The ads for therapy apps are everywhere – your favorite podcast, your social media feeds, and even showing up on television. They sound great. Acknowledging that everyone has mental health struggles at times, and normalizing talking with a professional when needed is a great way to combat stigma around mental health services. They emphasize the ease of connecting with a licensed therapist at any time and of changing therapists whenever you’d like. What is the reality of those big box therapy apps?
What Those Ads Are Not Telling You
These apps are technology companies at their foundation. Though they offer health-related services, they are not health companies and are not held to the same standards of confidentiality or ethical behavior as an independent licensed provider.
What do technology companies do? They specialize in data. They mine the data and use it to increase the probability that folks will use their product and other products with which they are associated. You know the disclaimer forms you have to agree to before using these therapy apps? Part of that language that no one reads says that by using their app you agree to their access and use of your personal health information in whatever way they decide is helpful to them as a company. You’ve already given your consent just by signing up.
How They Cheat Clients and Therapists
I’m not criticizing folks who use these services. They provide an entry point for therapy with easy access to professional services. The ads make the services sound all above-aboard and I can totally understand why folks utilize this method of seeking support.
However, I think it’s important to understand the ways that the big box therapy apps do a disservice to both clients and therapists. Disclaimer: I have not personally worked for one of these apps, but have spoken with both therapists who have worked for them and people who have received services as clients. You can hear directly from a licensed therapist who briefly worked for a therapy app in this podcast – she shares her story in the first 15 minutes of the episode.
To practice as a licensed mental health professional requires at least 2 years of graduate-level studies, as well as 2,000-4,000 hours of direct work with individuals under the supervision of another licensed provider after graduation. Depending on the specific license (counselor, social worker, marriage and family therapist, psychologist, etc.), one may also have some mixture of Ph.D. level studies, a national exam, and ongoing continuing education to maintain the ability to practice. Each provider also has a code of ethics to help protect clients from being manipulated or harmed within the professional relationship, in addition to being bound by HIPAA in regards to the confidentiality of information about those with whom we work.
Overall, the big box therapy apps do not acknowledge or support this professional level of training. In fact, their practices are often at odds with providers’ ethics and licensing restrictions. For example, some apps assign clients to therapists without regard to whether the therapist is licensed to practice in the location of the client. (i.e. I am licensed to practice in North Carolina; therefore, clients must be located in NC during any session I have with them. The apps disregard these requirements and do not require that clients disclose location, which can put a therapist’s license in jeopardy).
I have also heard from therapists who provided services with these companies that they were not provided basic information about their clients. This practice hinders the ability of a therapist to identify their client, which can potentially lead to insurance fraud when trying to bill for services. Also, I am ethically required to have contact and location information for my clients when providing telehealth services. This ensures that I am practicing within the scope of my license, and is important in the case of an emergency situation where I need to request assistance for my client. Without any contact information available, how would I ensure a client is safe if on-site care were needed?
From what I’ve been told, the apps expect constant availability from the providers – answering texts, available for sessions, no implementation of boundaries. Not only is this not sustainable, it is likely to mean that clients don’t get the best of their therapist because the provider is trying to juggle an expectation of unlimited availability for multiple people. Additionally, the overall pay to therapists working with these apps is generally not a livable wage, much less a reflection of the additional skill and training required to be a licensed mental health professional.
Therapists working with some of the apps have told me they’re paid by the word during text therapy, which may lead to focusing on continuing a conversation in order to make ends meet financially rather than having a clear focus on the client’s needs. Therapists have also shared that they’re paid by the number of clients seen, which provides an incentive to see more folks and provide less time per session. A user of on of these apps told me that their therapist only offered 30-minute sessions, even when working with adults who have a history of trauma and who wanted longer sessions. This model of therapy is driven by financial scarcity and not focused on an individual client’s needs, which does a disservice to both the client and the therapist.
Do You Really Want Your Therapist to Be Available 24/7?
It may sound great to have support available at all times. And there are times when folks need that level of support. However, that’s not the goal of outpatient therapy (i.e. you live at home and attend appointments rather than being in a hospital or other setting where appointments are held and more intensive care is available). My goal as an outpatient therapist is to support my clients in their journey, helping them develop a sense of mastery and self-efficacy. Essentially, I’m working myself out of a job.
There are quite a few reasons that I am not available to clients at all times. On the professional side, I need boundaries in relationships with clients – time to have fun and relax and ensure that I am able to offer them the support they deserve during our scheduled times together. For clients, it’s important to experience the need to utilize any skills or concepts we’ve been discussing in session. It’s much more difficult to tap into inner knowledge and strength when you can contact someone else to give you guidance at all times. Think of the child who is slow to learn to talk because older siblings do the communicating for the child. Constant availability of a therapist cheats the client out of aspects of growth.
What’s the Alternative?
For folks located in NC, I would be happy to chat with you and see if we might be a good fit to work together. Feel free to check out my website and contact me if you’d like to discuss working together toward your mental wellness goals.
If you’re outside NC and/or it doesn’t seem like I’d be a good fit for you, check out some of the therapist directories – Psychology Today, Therapy Den, Inclusive Therapists, Open Path (for lower fee providers), Reclamation Collective (religious trauma survivors). You can even use a Google search with terms such as “therapist”, “counselor”, “psychologist”, “social worker” and your location and main concern (ex: “anxiety”, “ADHD”, “relationship troubles”, etc.) to see what turns up in the search results.
And if you’ve used the therapy apps and found them helpful, I’m glad you’ve been able to connect with support. I encourage you to continue taking care of yourself in the ways that are accessible and beneficial for your needs.
Michelle F. Moseley is a licensed clinical mental health counselor providing telehealth services in the state of North Carolina. She specializes in providing support for folks who struggle with feelings of not being enough, which often stem from messages of being “too much.” She works from a trauma-informed perspective, and believes that ALL people deserve respect, compassion, and to feel heard. Learn more about Michelle by visiting www.MichelleFMoseley.com or following her on Instagram – @therapy_with_michelle