What’s it like to use an online counseling app like BetterHelp, and can it lead to a co-dependency? | mental health

After her mother’s death, Elizabeth* sought therapy to deal with the first trauma of her father abusing her mother while she suffered from dementia.

With a shortage of therapists on the New South Wales South Coast, she turned to online counseling platform BetterHelp, which claims to “Remove Traditional Barriers to Therapy”.

BetterHelp’s website says it offers “affordable and accessible” care and charges clients $90 to $120 a week to speak with a therapist “however you feel comfortable” by text, chat, phone or video — when you need it.

After meeting with a therapist on February 20, Elizabeth was immediately charged a monthly fee of $296.64, deducting her first week of therapy.

However, she found the only available option—a 30-minute live therapy session—restrictive. During her first consultation, she felt pressured to rush her story, including her childhood abuse by her father.

She also hadn’t realized it was a US-based company and would have to wake up at 3am Australian time to access the group therapy on offer.

Elizabeth says she took daily reminders to use the platform’s journaling feature, but none of what she wrote was forwarded to her therapist. “I was anxious reliving many things on a daily basis without finding a solution.â€

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.

Not a crisis service

As BetterHelp aims to expand its Australian operations and client base, mental health experts are concerned the US company’s subscription model risks creating therapeutic problems. They say there is a potential for co-dependency and a lack of an endpoint for therapy.

BetterHelp clients pay a monthly subscription in advance for one hour of therapist 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 Psychological Association, says it is “ethically troubling” that clients are charged a month in advance – regardless of how many sessions they attend – given the mental health issues that affect cognition. a person’s memory and ability to work. BetterHelp users must also actively unsubscribe.

Frances Carlton, a clinical counselor who offered therapy sessions on BetterHelp, says the platform advertises itself as an affordable option, but clients may be better off seeing someone in private practice when they need it.

While BetterHelp seems cheaper than traditional in-office therapy, clients who attend in-person counseling don’t pay for four weeks up front “like a gym membership” and don’t have to attend every week to get value for money. says Carlton. Instead, they can choose how often they attend the sessions.

Carlton also questions the value clients receive when 30- or 45-minute live sessions aren’t long enough. She says that in private practice she initially allows at least 75 minutes, because after 45 minutes a client is just starting to feel comfortable. After a few sessions, the therapist can reduce the time to an hour, she argues.

Carlton says that while BetterHelp cautions that it’s not a crisis service — the reality is that clients go into crisis during sessions because, sometimes, of what they’re talking about. She says she never turns these clients away when their time is up, but under BetterHelp’s model — that’s exactly what you should 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 working a 40-hour week earn US$70 an hour. The platform doesn’t pay overtime and deducts pay if a client signs up late, Carlton says.

Dober says BetterHelp’s pay levels are below the applicable private sector minimum wage, but contracting with platform fees is legal.

Carlton says BetterHelp gives clients the illusion that therapists will text every few days and advertises that “you can text 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 BetterHelp requires clinicians to text patients every three days and respond to patient texts within 24 hours and 48 hours on weekends.

“This can create a number of therapeutic issues, such as weak boundaries, co-dependency, and can affect the therapeutic relationship if the client perceives feeling forgotten or unimportant if realistic and supportive communication timeline expectations are not managed. from the beginning”. € says Dober.

Associate Professor Andrew Campbell, a psychologist and chair of the Cyberpsychology Research Group at the University of Sydney, says if the model of care is “too mixed” clients may believe their counselor can help them solve any problem . Campbell is also concerned about the lack of so-called exit points.

“There’s a question about activation; Is the model set up for an exit point where the person won’t use the app anymore because they feel better? Or is it designed to be confusing enough where they think, ‘I’m going to build a relationship with this counselor and they will be able to help me with any problem I have, whenever I want, wherever I want?†.

Campbell says psychologists aim to set goals with clients and when those goals are achieved suggest a break from therapy.

Pushing BetterHelp into Australia is a two-sided coin, Campbell says. On the one hand, “we have a huge demand for mental health services that needs to be met and there is room for mental health offerings.”

“The other side of the coin is about the quality and safety of the service” and that is my concern about BetterHelp. Because it has a reputation for doing, I would say, quantity over quality.â€

Carlton says if people feel let down by the platform, there’s a risk they won’t seek mental health care in the future.

A spokesperson for BetterHelp 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 a year based on 52 weeks of work – but actual earnings varied due to conversion rates, caseload and client engagement on the platform.

“Our compensation model is designed to be competitive, and we regularly review it to make sure 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 subscription to BetterHelp, Elizabeth decided to see a private therapist via telehealth for an hour every three weeks. She thinks this is a better value and gives her time to reflect and work towards her goals.

Guardian Australia has previously featured ads from BetterHelp on its podcasts.

*Name changed for privacy reasons