(2020-12-31) The Problem With Uber For Therapy

The Problem With ‘Uber for Therapy’. At 10 o’clock one morning this November, Rob Beal’s bosses summoned him and his co-workers onto a mysterious Zoom call. Beal had spent more than two years working as a coach for AbleTo, which provides mental-health services to people through apps, videochats, and calls, like Uber for anxiety.

But now Beal’s feel-good job was coming to an abrupt end. The manager on the call said Beal and his six fellow coaches were being terminated. Their role no longer fit the company’s business model. They wouldn’t be calling to check in on their clients that day.

The city of Reno, Nevada, for instance, is using federal funding to provide the Talkspace app, best known for its texting-based therapy, to all residents for free.

I used Joyable’s social-anxiety program in 2018, had a good experience, and wrote about it in my book and for The Atlantic. In that program, users write down thoughts that are making them anxious and try to come up with new ways of thinking about the situation that are more accurate and less anxiety-inducing.

Derrick J. Hoard, a marriage and family therapist based in Seattle, signed up to offer therapy through BetterHelp, a virtual therapy program, about two years ago. He remembers a relentless schedule of back-to-back sessions, 24/7 texts from clients, limits on the number of words he could exchange with clients, and a rate that amounted to less than $30 a session, compared with the $200 he charges in his private practice currently

A group of therapists called the Psychotherapy Action Network has spoken out against the rapid rise of these apps at the expense of traditional, long-term psychotherapy. Talkspace sued the group for defamation after its chairs wrote a letter to the American Psychological Association expressing concern that some health-insurance plans cover Talkspace.

After his firing, Beal felt a little depressed himself. He derives joy from connecting with people, but his tether to the beautiful chaos of other humans was unexpectedly cut. He wasn’t able to tell any of his clients—some of whom he had spoken with nearly 100 times—that he was leaving.

Some therapists who have worked for other virtual mental-health providers, such as BetterHelp and Talkspace, have complained of low pay and difficult working conditions. One therapist who offered services on Talkspace found that when she provided a client with links to therapy resources outside the app, a company representative contacted the therapist to say she “should seek to keep her clients inside the app,”

A few months ago, Beal and his colleague say, AbleTo hired a team of part-time coaches based in Florida, who he says also did not receive health benefits, paid time off, or sick pay. “I spent a lot of time supporting those new folks, without realizing that those are the people coming in to take our jobs,” Beal’s colleague told me.

Over time most of Beal’s clients were receiving the service as a fringe benefit paid for by insurers or by their employers.