What makes therapy “work”? What encourages someone to open up, challenge themselves, commitment to change? It might come down to the approach your therapist takes, the rigour with which they interrogate your statements, the space they provide for you to feel difficult emotions. Regardless, it will always involve care, trust and dedication. These are the essentials that cultivate an environment in which people feel safe enough to wade through the discomfort of self-reflection, the conditions that enable them to explore and find material improvements to their lives.
Is there a way to circumvent these fundamentals and get the same results? That is the solution pitched by BetterHelp, an online counselling service dubbed the “Uber of therapy”. People can pay monthly or one-off rates to have access to thousands of online therapists via a single digital platform. Sessions are relatively cheap and can be booked with only a few minutes’ notice (cancelling comes with just a small penalty charge). These meetings don’t happen in person; they can be by video call, but often take place over the phone or text, or as online group sessions.
BetterHelp has seen a spike in popularity over the last year and is now ubiquitous in ads on Instagram, YouTube and TikTok. In 2023, it was the biggest podcast sponsor in the United States. Its services (along with those of similar companies such as Talkspace, Brightside Health or OnlineTherapy.com) seek to address a familiar problem. We are in a cost-of-living and a mental health crisis – phenomena that are likely to be closely related – and, with inaccessible pricing and long NHS waiting times, talking therapies that are more affordable and available immediately, from qualified therapists, could offer a lifeline to many.
But, despite the promise and popularity of therapy apps, there are downsides. While more affordable than many private therapists, typical sessions still cost between £50 and £80, and run for only 30-45 minutes, less than the standard 50 minutes. For those who want urgent support without lengthy wait times, this may be a positive. But the quality of the help on offer can vary.
Beyond this, there are more serious allegations around the quality of therapy provided by some platforms. In November, a Channel 4 Untold documentary, I Don’t Trust My Therapist, found that some users of online therapy were receiving dangerous advice, such as one woman claiming her therapist told her – after she had described being raped by her partner – that she couldn’t be sexually assaulted if it was by someone she was in a relationship with. She reported the therapist as having told her: “It’s not like someone climbed through your window and attacked you in the night.” Other former users have said that the short sessions led to them being rushed to explain traumatic personal histories, such as experiences of child abuse.
The issues impact therapists too. Therapy apps often pay poorly compared to even the lower end of traditional therapy fees and come with higher rates of cancellation, without the commitment of a formalised relationship (and though BetterHelp charges the client a higher per-session and cancellation fee, therapists only see a small portion of that payment, the majority going to the company). While there may be a few unethical therapists using these apps to make quick cash, it seems likely that there are many more who truly want to help others, but are left contending with the inherent flaws of these platforms: flaws that are difficult to separate from the business model itself.
It’s clear that these apps sell a different experience in theory than in practice, to both users and therapists. But the foundational issue is that this form of talking therapy – cheap, fast, requiring little commitment – is antithetical to the way therapy helps people in most cases where it proves effective. Rarely are a few one-off conversations going to solve a problem: most clients take months (many even years) to feel the effects of talking therapies. Like anything else that requires dedication, the benefits don’t happen overnight. You can’t improve your well-being in the long term by contacting a digital therapist for a one-off session in an acute moment of stress (though you will be £80 poorer). That type of support is traditionally considered a crisis service – like those offered by emergency departments or helplines such as the Samaritans or Mind. But BetterHelp insists it is not a crisis service: a claim that seems to avoid the reality of many who might be using the platform.
There are further concerns over privacy. Last year, BetterHelp was forced to pay $7.8m to its customers by the US Federal Trade Commission to settle charges that it had shared user data with social media sites like Facebook and Snapchat – including email addresses and answers to personal health questionnaires – in spite of privacy commitments to its users. A report published on 18 June by consumer advocates in Australia urged the government to investigate whether BetterHelp had breached local privacy laws following its rapid expansion in the country.
In the UK, people are driven to these platforms by an inaccessible NHS, with waiting lists leaving many who need help months away from seeing a qualified therapist. In other countries, cuts to health services, as well as privatised healthcare, are having similar effects. There are huge incentives – and money to be made – in exploiting this gap in the market. The rise of these apps are the logical conclusion of declining standards of living.
But therapy platforms are motivated by profits, not results. The lucrative promise of quick-fix therapy is based on a fantasy of how therapy works. The care so many so desperately need can’t be provided by a business model that is based on convenience.
[See also: The death of the levelling-up dream]
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