BetterHelp redefines teletherapy, raises issues among students

January 6, 2022

The+COVID-19+pandemic+created+a+drastic+need+for+telehealth+platforms+such+as+BetterHelp.

Avery Bleichfeld

The COVID-19 pandemic created a drastic need for telehealth platforms such as BetterHelp.

When Olga Prifti decided to cut off contact with her therapist, a woman she had never met in person, there were complications.

It started when Prifti, a fourth-year bioengineering major, was having trouble adjusting to off-campus life amid the pandemic. Riddled with feelings of isolation and anxiety, Prifti turned to BetterHelp, a mental health platform used as a referral option by Northeastern University that offers “telehealth” counseling therapy via video chat, phone calls and messaging. 

“I thought of telehealth as a temporary solution for me because I was like, ‘I cannot find a therapist through other ways,’” Prifti said.

Prifti struggled with BetterHelp’s scheduling interface, a convoluted system where only one appointment can be scheduled at a time. A user is given a series of random time slots, making a regularly scheduled therapy appointment almost impossible to come by. This is one of many obstacles for users who need a habitual appointment to fall back on, Prifti explained.

“Sometimes I’m not super on top of things,” Prifti said. “I think it’s easier to lose track of things and accidentally miss therapy appointments, when maybe that’s the reason you should be going to therapy.” So she simply stopped using the platform, cutting off communication with the therapist she barely knew. 

Prifti is one of thousands of people who are seeking therapy through a telehealth platform for the first time in the midst of the pandemic. For some, online therapy platforms like BetterHelp and Talkspace create an accessible way to manage their mental health. But for others, the self-directed nature of a click or swipe access point creates barriers to the care they need. 

BetterHelp — For better or for worse?

BetterHelp specifically is a low-cost option that many universities and organizations partner with to provide counseling to large communities. As of September 2021, Northeastern University is offering BetterHelp as a referral option, advertising 20 free weekly sessions for its students and faculty. 

Online teletherapy platforms are merely a fragment of the telehealth realm, and should not be confused with teletherapy as a whole, which is broadly defined as counseling over the phone and online. Teletherapy is widely used, becoming a post-pandemic standard for counseling. According to a 2021 TIME poll, 58% of Americans using mental health services have met with a therapist over video or audio call in the past year. 

Drawbacks to teletherapy are widely understood — in the virtual realm, interfaces are difficult to navigate and personal contact is difficult to replicate. Yet in a world where workplaces have migrated online, a remote option for therapy is not too far outside our collective comfort zone.

The need for mental health professionals is high, which Andrew Ferrante, a licensed counselor in Boston, attributes to the “stressors of the COVID-19 pandemic.” In a 2020 survey conducted by the American Psychological Association, or APA, a third of U.S. therapists reported that they are seeing more patients overall. 

On virtual platforms like BetterHelp and Talkspace, enrollment is also spiking. BetterHelp reported a 60% increase in its user base in the past year, reporting over 2 million users as of October 2021. But Ferrante notes that some reliable mental health solutions do not always translate to large-scale online platforms like BetterHelp. 

“There is a difference between a private practice approach where you schedule with one therapist pretty consistently, versus using a service where you have various and sundry experiences,” Ferrante said.

On BetterHelp, users create an account and fill out a questionnaire concerning preferences that they may look for in a therapist, such as gender identity, age or counseling specialities. That user is then matched with someone who fits one or more of those qualities. MacKenzie Stuart, a care manager at [email protected], said that this option is a time-efficient alternative to searching for a private practice therapist.

“We are finding that private practice therapists in Boston have been overbooked because of COVID. It’s not as timely for students who may be looking for care,” Stuart said.

This year, according to a nationwide APA survey of psychologists, 81% of respondents indicated that they continue to see between 75% to 100% of their patients via telehealth. 

At one point, there were only two counselors in the Boston area that had availability. Since most private practice counselors in the area are doing virtual counseling anyway, BetterHelp is a solid option for our students.”

— MacKenzie Stuart

Diana Appell, a marriage and family private practice counselor in Boston, completely abandoned her in-person private practice in the wake of the pandemic. Appell’s services are now offered completely via video conferencing, and she does not use the therapy-by-text feature found on many teletherapy platforms. 

“I’m not going back to an office, I’m all-virtual. I’ve figured out how to work virtually in a way that is as efficient as my in-person sessions used to be. I can manage it, but I recognize the limitations,” Appell said. 

Appell explained that her patients prefer to stay virtual since many of them have already adjusted to working from home. While the virtual format provides flexibility for both private practitioners and patients, Appell said that private practice therapists are becoming harder to find due to an increased need for mental healthcare.

“I have so many referrals that I just can’t take any more,” Appell said.

The need for therapy has grown exponentially. According to a 2020 study by the APA, nearly 70% of U.S. psychologists with a waitlist reported that it had grown longer since the start of the pandemic, and 40% reported being unable to meet the need for treatment. This is where virtual telehealth services come in — their virtual interfaces make it easier to get in contact with a therapist at all.

“At one point, there were only two counselors in the Boston area that had availability. Since most private practice counselors in the area are doing virtual counseling anyway, BetterHelp is a solid option for our students,” Stuart said. “From the time you make the account and get matched with a therapist, it’s 24 to 48 hours before you can start [scheduling sessions],” Stuart said.

However, Prifti said that BetterHelp’s quiz-like interface that matches users with therapists was not as effective as the app promotes. 

“I really wanted a woman or gender-nonconforming therapist, and I just kept getting matched with men,” she said. Prifti ended up filling out the questionnaire multiple times before finding a therapist she felt comfortable talking to.

While problems with telehealth platforms are easy to identify, Ferrante admitted that there is a hesitancy for many in pointing out the benefits of telehealth therapy as a whole. The advent of telemedicine for mental health has brought about an easy method of care for those who may be unable to attend in-person sessions.

“Folks who experience a great deal of social anxiety or even some folks on the autism spectrum have benefited a bit from the new context — being able to pull up their therapist on their computer, and not have to get on the subway and manage all the social stimuli that come with that,” said Ferrante, who has a focus in addressing the needs of those on the autism spectrum.

Ashley Brown, a second-year biochemistry major, has used BetterHelp since January 2021. Brown said having BetterHelp as a resource put mental health solutions at her fingertips.

“I think the convenience balanced out my experience. It’s Zoom fatigue, instead of the fatigue of having to travel to a place and have that take an extra 30 minutes of my day,” Brown said.

Prifti explained that the accessibility that platforms like BetterHelp bring, especially for students who may be struggling financially, is beneficial in the long run. 

“I wouldn’t say I had the worst experience with BetterHelp. When I have friends that are like, ‘I can’t find a therapist right now,’ I do recommend it, especially if they’re students. I say, if it’s free you have nothing to lose,” Prifti said.

Additionally, Stuart said that the school actually offers unlimited free counseling through BetterHelp, which is a sweeping move for accessible mental health resources, but does not want to make that information widely known.

“It is unlimited, but we don’t advertise it as such. We give the students 20 sessions to start due to the chances students could call for multiple referrals. If students need more than 20 sessions, they can let us know privately,” she said. 

But no online therapy service is perfect, and BetterHelp provides a different experience than one could find, virtually or in person, through an independent therapist. Prifti has now switched to a private practice therapist that she continues to see virtually — every Monday.

The business of teletherapy platforms

An increased demand for private practice therapists has caused many people to turn to telehealth platforms, but increased reliance on these virtual therapy companies creates uncertainty for the future.

Mental health platforms such as BetterHelp and Talkspace are very different from a private practice therapist, benefiting from billions of dollars in investments and marketing. According to financial data firm PitchBook, investments in mental health startups and apps topped $1 billion in 2020 and are set to grow. 

At the end of the day, these therapy companies are companies first and they happen to host therapeutic activity second.”

— Hannah Zeavin

Dependence on these virtual services is becoming the norm, and advertising and data sharing are surefire moneymakers for these large companies. As monetary gain meets mental health, users may be negatively affected. 

“At the end of the day, these therapy companies are companies first and they happen to host therapeutic activity second,” said Hannah Zeavin, author of the 2021 book “The Distance Cure: A History of Teletherapy.”

Mental health platforms have widespread marketing campaigns across social media platforms like Twitter and Instagram. These apps are easy to promote — a mere download link to an app store is much faster than finding and calling a private practice. According to advertising intelligence website MediaRadar, BetterHelp spent $100 million in digital, print and national television advertising in the past year. 

BetterHelp, the leading telehealth platform on the Apple App Store, is known to partner with social media personalities, such as YouTuber Shane Dawson, for discounts and affiliate links which reportedly generate profit every time a fan subscribes to the service. 

BetterHelp competitor Talkspace recently partnered with Olympic athlete Michael Phelps for a series of television commercials. According to David Luxton, co-author of the 2016 book “A Practitioner’s Guide to Telemental Health,” this marketing allows therapists to benefit from the publicity and name recognition of well-known services. 

“They’re positive for the clinicians because they have some infrastructure around their practice by joining these organizations and providing services, you know, they can take advantage of the marketing that comes with it,” said Luxton, who is also an associate professor at the University of Washington School of Medicine in Seattle.

While platforms using large-scale advertising to promote therapy is an effective business strategy, some users find that it depersonalizes their mental wellness experience. 

“Obviously, therapists need to make money, but BetterHelp as a platform sometimes advertises in a way where it’s like, ‘Oh, like that feels kind of rude,’” Prifti said.

After the Nov. 8 Astroworld tragedy in Houston, a music festival where 10 people were killed and hundreds were injured, rapper Travis Scott pledged to provide Astroworld attendees one month of free membership through BetterHelp. This was advertised in a press release on both Scott’s and BetterHelp’s social media accounts. 

“With over 20,000 therapists nationwide, we are uniquely qualified to meet the needs of large numbers of people when tragedies like this occur,” BetterHelp said in a statement on their FAQ webpage.  

Backlash to this partnership was rampant online, as users questioned whether Scott or BetterHelp were making money off of this collaboration (BetterHelp responded on their FAQ page with a mere “No.”). Zeavin noted that as telehealth platforms are growing in popularity, she is seeing more of their users create discourse around them. 

“This kind of criticism arose of using tragedy as a way of doing marketing. I think that there’s been much more attention on teletherapy, so there is more pushback. I think people are more at their limit and more aware of the kind of insidious ways that these companies operate,” Zeavin said.

Brown said that she considered terminating her membership as a response to the Astroworld marketing, as well as the allegations that BetterHelp does not properly compensate their therapists

“I was like, ‘Well, I don’t want to be using something that kind of has those effects,’” Brown said.

Another concern of telehealth platform users is data sharing — a 2021 Consumer Report showed that mental health apps do not always fall under the Health Insurance Portability and Accountability Act, or HIPAA, a federal law that protects data collected by healthcare providers. The report also showed that mental health apps such as BetterHelp, Talkspace and Wysa admitted to selling “limited information” about their users to Facebook for targeted advertising.

Luxton, who teaches about data security at the University of Washington, said that while many mental health platforms are cognizant of what constitutes private information, users should remain vigilant about what they choose to share as these platforms become more widely used.

“My concern about using mobile apps is to make sure that your information is not being sold to some other company,” Luxton said. “With anything that you’re putting information on the internet and filling out any forms, you want to read the small print, to make sure your information is really secure, whether or not they’re following federal laws, such as HIPAA.”

When asked about user security via email, a representative from BetterHelp referred to its privacy policy, which states that it does not collect or store information from therapy sessions without user consent.

“Due to the use of cookies and web beacons, information regarding your activity on our websites, excluding activity when you are logged in and have started therapy, may be disclosed to our advertising partners to optimize marketing,” the privacy policy reads. 

While concerns about marketing and data security are raised, mental health platforms are continuing to gain prominence. The value of the mental health app market is poised to grow rapidly by 2027, which will undoubtedly attract more users and therapists to log on. Looking forward, the future of mental health may be the smartphone in your pocket.

“Apps like Talkspace and BetterHelp were built as alternatives because they were teletherapy,” Zeavin said. “But right now, all therapy is teletherapy. All teletherapy is understood to be kind of the basic form, it is no longer in the shadow.”

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