A clinical psychologist tries BetterHelp as a patient and as a therapist

January 22, 2024 6:08 PM

I suspect BetterHelp therapists feel pressure to help quickly— in order keep up their caseload and avoid being ghosted on a platform where patients are encouraged to provide a star rating for each session.

The interviewer said I could start seeing patients once I completed a background check by a third-party service and completed a quiz I would receive shortly by email. The quiz included six easy multiple choice questions about psychotherapy, followed by a prompt to write a response to a female patient’s initial written request for therapy. The interviewer said no one she screened had ever failed it. The background check was completed quickly.
posted by spamandkimchi (31 comments total)

The TLDR

One common principle supported by decades or research is the importance of therapists promoting a sound, collaborative relationship with their patients. At places like BetterHelp, where underpaid clinicians are pressured to work long hours, without adequate support, it is unlikely that clinicians can regularly create such connections.

Instead, BetterHelp can advertise that it provides therapy, though there is no credible evidence that what patients on average receive is effective, or if therapists can even work competently under its stringent work requirements. If companies like BetterHelp continue to take over the marketplace, psychotherapy will become a frenzied, low-paying profession, which will discourage talented individuals from entering the field and burn out the ones who do.

posted by spamandkimchi at 6:10 PM on January 22 [43 favorites]

If companies like BetterHelp continue to take over the marketplace, psychotherapy will become a frenzied, low-paying profession, which will discourage talented individuals from entering the field and burn out the ones who do.

The logic and incentives that enable BetterHelp to pretend to offer therapy are the same as those that enable United Healthcare, et al to pretend to pay for behavioral health treatment. Basically if we’re going after BetterHelp we need to also go after the whole damn thing.
posted by flamk at 6:28 PM on January 22 [39 favorites]

I called Beyond Blue when I was trapped in hotel quarantine with my wife after returning home from her mother's funeral. They were so fucking useless I'd say they actively make things worse, yet at the end of every ABC news segment with even a vaguely self-harm or depression theme, there they are being promoted like they aren't worse than nothing.

I really wish the Sailing La Vagabonde YouTube channel would stop advertising BetterHelp. You can get in trouble advertising financial services if you're not licensed for that, so why can you promote a therapy service with no oversight?
posted by krisjohn at 6:33 PM on January 22 [17 favorites]

Is anyone checking that my therapy that I pay for out of pocket is effective? I’ve worked with the same person for over 2 years.

I’ve thought about getting my MIL a BetterHelp account for a long time because she is lonely and needs someone to talk to about EVERYTHING. And she needs someone to say mean stuff about us to! And someone to hear her vent about her ex and someone who will never ask her about any of her mental illness issues or learn about her excessive hoarding. That was her last in-person, regular therapist. Had no clue she was a hoarder.

I do believe everything about this article and I also believe that mental health assistance could actually span a range of activities. But we are a sick culture with sick systems and working within that makes for twisted solutions.
posted by amanda at 6:38 PM on January 22 [8 favorites]

Like Uber for LCSWs, right? This is an awful idea.

And if your MIL (or really anyone else) just needs to talk with someone I’d recommend a peer support warm line. Much better and doesn’t cost a dime. Real people on the other end with excellent supervision, support and training. Just google around; they are in nearly every state.
posted by cybrcamper at 6:48 PM on January 22 [11 favorites]

My impression of this as "well, better than nothing, I guess" is about confirmed. Now back to my use of Woebot!
posted by jenfullmoon at 7:13 PM on January 22 [3 favorites]

I've had two rounds of experience with therapy so far in my life.

One of them was paid for by my then-work insurance, one of those "we give you X number of visits in a year" sort of programs. The woman I found to provide my therapy was helpful but wasn't entirely what I thought a professional therapy relationship would be, and regardless only lasted 6 sessions because that's all that would be paid for.

This round that I've currently started is through Medicaid, and is through a referral from my PCP and is into a large mental heath care practice, and the difference is shocking. I had an actual intake appointment, and was assigned someone to see based on that. I haven't gotten any medications prescribed yet, but in a couple of weeks I'll have a full hour with the person in that practice who is dedicated to prescribing meds to people and that will be a full hour talking to someone specifically about mental health meds and won't be just me talking to a general practitioner and getting some random pill prescribed.

Like, I don't know if this is the normal experience, and it surely can't be because I know people find their own therapists all the time, but being referred to this larger practice and having them working on my mental health as a team feels AMAZING after basically zero years of any of this before now.

I can't imagine what Better Health is providing is any good. Very early on I heard it was a privacy nightmare [FTC.gov article], and that put me off of it entirely even when I might have been able to pay for it out of pocket.
posted by hippybear at 7:25 PM on January 22 [15 favorites]

Man, I don't begrudge any creator from taking sponsorship money from BetterHelp because (1) as discussed in the Substack FPP, it's hard out there, yo. and (2) honestly BetterHelp's aggressive advertising has, if nothing else, normalized some of the ideas of therapy. I also know from friends in the biz that no practice setting is free of problematic and possibly harmful therapists.
posted by midmarch snowman at 7:43 PM on January 22 [5 favorites]

The interviewer said I could start seeing patients once I completed a background check by a third-party service and completed a quiz I would receive shortly by email. The quiz included six easy multiple choice questions about psychotherapy, followed by a prompt to write a response to a female patient’s initial written request for therapy. The interviewer said no one she screened had ever failed it. The background check was completed quickly.

This quote in the post leaves out the crucial context that this was only after the writer submitted proof of being a licensed mental health professional. They weren't hiring randos .
posted by kickingtheground at 7:45 PM on January 22 [13 favorites]

Yeah, my opinions about podcasters taking money from BetterHelp are entirely separated from whether anyone should use BetterHelp for their mental health.

As with all podcast advertisers, my opinion is "podcasters bleed them dry, listeners ignore them". Because I don't think there's been a single one that has been actually a worthwhile company aside from them giving podcasts money.
posted by hippybear at 7:46 PM on January 22 [7 favorites]

so the reason why there's such a sharp pay differential between therapists based on how many hours a week they work (30 bucks an hour for ten hours or under, 70 an hour for 35 hours or above) is because they're expanding too rapidly and couldn't push through the volume of customers they want unless they cut pay for therapists who don't work long hours?

i mean okay that is a totally rational play in market terms but also it's a recipe for everyone involved feeling awful all the time and no one getting what they want nor need.
posted by bombastic lowercase pronouncements at 7:54 PM on January 22 [3 favorites]

I will say, the rates that the practice that I'm attending via Medicaid are around $175/hour, which I think is maybe more in line with actual therapist pay?
posted by hippybear at 8:00 PM on January 22 [3 favorites]

If companies like BetterHelp continue to take over the marketplace, psychotherapy will become a frenzied, low-paying profession, which will discourage talented individuals from entering the field and burn out the ones who do.

Well, the practice of 8 therapists my wife, daughter, and I go to has no problem both charging $180-$200 a session (thank Christ for super-bills and UHC out-of-network 70% coverage) and also staying completely booked. I also know a couple LMFTs though friends and have been basically booked out for basically forever, and were so before COVID even.

I don't think BetterHelp was ever really competing for patients with established, "serious" therapists.
posted by Back At It Again At Krispy Kreme at 10:28 PM on January 22 [1 favorite]

Honestly, this sounds bad, but in a way it's not all that much better in entry level positions in the field.

A few years pre-COVID, my wife decided to pursue becoming an LPCC with a focus on kids/education because she's been a teacher. She worked hard, got her masters and began working to get her hours. She started at one place over in the barrio that was a private company with large state funds to provide services to the community. The hours, the paperwork and the grind, grind, grind approach to the caseload wasn't what she expected and she burned out quickly. Had a bad experience with another boss who was unstable and she took that as her sign to go back to the classroom for a while.

Better Help sounds like the techbro capital extraction version of that first gig of hers.
posted by drewbage1847 at 11:45 PM on January 22 [6 favorites]

I mean, the real problem is that people need therapists, can’t get them, and can’t afford to pay sticker price for them. At 175$ an hour, if you need sessions once a week, which is about what most people at the stage of desperately needing therapy really need, that’s 700$ a month. Who has the money for that?
posted by corb at 12:05 AM on January 23 [22 favorites]

I don’t trust BetterHelp after reading a therapist ‘told man to stop being gay’.
posted by ellieBOA at 12:53 AM on January 23 [9 favorites]

Pretty much no medicaid insurance pays $175 for therapy, even for LCSW. The remimbursent rates for Medicaid for all professional services is pretty terrible, which is why mostly only health systems take it now a days, procedural specialities, or places that do large volume. It’s a particular travesty since medicaid patients end up usually having higher complexity due to who can be on medicaid. Cash pricing for therapy is partly higher for all the overhead and weird pricing logic that goes into insurance company negotiations. If a place charges high prices and is cash only they are just taking advantage of how screwed up access and the weirdness of US healthcare and pricing. Even “good” insurance pays pretty poorly for mental services for the level of training and supervision it takes to get good at it.
posted by roguewraith at 1:06 AM on January 23 [10 favorites]

My experiences with BetterHelp were not very good, One
therapist kept canceling at the last minute but the billing still went through. I eventually got my refund, but it was a frustrating experience. A second therapist was good at listening and mirroring my words back to me, but no attempt to address behavioral changes, which is what I repeatedly asked for.

I get the feeling that it’s for people who have never had therapy before and need someone to talk to, but not a replacement for previous standards of care for those of us with complex mental health histories.
posted by Jon_Evil at 3:48 AM on January 23 [5 favorites]

BetterHelp has been the target of a ton of complaints on Reddit, enough of which make me think that it's actively harmful as opposed to merely a ripoff. Young gay guys being told that homosexuality is a mental disorder, young women with therapists who expose themselves. Even if you're not retraumatized by your therapist, you can still get a therapist who "takes an appointment" while they're driving somewhere else or, as JonEvil had, someone who keeps cancelling or is a coach, not a therapist. And it's still $65 a week out of pocket at least, which is a ton of money for the intended audience.

Whenever I hear the ads on a podcast I trust the podcast that bit less.
posted by kingdead at 3:52 AM on January 23 [18 favorites]

Is there an Internet-based therapy product out there that isn't awful?
posted by Nelson at 7:25 AM on January 23 [2 favorites]

the phrase "therapy product" entertains me. there's an implied relationship there: therapy is to therapy product as cheese is to cheese product.
posted by bombastic lowercase pronouncements at 7:32 AM on January 23 [14 favorites]

You can definitely get internet-based therapy that isn't awful. I did, when I was living in a small town in Iowa and wouldn't have been able to commute to Ames or Des Moines weekly for therapy. But I don't think it's possible to do a gig-economy venture-capital-funded Uber for Therapy and have it go well; how are you going to give investors a return on their investment without paying therapists so badly that the good ones defect as soon as they can?
posted by Jeanne at 7:45 AM on January 23 [10 favorites]

You get the behavior you incentivize for. But if you encourage more patients/day and higher ratings you're putting therapists in a no-win situation. Something's gotta give and quality is likely it.
posted by tommasz at 8:24 AM on January 23 [2 favorites]

Is there an Internet-based therapy product out there that isn't awful?

The thing is, there are remote therapists that are just your usual roll-the-dice professionals - my mother is one, she never went back to in-person after 2020 - and some of them even take insurance. But insurance is so shitty on mental health for the therapist, too, that there's not much incentive for them to take it and a huge incentive not to. Reimbursement rates don't get adjusted with cost of living/inflation, certainly not with supply/demand, and the administrative burden is enormous. My mom has to pay someone else to do her billing just to get - she calculated once - payment for 50% of the services she has rendered, and some of the insurance companies pay something like $45/session.

She's 78, can't afford to retire, and may never be able to. She still takes insurance, though, because she can't stand the thought of abandoning all her clients that depend on it. It's a shitty situation all around.
posted by restless_nomad at 8:49 AM on January 23 [15 favorites]

It sounds like this maybe isn’t common, but personally I have had two separate, very positive experiences seeking CBT through Talkspace. I had one neutral experience.
posted by samthemander at 9:18 AM on January 23 [2 favorites]

likely cbt is the modality least bad for this context. i just have beef with cbt (this beef is downstream from my beef with the stoics, and i will never stop beefing with any stoics unfortunate enough to be in my vicinity).
posted by bombastic lowercase pronouncements at 9:22 AM on January 23 [2 favorites]

Their sister site sees minors, and the paper I wrote at Loyola thinks they are not prepared for the responsibility nor the fallout from failing to mandatory report child abuse and neglect. I believe we will see a lot of lawsuits from this.
posted by lextex at 9:28 AM on January 23 [3 favorites]

I tried both BetterHelp and Talkspace. In both cases, I found it to be a mighty struggle to identify a therapist who didn't trigger alarm bells. Frequently, it was just a dogwhistle in the person's bio alluding to their "Christ-centered practice" or "strong faith in making our country great again" or some such nonsense.

I found two counselors who seemed to fit the bill, though--one on each platform. One was based in Hawaii and closed her practice after I met with her once. I hope I wasn't the final straw for her. Another was in New York and pushed (too) hard for me to sign up for a separate "life coaching" service.

Then, of course, the FTC got involved, and I was done with my online therapy adventures.
posted by yellowcandy at 10:08 AM on January 23 [5 favorites]

The one thing I will say for Betterhelp after trying it out for a couple months, is that it offers many different group therapy options on a wide variety of topics.
Going to group therapy in person seems really intimidating ,but signing in from the comfort of home and being able to see people going through the same thing was really effective for me personally.
posted by winterportage at 5:04 PM on January 23 [2 favorites]

I could see online being much better for group sessions than in-person, although I have never gone to a group therapy session. Just intuitively, it feels like it might be built for that on some level.
posted by hippybear at 6:03 PM on January 23

I tried Betterhelp back in the pandemic.

The huge advantage it has over the usual alternatives is that you can really start talking to somebody in a day or two whereas finding a therapist today is often: signing up for a waiting list for six months to only get online appointments, getting ten referrals from your primary care doc and finding most don't answer the phone and the others aren't taking new patients, or sending an e-mail to someone who wrote a review paper about your common but obscure neurodevelopmental condition asking for a referral and finding they can't do any better than your primary care doc, etc.

I had one therapist with Betterhelp who I got along very well with but was working at home where she had a child and missed a few appointments, something that didn't bother me because we could reschedule easily. She got kicked out for tardiness.

I did not get along with my second therapist at all, something I found entirely unprecedented but was probably my fault because my "evil twin", the construct in the upper left corner of this diagram

https://mastodon.social/@UP8/111687412198643478

was out in full force. She was into some hokey stuff like the Myers-Briggs type indicator but was perceptive enough to almost immediately make observations that made me get my Kohut books off the shelf and print that card. She had a kid in the house too which might not have been good considering the subjects we talked about.

I think they have very high turnover from therapists not being able to follow the rules.
posted by devonianfarm at 4:35 PM on January 26