The need for accessible mental health care has become more and more apparent since the initial pandemic, and many online services have arisen trying to fill that void. The goal of this resource post is to provide tools to help readers assess whether a therapy site is reputable and how to protect your data if you do seek an online therapist.
If you are looking for therapist/group therapy suggestions, particularly for marginalized communities, head over to this resource post instead.
Online Therapy: Security, Ethics, and Legal Issues (VeryWellMind, Kendra Cherry)
Things to keep in mind when choosing a therapist and databases to check credentials.
While therapists can treat clients from all over the globe, they should adhere to the laws and ethical guidelines of the state or country where they are licensed to practice. Unfortunately, the global nature of the Internet can make codes of conduct challenging to enforce, so if you are thinking about using an online counselor, be sure to look into their certification and credentials.
While states have differing laws, many specify that therapists must see clients within the state where they are licensed. Many states temporarily suspended these requirements due to the COVID-19 pandemic.1 With many of these changes now expiring, some clients may have to change therapists in order to conform with state guidelines.
A practice agreement known as the Psychology Interjurisdictional Compact, or PSYPACT,1 may change this. It is an interstate licensing agreement that allows therapists to practice remotely across state lines in those states participating in the agreement.
YouTube’s BetterHelp mental health controversy, explained (Polygon, Julia Alexander)
Maybe the most aggressively marketed service in this market, it does not guarantee users will match with a licensed therapist.
But in ad reads for the app, YouTube creators describe a product that more and more people are expressing concerns over. ChandlerNWilson told his viewers the app was full of psychologists who could help people going through a tough time; Gabbie Hanna used the word “professional” to talk about the mental health experts available to talk to people.
The company’s terms of service tell a different story, though. The terms of service explicitly state that the company can’t guarantee a professional or even licensed professionals.
“We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you,” according to the terms of service.
[…] The BetterHelp terms of service were last updated in July 2016. None of this information appears in any of the videos that are sponsored by the app.
Since then, BetterHelp founder and CEO, Alon Matas, has taken to Reddit to defend BetterHelp’s name from concerned YouTube fans and numerous customers who have reported terrible experiences while using the app. People on Reddit, Twitter and in YouTube comments have claimed that counselors never showed up for appointments, or the company took hundreds of dollars for one month’s payment before the seven day free trial was up.
Talk therapy apps face new questions about data collection from senators (The Verge, Makena Kelly)
The letter in question addressed both BetterHelp and fellow large platform Talkspace.
While personal information isn’t as sensitive as medical data, it can still reveal intimate insights into a user’s life. For example, Jezebel reported in 2020 that BetterHelp shared the metadata of messages between a patient and therapist with Facebook. The data does not include the contents of these messages but could alert online marketers to how frequently and where a user could be using the app.
“Even though you claim this data is anonymized, it can still provide third parties with important and identifying information,” the senators wrote, citing a 2019 MIT Technology Review study on how multiple pieces of anonymized data could be used to construct individual user identities.
How to protect your privacy when using mental health care apps (NPR, Shauneen Miranda)
Basic tips for preventing tracking from third-party apps.
Users can also disable their mobile advertising ID, which limits the ways that companies can collate your data, location, search history and browsing history, according to Davisson.
For iPhone users, go to Settings > Privacy > Tracking to see if there are any apps you previously allowed access to track. Switch the slider to “off” where it says “Allow Apps to Request to Track” so the button appears gray.
For Android users, go to Settings > Privacy > Ads > and tap “delete advertising ID.” An older version of Android may instead give the option to “Opt out of Ads Personalization.”
Mental Health Apps Aren’t All As Private As You May Think (Consumer Reports, Thomas Germain)
Deep dive into the limits of HIPAA protections when using online therapy apps.
Consumer Reports saw the BetterHelp, Sanity & Self, Talkspace, and Wysa apps all sending data to Facebook. Separately, Youper told us it shares data with the social media titan, though we didn’t see that occur during our testing.
Facebook’s policies say that sensitive data like your medical symptoms isn’t used for targeted ads. However, the company doesn’t treat the fact that you’re using a mental health app the same way. And according to a Facebook spokesperson, the company hasn’t signed a business associate agreement that would restrict its use of identifying data with any of the app developers in our study.
The companies that responded to our questions say they share only limited information with Facebook. BetterHelp president Alon Matas told CR that Facebook “can use data from other apps on an aggregated level, not on an individual basis. It says so explicitly both in their engagement with advertisers like us, as well as in their public information.” A Talkspace spokesperson says the company collects data using Facebook’s tools to optimize ads for Talkspace that the company might run in the future, though the data isn’t being used that way right now. And, the company says, the data includes only details about users’ interactions before they start therapy.
After our initial tests, Wysa began obscuring the IDs the company shares with Facebook.
What this all means is that companies like Facebook might learn that you use a mental health app, and that piece of information could be combined with many other data points—from your gender to your hobbies to your location—to determine which ads Facebook shows you on its platform or on other websites. (Consumer Reports uses Facebook tracking technologies to market its own products and services.)
Pride Counseling Online Therapy Review (VeryWellMind, Mary K. Tatum MS, LMHC)
Pro and con assessment of the largest online therapy site specializing in LGBTQ+ patients. The service costs between $60 and $90 per week and bills solely out of pocket, making it inaccessible for a large portion of the community.
Compared to the other 33 online therapy companies we reviewed, Pride Counseling’s average monthly subscription costs are above average, though it’s important to note that the price varies significantly based on where you live and what therapist you match with (more on that below.)
About 70% of respondents we surveyed thought the cost of the company’s service was either very good or excellent. However, it’s important to note that the socio-economic realities faced by most LGBTQIA+ people are not reflected in our data.
Respondents to our questionnaire about their experiences with Pride Counseling were overwhelmingly white (91%), cisgender (100%), and relatively wealthy. Forty-one percent reported annual household incomes ranging from $75,000 to $200,000 or more. For reference, the Census Bureau found that the median household income in 2019 was $68,703.
The Best Affordable or Free Online Therapy Services of 2022 (Healthline, Ashley Braun MPH RD)
Bullet point comparisons of seven low-cost online therapy options.
We selected each free or low cost online therapy service based on key features to ensure the mental health support offered is:
We also considered how long you need to wait for an appointment, whether the service offers 24/7 support, and if the service offers video and phone chat, live chat, and text messaging.