Big Business, Big Pharma, Big Mental Health? The proliferation of Multitherapist Muticlient Web-based Platforms
Part II
In this installment, I will review the costs of BetterHelp and some of the other legal/ethical issues that they are currently facing.
Is BetterHelp really more affordable than ‘real’ therapy?
BetterHelp advertises that they are cheaper than traditional therapy. This can be a bit difficult to assess because BetterHelp charges a monthly subscription fee rather than per therapy session. In my case, I paid 2300 DKK for a month (roughly 314 USD). This is the cost of two sessions with two experienced therapists in Denmark. Had I received four sessions in a month, it would for certain be a good deal. However, there are two factors that affect whether you are getting a ‘good deal’ through BetterHelp:
- BetterHelp does not advertise this up front, but the sessions are only half an hour long. You can request a 45-minute session, but you must know to do this. Obviously, the session length affects the value. Four half hour sessions a month for the price of two whole sessions (50-60 minutes) of an in-person session ends up being equal.
- Whether you receive four sessions a month is dependent on your therapists’ availability. In my case, she did not have any sessions for three weeks, so I ended up paying the price of two full price sessions for one half hour session, over the course of a month.[1]
- Finally, you get what you pay for. BetterHelp seems to cater to therapists right out of school and the more experience they acquire, the more likely it is that they leave and start their own practice.
Ongoing Issues
I saw my therapist for a total of five times. As mentioned above, therapy sessions are only half an hour unless you specifically request a 45-minute session. My therapist was fine. She was young. She did a respectable job of reflecting back what I said to her in ways that I found helpful. I do not want to say any more than that because I know she is just a cog in a big wheel. It was not her fault when technical problems made audio difficult in our sessions. Like me, she was just a therapist trying to make a living.
She told me that they do not get vacation and for most therapists, this is a ‘side hustle.’ They work on contract. She also mentioned that when the platform goes down (BetterHelp’ s fault) they do not get compensated. Which brings us to another problem with BetterHelp:
How are the therapists treated?
The world is in the middle of a mental health crisis in our post-COVID times and BetterHelp has been there to capitalize. They have an impressive platform and a system designed to serve thousands of people, potentially at once.
Regardless of how impressive the platform is, how well do they treat their employees? The answers are mixed if you peruse the indeed.com database of employee reviews (see link below).
Many people are satisfied, though generally they complain about low pay, long hours, and lack of benefits. One person calls it ‘The Uber of Therapy.’ Many of us realized, with the advent of Uber, that it was great for the consumer and horrible for the taxi driver. The country I currently live in has outlawed Uber because of the poor working conditions they offer. The same seems to be true when you look at employee complaints about working for BetterHelp. See some of the other reviews in the link below:
https:// www.indeed.com/cmp/BetterHelp.com/reviews?ftopic=paybenefits
Billing issues:
BetterHelp operates as a subscription service. You pay per month, and they automatically renew your subscription unless you specifically tell them not to. I did not personally have a problem with this. However, if you do a little research with the Better Business Bureau (a consumer protection agency in the U.S.), it seems quite a few people have had problems related to canceling their subscription. Many people complain that they try to cancel their subscription or end therapy but end up getting billed again. Have a look at some of the complaints regarding BetterHelp’s billing on these two sites:
https://www.complaintsboard.com/BetterHelp-b126477
Sharing your data:
BetterHelp has denied selling of data but acknowledged that they share user data with their advertisers. They have remarked that this is legal and appropriate because they do not share session data (things you reveal to your therapist during a session). Several investigators have found that BetterHelp fares worse than other apps, in protecting their clients’ privacy. Even today, the United States Senate is investigating BetterHelp regarding their privacy policies.
From Health IT Security[2]:
“A February 2020 investigation found that BetterHelp was sharing analytics with Facebook about how often users opened the app and metadata from every message shared on the platform – giving the company a sense of when, for how long, and where users were using mental health services.”
Other legal troubles
At the time of this writing, it should be noted that BetterHelp is involved in several lawsuits. They are too numerous to mention but include things such as: 1) misrepresenting financial records to investors, 2) stealing therapist data to inflate how many therapists they have, and 3) copyright infringement.
Final Question:
A thorny issue in the USA is that licensing is a state, not federal task. This means that if a therapist is licensed in one state, they cannot practice outside of that state. BetterHelp claims that the therapists do not practice over state lines. However, the fact that as a client in Denmark, I was seeing a therapist in Idaho, suggests that they have no problem practicing outside of country lines. Did they do their due diligence and research the licensing requirements in Denmark? It seems highly unlikely given that the website is in Danish. They say nothing about other countries but clearly the therapists practice with clients over national lines. They are taking a ‘forgiveness rather than permission’ strategy. I have mixed feelings about this because, while licensing laws were written to protect the consumer (and to create a revenue stream for the jurisdiction), they have slowly been becoming defunct due to the internet and proven effectiveness of online therapy. In the extreme example of the USA, it just seems silly that someone licensed in Vermont cannot practice in Texas. However we don’t yet have worldwide licensing laws so I would bet that BetterHelp is playing fast and loose here.
Summary:
I feel okay about my experience with BetterHelp. For a no frills talk with a licensed therapist, it was easy to use and access. I worry more about what this does to the future of my profession: will it be controlled increasingly by web developers and corporate suits and less by people who have a real interest and passion for helping? Some would argue that traditional medicine has already gone this route in the USA, at least.
I can understand why people might want the ease of online counseling. Expats (the population I work with), may utilize a service like BetterHelp to more easily access therapists from their home culture. Hopefully, this article will help some people to make an informed decision about whether and how to use Betterhelp. All therapists ultimately practice to support themselves. It’s unreasonable to think that therapists should do this only for the love of their profession or for only altruistic reasons. However, bear in mind that when you are paying for BetterHelp, only a fraction of your fee goes to the therapist. A larger portion of the fee goes to administration and corporate interests and people who know little or nothing about what it means to provide psychological care. I am probably naïve, but I continue to hope that there is a place for solo practices and small clinics.
[1] It should be notes that I alerted Betterhelp to this and they gave me three extra weeks.
[2] McKeon, J. (2022 June 30). Senators Question Talkspace, BetterHelp On Patient Data Privacy Practices. Health IT Security. https://healthitsecurity.com/news/senators-question-talkspace-betterhelp-on-patient-data-privacy-practices