audience to seek mental health care. Yes, these tech companies are primarily focused on profits, but at least they’re using their impressive marketing reach to destigmatize seeking help.
Therapy apps have made mental health treatment more accessible and affordable. This is particularly true for consumers who reside in mental health deserts (i.e. communities in which there are not enough mental health providers to meet the demands of the population).
Therapy apps like BetterHelp and Talkspace appear well intentioned. But as a licensed psychologist in private practice, I have a few reservations. I’m concerned about the quality of services these apps provide, their business ethics, and whether app-based counseling can fully replace a face-to-face relationship. In this article, I’ll go over the differences between the type of help I offer and the type of help you might receive using mental health apps.
What Are The Options For Therapy?
Traditional Talk Therapy
Face-to-face interactions with a licensed therapist. Usually takes place in an office setting. Pretty much what you see on tv.
Walk And Talk Therapy
A walk and talk therapy session looks like you're walking with a friend outdoors. Walk and talk therapy gets you outside, encourages healthy movement, and lowers cortisol levels. You receive all of the well-established mood benefits of being in nature while simultaneously discussing your personal concerns with a skilled therapist. You can bask in the sunshine while feeling seen and heard by a trained mental health professional. Read more about walk and talk therapy here.
Virtual Therapy
Virtual therapy sessions may consist of meeting over video, chat, or email. Virtual therapy is helpful for busy people or those with unpredictable schedules. It is also a perfect option for folks who are unable to find a good therapist within their local community. Plus, it saves gas! The convenience of utilizing technology to meet with your therapist from home is part of what attracts people to mental health apps.
Is Your Therapist A Licensed Mental Health Professional?
As you look into therapy apps, please ensure that the therapist assigned to you has the proper license and credentials. Some apps may match you with a mental health coach or “trained listener” as a way to get around hiring licensed professionals. Even the terms "therapist" and "psychotherapist" are not legally protected, so anyone can use them regardless of their qualifications.
The American Psychological Association warns that it's not easy to know you're receiving psychotherapy from a licensed mental health provider.
"Therapist and psychotherapist are not legally protected words in most states, meaning anyone can claim to be a therapist and offer services that may appear as therapy." (APA)
Receiving mental health advice or care from someone who has not been through the correct licensing process can be potentially harmful.
For a while, some therapy apps were operating in a grey area in which they marketed their services as “therapy” but carefully avoided using the term “therapy” in their legal user agreements. Weird, right? And since 2018, the APA has refused to allow Talkspace to advertise in any APA publications or sponsor any conventions. I’ll let you draw your own conclusions on that one!
Privacy And Technology Concerns
Privacy leaks and hacks may be a concern for users of mental health apps. While privacy and HIPAA laws extend to online counseling, be aware that some platforms and websites lack privacy safeguards. If you sign up for a therapy app, I strongly recommend reading through the privacy agreement to understand how your data may be sold or shared.
I recently heard Jeff Guenther, creator of TherapyDen, talk about data mining on a podcast. Jeff said, "They [Therapy apps] take your data and sell it to Facebook, Google, and Pinterest. The intake form is sent to advertisers that want to know more about you."
It is illegal to share any of my client information with anyone else. It is deeply concerning to see therapy apps getting away with this. Even if it was legal, my strong ethical code would prevent me from ever selling your data. You are a client, not a customer.
Struggling to Communicate
While the promise of unlimited messaging with your therapist may sound appealing, I have concerns about this method of care. How do you reach your therapist if you are in crisis? Are the text convos synchronous (exchanges happening in real time) or asynchronous? I recently browsed online reviews of Talkspace. Oy vey! Many users describe struggling to communicate with their therapist (e.g., texts going unanswered for weeks, receiving unhelpful responses that seem canned or scripted). As a clinician who cares, the reviews are painful to read. It upsets me that this app may be taking advantage of vulnerable people who are just looking for help.
Body language and tone of voice are imperative for nurturing a meaningful connection between you and your therapist. If your therapist cannot see you, they are unable to see your nonverbal cues. Effective therapy is all about timing and the therapist’s intuitive sense of where you are at emotionally. Skilled therapists are adept at offering the exact type of care YOU need, not following a script. In my work with clients, my responses are intuitive, spontaneous, and hyper-specific to the moment. My interventions are not so much based on what you’re saying but on how you’re saying it (i.e., what I glean from your nonverbal communication).
Communication is a two-way street. During a text-based therapy session, you are missing out on all the warmth, empathy, and understanding your therapist can offer to you through their facial expressions and tone of voice.
And get this! Some therapy apps, like Talkspace, are collecting chat data for the purpose of building bot-driven programs. They are using transcripts of your sessions - transcripts that contain highly sensitive and personal information - to develop algorithms and eventually create AI therapists. In fact, one AI-powered app already exists. It’s called Woebot. Admittedly, I’m super skeptical that a bot could ever mimic the heartfelt, human-powered connection I have with my clients. However, I also understand the desire to increase access to mental health care.
If you’re curious to learn more about the future of chat-based therapy, this New York Times article outlines the intriguing controversies surrounding Woebot. And as long as you’re in a reading mood, why not check out this article from The Verge for a deep dive into the ethical controversies surrounding Talkspace’s model of care?
Are Therapists Who Work For Mental Health Apps Happy?
Consider the reasons for the affordability of the app. You might compare therapy apps to a low-cost hair salon like Supercuts or a popular massage chain like Massage Envy. While the cost to the consumer seems like a great value, the hairstylist or massage therapist is quite underpaid for the service they are providing. And if you do find a stylist or massage therapist you like, they might not be there in a month. It can be challenging to form a consistent relationship because of the high turnover rate at those franchises.
The same is true of mental health professionals on therapy apps. Because therapists are not getting paid very well, they are likely to leave and seek out other employment. They may also be forced to work more hours than they can mentally handle, which leads to exhaustion and burnout. It's common to hear that counselors employed on therapy apps are unhappy with the compensation structure.
Read the reviews from current and former BetterHelp employees on Indeed here. Many therapists have signed up for the apps due to a need for supplemental income but are disappointed and frustrated with the pay scale and the technological limitations of the platform.
How Does Your Therapist's Work/Life Balance Affect You?
Overwork and unhappiness can potentially lead to lower quality of care. If your therapist is stressed and frustrated, they are unlikely to be able to hold space for your concerns. Suppose they are worried about money or even resent their employer (the app). In that case, they may struggle to be fully present with you during your counseling session.
In my practice, I do not over-schedule myself. I set my fee structure in such a way that I do not feel obligated to take on more and more clients to survive financially. You can rest assured that I allow myself plenty of time to prepare for your session. I am not overworked or preoccupied by job frustrations. I am able to be fully present and connected with you during our time together. I also run my own practice, so there is no danger that I will switch jobs or leave the company!
Is There A Downside To Cheap Therapy?
There are days when you just don't want to do anything. Believe me, I get it.
If you have one of these days, you may feel inclined to skip your app appointment. To some, it's easier to miss because the session was not costly enough to become a priority. But unfortunately, avoiding your app appointments can quickly turn into an expensive habit as most of these companies follow a subscription model (similar to a gym membership).
Additionally, getting into the habit of skipping appointments will not help you reach your goals, improve your well-being, or address the concerns that brought you to counseling in the first place.
Bottom Line
In this article, I shared several concerns regarding app-based therapy services. I hope this article helped you feel more informed should you decide to sign up for a mental health app, such as BetterHelp or Talkspace.
And if you do sign up and aren’t satisfied with the services offered, I will be here! I am a one woman business which means no shady investors, no risk of a buy out, and no corporation controlling how I run my practice or looking into your data. If that sounds good to you, click here to book an appointment.