Why therapy apps are all talk

What makes therapy “work”? What encourages someone to open up, to challenge themselves, to commit to change? It can come from the approach your therapist takes, the rigor with which they question your statements, the space they provide for you to feel difficult emotions. Regardless, it will always involve care, trust and commitment. These are the essentials that cultivate an environment in which people feel safe enough to go through the discomfort of self-reflection, the conditions that enable them to explore and find material improvements in their lives.

Is there a way to bypass these basics and get the same results? That’s the solution presented by BetterHelp, an online counseling service dubbed the “Uber of therapy.” People can pay monthly or one-time fees to access thousands of online therapists through a single digital platform. Sessions are relatively cheap and can be booked with just a few minutes notice (cancellation only comes with a small penalty fee). These meetings do not happen in person; they can be done by video call, but are often done by phone or text, or as online group sessions.

BetterHelp has seen a surge in popularity over the past year and is now ubiquitous in ads on Instagram, YouTube and TikTok. In 2023, it was the largest 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 known problem. We are in a cost of living crisis and a mental health crisis – phenomena that are likely to be closely linked – and, with unaffordable prices and long NHS waiting times, talking therapies that are more affordable and readily available, from qualified therapists, can provide a lifeline for many.

But despite the promise and popularity of therapy apps, there are some downsides. While more affordable than many private therapists, typical sessions still cost between £50 and £80 and last just 30-45 minutes, less than the standard 50 minutes. For those who want emergency support without long wait times, this can be a positive. But the quality of help provided can vary.

Beyond that, there are more serious allegations about the quality of therapy offered by some platforms. In November, an untold Channel 4 documentary, I don’t trust my therapist, found that some online therapy users were getting dangerous advice, such as a woman who claimed her therapist told her — after she described being raped by her partner — that she couldn’t be sexually assaulted if she was from someone he was in a relationship with. She reported that the therapist told her, “It’s not like someone jumped through the window and attacked in the night.” Other ex-users have said that the short sessions led them to rush to explain traumatic personal stories, such as experiences of child abuse.

Issues also affect therapists. Therapy apps often pay poorly compared to even the lowest fees of traditional therapy and come with higher cancellation rates, without the commitment of a formalized relationship (and although BetterHelp charges the client a higher fee per session and cancellation, therapists only see a small portion of that payment, most of which goes to the company). While there may be some unethical therapists using these apps to make a quick buck, it seems that there are many others who genuinely want to help others, but are left facing the inherent drawbacks of these platforms: flaws that are difficult to separate from the business model itself.

Clearly, these apps sell a different experience in theory than in practice, for both users and therapists. But the underlying issue is that this form of talk therapy—cheap, quick, and low-commitment—is at odds with how therapy helps people most of the time it’s effective. Rarely will a few back-to-back talks solve a problem: most clients take months (even years) to feel the effects of talking therapies. Like anything else that requires commitment, the benefits don’t happen overnight. You can’t improve your well-being in the long term by contacting a digital therapist for a single session in an acute moment of stress (although you will be £80 poorer). This type of support is traditionally considered a crisis service – such as that provided by emergency departments or helplines such as Samaritans or Mind. But BetterHelp insists it’s not a crisis service: a claim that seems to avoid the reality of the many people who might use the platform.

There are further privacy concerns. Last year, BetterHelp was ordered to pay $7.8 million to its customers by the US Federal Trade Commission to settle allegations that it shared user data with social media sites like Facebook and Snapchat — including addresses of email and responses to personal health questionnaires – despite privacy commitments to its users. A report released June 18 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 directed to these platforms by an inaccessible NHS, with waiting lists leaving many in need of help months away from a qualified therapist. In other countries, cuts to health services, as well as privatized health care, have similar effects. There are huge incentives – and money to be made – to exploit this gap in the market. The growth of these applications is the logical conclusion of declining living standards.

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 that so many people so desperately need cannot be provided by a business model that is based on convenience.

[See also: The death of the levelling-up dream]