After her mother’s death, Elizabeth* sought therapy to process the trauma of watching her father abuse her mother while she suffered from dementia.
Faced with a lack of therapists on the New South Wales south coast, she turned to online counseling platform BetterHelp, which claims “remove traditional barriers to therapy.”
BetterHelp’s website says it provides “affordable and accessible” care, charging clients between $90 and $120 per week to speak with a therapist “however you feel comfortable: text, chat, phone or video… when I need it.”
After contacting a therapist on February 20, Elizabeth was immediately charged a monthly fee of $296.64, discounting her first week of therapy.
However, he found the only option available (a 30-minute live therapy session) restrictive. During her first consultation, she felt pressured to rush her story, including her father’s own abuse of her during childhood.
She also hadn’t realized it was a US-based company and she would have to wake up at 3am Australian time to access the group therapy on offer.
Elizabeth says she received daily reminders to use the platform’s journal feature, but nothing she wrote was sent to her therapist. She “I was anxious to relive many things daily without finding a solution.”
Elizabeth canceled her subscription because she couldn’t justify $90 a week during a cost of living crisis for a service she said wasn’t helping her.
It is not a crisis service
How BetterHelp searches Expand your operations and customer base in Australia, mental health experts are concerned that the American company’s subscription model risks creating therapeutic problems. There is the potential for codependency, they say, and the lack of an endpoint for therapy.
BetterHelp customers pay a monthly subscription up front for one hour of a therapist’s time each week that includes a 30- or 45-minute live session. The remaining time is for the therapist to send messages, emails, and worksheets to clients.
Carly Dober, a psychologist and director of the Australian Psychologists Association, says it is “ethically concerning” that clients are being charged a month in advance regardless of how many sessions they attend, given that mental health problems affect cognition. , memory and ability of a person. work. BetterHelp users must also actively cancel subscriptions.
Frances Carlton, a clinical counselor who has provided therapy sessions on BetterHelp, says the platform is advertised as an affordable option, but that clients would be better off seeing someone in a private office when they need it.
While BetterHelp seems cheaper than traditional in-office therapy, clients who attend in-person therapy don’t pay four weeks in advance “like a gym membership” and don’t have to come every week to get a good value. -price, says Carlton. Instead, they can choose how often they attend sessions.
Carlton also questions the value clients receive when 30- or 45-minute live sessions aren’t enough. She says that in private practice she allows at least 75 minutes initially because after 45 minutes the client is just beginning to feel comfortable. After a few sessions, the therapist can reduce the time to an hour, she says.
Carlton says that while BetterHelp advises that it is not a crisis service, “the reality is that clients go into crisis during sessions sometimes because of what they are talking about.” She says she never fires those clients when they run out of time, but according to BetterHelp’s model, “that’s exactly what to do.”
BetterHelp pays therapists $30 an hour if they work up to five hours a week. The rate increases by $5 for every five additional hours worked until those who work 40 hours a week earn $70 an hour. The platform does not pay overtime and deducts pay if a customer logs in late, Carlton says.
Dober says BetterHelp’s pay rates are below the minimum wage under the applicable private sector award, but hiring at the platform’s rates is legal.
Carlton says BetterHelp gives clients the illusion that therapists will message every few days and advertises that “you can message your therapist anytime, from anywhere.” However, the salary structure does not compensate therapists for that amount of work.
Quantity over quality?
Dober is also concerned that BetterHelp requires doctors to text patients every three days and respond to text messages sent by patients within 24 hours and 48 hours on weekends.
“This can create a host of therapeutic problems, such as poor boundaries, codependency, and can affect the therapeutic relationship if the client perceives that they feel forgotten or unimportant if realistic and supportive expectations are not managed from the beginning in the treatment schedule. communication,” Dober says.
Associate Professor Andrew Campbell, a psychologist and chair of the Cyberpsychology Research Group at the University of Sydney, says if the care model is “too complex”, clients may believe their counselor can help them solve all the problems. Campbell is also concerned about the lack of so-called exit points.
“There is a question about qualification; Is the model set up for an exit point where the person will no longer use the app because they feel better? Or are you set up to be pretty messed up where you feel, “I’m going to build a relationship with this counselor and they’re going to be able to help me with every problem I have, whenever I want, wherever I want?” he’?”.
Campbell says psychologists should set goals with clients and, when those goals are met, suggest a break from therapy.
BetterHelp’s advance in Australia is a two-sided coin, says Campbell. On the one hand, “we have a High demand for mental health services. “That needs to be met and there is room for mental health offerings.”
“The other side of the coin has to do with the quality and security of the service… and that is my concern about BetterHelp. Because it has a reputation for putting quantity over quality.”
Carlton says if people feel let down by the platform, there is a risk they will not seek mental health care in the future.
A BetterHelp spokesperson said “we are confident in the quality and safety of our offerings.”
The spokesperson said therapists were offered competitive compensation of up to A$137,410 per year based on 52 work weeks, but actual earnings varied due to conversion rates, caseloads and client engagement. platform.
“Our compensation model is designed to be competitive and we review it periodically to ensure it meets the needs of our therapists. “We also provide extensive support and supervision to maintain high standards of care and therapist satisfaction,” the spokesperson said.
After canceling her BetterHelp subscription, Elizabeth decided to see a private practice therapist via telehealth for one hour every three weeks. She believes that this is better and gives him time to reflect and work towards achieving her goals.
Guardian Australia has previously run BetterHelp adverts on its podcasts.
*Name changed for privacy reasons
