by Vansh Bansal, M.A., Virginia Tech
When the COVID-19 pandemic interrupted the traditional provision of psychological services, telehealth sessions became the “new normal:” one large provider, for example, shifted from near-zero to over a thousand telehealth visits per day (Woski et al., 2020). This newfound need for virtual care, coupled with disproportionate lack of mental health resources in rural areas as compared to metropolitan areas (Andrilla et al., 2018), opened a door for digital therapy providers. These companies primarily use mobile applications and websites to both register patients and connect them with their therapists. Unlike typical clinics, these applications are designed to offer services at scale: therapy platform BetterHelp has registered over 2.5 million users across the United States and even abroad (Medical News Today, 2023). The following report summarizes positive and negative aspects of this new distribution of therapy.
Overall experiences with these kinds of platforms is likely mixed given the variety of therapists on platform and even the diversity of service types (text therapy and regular sessions to name a few). A Forbes review of TalkSpace, another large digital therapy provider, cited multimedia contact and psychoeducational resources as positive aspects and lack of reliability and lack of therapist depth as drawbacks of the service (Forbes, 2023). While telehealth itself has yielded results comparable to in-person care (Bulkes, 2022) a meta-analysis failed to yield meaningful findings when trying to evaluate therapeutic alliance on digital mental health apps (Henson et al., 2019), citing a lack of published studies as a key issue. An interesting point raised by the authors is the need for a measure of therapeutic alliance in this space. Given a growing emphasis on measurement-based care in psychological services, leveraging both existing tools as well as development of telehealth-specific measures may be an important route to evaluating the overall effectiveness of these platforms and comparing them to traditional clinical settings.
As with many technology companies, digital mental health initiatives have been scrutinized for security and data management policies. The Federal Trade Commission recently fined BetterHelp $7.8 million for significant breaches of privacy, selling user data to other companies including Snapchat and Meta (Ritchie & Jones, 2023). While the misuse and sharing of data is hardly novel for large technology companies, HIPAA standards around personal health information are strict, making the offenses shared by the FTC somewhat surprising. These will no doubt further deter potential users as our healthcare system continues to bridge services to telecare. Other complaints have come from the provider side, as therapists have revealed the BetterHelp pay structure only allows for earnings of $30 for the first five hours worked per week and $35 for the next five hours (Johnston, 2023).
A lack of depth and authenticity of care—coupled with poor treatment of relevant members of the business model—may dampen user interest in such platforms. However, their ability to access those facing more financial and geographic constraints should not be ignored. A more mid-sized provider that can both afford to manage the quality of services being provided and incur more manageable costs (thus avoiding profit-gauging practices) may have a role to play in provisioning mental health services for those who either cannot reach it, cannot afford it, or both. Clinical psychology students entering the field as practitioners, particularly in the domain of private practice, may be able to leverage some of the positives derived from digital therapy platforms. Providing ample telehealth availability, potentially through the Psychology Interjurisdictional Compact (PSYPACT), may be a wise approach to broaden access to patients. In private practice settings, consideration of alternatives to the traditional office space and related costs may help alleviate financial burdens of therapy without limiting the earning power of therapists.
References
Wosik, J., Fudim, M., Cameron, B., Gellad, Z. F., Cho, A., Phinney, D., … & Tcheng, J. (2020). Telehealth transformation: COVID-19 and the rise of virtual care. Journal of the American Medical Informatics Association, 27(6), 957-962.
Andrilla, C. H. A., Patterson, D. G., Garberson, L. A., Coulthard, C., & Larson, E. H. (2018). Geographic Variation in the Supply of Selected Behavioral Health Providers. American journal of preventive medicine, 54(6 Suppl 3), S199–S207.
MediLexicon International. (n.d.). 2023 better help review: Our experience and more. Medical News Today. https://www.medicalnewstoday.com/articles/betterhelp-reviews
Forbes Magazine. (2023, November 24). Talkspace review: Tried and tested (2023). Forbes. https://www.forbes.com/health/mind/talkspace-review/
Bulkes, N. Z., Davis, K., Kay, B., & Riemann, B. C. (2022). Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults. Journal of Psychiatric Research, 145, 347-352.
Henson, P., Wisniewski, H., Hollis, C., Keshavan, M., & Torous, J. (2019). Digital mental health apps and the therapeutic alliance: initial review. BJPsych open, 5(1), e15.
Ritchie, J. N. & A., & Jones, N. (2023, July 14). FTC gives final approval to order banning BetterHelp from sharing sensitive health data for advertising, requiring it to pay $7.8 million. Federal Trade Commission. https://www.ftc.gov/news-events/news/press-releases/2023/07/ftc-gives-final-approval-order-banning-betterhelp-sharing-sensitive-health-data-advertising
Johnston, I. (2023). Therapists sound alarm on BetterHelp’s rapid UK expansion. (n.d.). https://www.ft.com/content/b49d875d-76f8-4451-8ca2-1ad2fba0ebb5