It can be surprising to think of searching for therapists and applying for mental health care the same way you might browse a menu on Grubhub or hail a car on Lyft.
But over the past decade, digital access to therapy has become increasingly common, in some cases replacing the traditional model of weekly in-person sessions between a therapist and client.
Mental health and wellness apps range from mood trackers, meditation tools, and journals to therapy apps that connect users with a licensed professional. My team’s research focuses on therapy apps that work by connecting clients with a licensed practitioner.
As a social work researcher, I am interested in understanding how these applications affect clients and professionals. My research team has studied the attention app users receive. We’ve talked to therapists who use apps to reach new clients. We also looked at the app contracts that mental health professionals sign, as well as the agreements that clients agree to when using the apps.
Real questions remain about how apps are regulated, how to ensure user privacy and quality of care, and how insurance can reimburse remote therapy. As those debates continue, people regularly use apps to connect with therapists for help with emotional and mental struggles. And through these apps, therapists interact with people who may never have considered therapy before.
In the first year of the pandemic, rates of depression and anxiety increased 25% worldwide, according to the World Health Organization. In a June 2020 survey from the Centers for Disease Control and Prevention, 40.9% of respondents reported at least one adverse mental or behavioral condition, compared to just 19% in 2018.
The old model of therapy, in which therapists and patients sat face to face, was already out of reach for many. In fact, mental health apps are a response to customer demand for more accessible therapy services.
The COVID-19 pandemic fueled both trends: the growing need for mental health care and the use of technology to access it. For existing mental health clients, stay-at-home orders closed clinics and therapists’ offices for in-person visits, resulting in an unprecedented shift toward online therapy access.
how they work
Consumer mental health platforms like Better Help and TalkSpace connect clients with licensed therapy providers. With ads on TV, social media channels and roadside billboards, the apps promote flexibility, convenience and support with slogans like “You deserve to be happy” or “Feeling better starts with a single call.”
When app users enter a platform’s online space, its proprietary software offers a digital dashboard and communication tools. These platforms also promise instant access to a professional therapist, immediate response from them, and anonymity.
Users of the app choose a therapist by reviewing a list of providers accompanied by thumbnail photos, resume-like biographies and consumer reviews. Users also choose how they will connect with therapists: phone or video calls, email, text, or some combination. The apps also allow clients to switch therapists at any time.
As the client and chosen therapist connect and communicate, behind the scenes the app collects and maintains records, then calculates the chosen therapist’s payment and bills the app user.
AP Photo/Natacha Pisarenko
Michael Phelps has partnered with Talkspace Online Therapy to share the story of how therapy helped save his life.
Interestingly, although mental health app platforms market themselves as providers of mental health services, they do not actually take responsibility for the counseling services they provide. The apps treat therapists as independent contractors and the platform acts as a matching service. And the apps can help users find a more suitable fit if requested.
But no law or precedent protects consumers or clarifies the rights of app users. This differs from face-to-face therapy, in which professionals work under the supervision of state licensing boards and federal law. Some of the leading therapy apps have been accused of mining customer data and being at risk of data breaches.
Like other virtual spaces, online mental health services domains operate under localized and constantly evolving regulations.
Who benefits?
The social workers our team interviewed talked a lot about who can benefit from this type of app-based therapy and, more importantly, who can’t. For example, the Platforms are not configured to treat people with serious mental illnesses or mental disorders that substantially interfere with a person’s life, activities, and ability to function independently.
Similarly, app-based psychotherapy is not suitable for those with suicidal thoughts. Platforms screen users for self-harm risk when they sign up. If a client ever harms themselves or someone else, the user’s anonymity on the apps makes it almost impossible for a therapist to send a crisis response team. App-based professionals told our research team that they sometimes end up monitoring their clients for signs of crisis by contacting them through the app more frequently. It’s one of the reasons app therapists, who also screen users, sometimes turn away potential clients who may need a higher level of attention.
For those who do not have a serious mental illness, app-based therapy can be helpful in connecting clients with a professional familiar with a variety of issues and stressors. This makes the apps attractive to people with mild to moderate anxiety and depression. They also attract people who wouldn’t normally seek therapy at the office, but who want help with life issues, such as marital problems and work-related stress.
The apps could also be practical and convenient for those who are unable or unwilling to receive formal therapy, even remotely, at a mental health clinic or office. For example, the anonymity of apps can be attractive to people with disorders like social anxiety or agoraphobia, or to people who can’t or don’t want to appear on a video call.
Therapy apps have helped normalize the idea that it’s okay to pursue mental health treatment through non-traditional routes. And with high-profile people like Michael Phelps and Ariana Grande partnering with these apps, they could even be on their way to making mental health treatment cool.
