Prior to launching my online private practice, I worked for a popular, low cost, online therapy site. I'll let you guess which one, but it doesn't matter. I'm willing to take a risk and assume that they all operate in a similar fashion.
The kind where a client can be lured in with a free trial, is promised 24/7 access to texting their therapist, and promised some level of anonymity (e.g., not sharing last names or phone numbers with the therapist). For a fraction of the cost, you get access to a therapist without having to show your face (unless you want to).
Purchasing these low cost options can be really tempting for consumers, especially for folks on a tight budget who don't have health insurance or mental health coverage. Articles such as this one will do very little to put a dent into the mammoth market that has exploded over the years.
But I still offer a word of caution to the consumer: using one of these sites and expecting to meet a therapist who will address your deepest mental health concerns is like going on Tinder and expecting to meet the love of your life….it *might* happen...it probably has happened...but it most likely won't happen.
Here's part of the problem. The selling points for the therapist and the selling points for the consumer are directly contradictory. Therapists are promised autonomy in setting their own schedules, seeing only the clients they want to see, and getting paid a respectable income.
For consumers, false ads are plastered all over the internet of real-time texting with their therapist like they're texting their best friend. Consumers are promised 24/7 access to people who are--to put it bluntly--getting paid absolute shit. Consumers are promised low cost options, and they are typically delivered. But what you are getting is most likely a therapist who is working way too many hours to just barely survive.
A little perspective: Community Mental Health is often considered bottom-of-the-barrel pay. But it often comes with a few perks. For me, the number one reason was the prospect of student loan forgiveness (via the PSLF). I'm not shy about admitting that I graduated $130,000 in the hole. And I have considerably less debt than my fellow doctoral level therapists. My second reason was the fact that my community mental health job came with excellent health insurance, which is a priority for most millennials.
But I digress. The main point is that we are among the lowest paid mental health professionals. These online therapy platforms are managing to pay even less than your typical community mental health job. Think about that. Low pay without health insurance, a retirement plan, or even the possibility of student loan forgiveness. All for the sake of working at home in your pajamas (which is another problem, but let's not go there).
Because of the low pay per session, therapists working under these online businesses are often encouraged to take on way more clients than are reasonable in order to make a decent living. The company I worked for offered 4-figure bonuses to therapists willing to run the hamster wheel with 30-50 clients.
Think about that...Any therapist who spends more than 10 minutes a day reflecting on their life will tell you that 30-50 clients is professional suicide. It might work just fine for a year or two, but it is a recipe for burnout. It's absolutely insane and I would never support a single one of my therapist friends if they decided to pursue this number of clients.
So when you sign up for these services, please understand that you need to set the bar low, REALLY low. It's a dice-roll. Maybe you'll get a therapist who's independently wealthy and keeps a small caseload and can dedicate the time and energy to meet your mental health needs and respond to your sporadic messages at 11PM. But you're most likely getting an overworked, underpaid therapist who's working entirely too hard just to survive who will answer your sporadic 11PM messages because they need an extra few dollars. There's no way this doesn't impact the quality of the clinical work. I spent hours on forums among therapists working for these businesses and even those who swear they are thriving are burnt the f*ck out.
As I mentioned, I'm just one therapist. I don't expect to put a dent in this industry; hell, I even think they have their place in the world. I just want to make sure people are informed about what they're getting. Don't walk into Walmart expecting to find a Coach purse. Don't go on Tinder expecting to meet the love of your life. Don't use a free trial on a therapy app and expect an afternoon with Brené Brown.
I'm not the only one calling bullsh*t on these apps
The Situational Therapist Derrick Hoard weighs in
The Modern Therapist Survival Guide Weighs in on Therapy Apps
For therapists considering working for these types of companies:
Note: This blog post was originally published on November 6, 2020 and was reposted with some revisions on June 18, 2021.