Geographic distribution is just one of the ways the mental-health profession fails to match the people in need of care: Doing so would also require more therapists who speak Spanish, more therapists of color, more therapists with LGBTQ expertise. Even in a therapist-rich environment like New York City, intangibles intervene. How do you find someone to whom you feel comfortable saying things you may feel uncomfortable saying at all? People seeking therapy face all these challenges even in the best of times, and these are not the best of times. According to a CDC report released last summer, 40 percent of American adults were dealing with mental-health or substance-abuse issues in late June, with younger adults, people of color, essential workers, and unpaid caregivers disproportionately hard-hit.
Accelerated by the pandemic, Zeavin’s subject has gone from an academic curiosity to a growth sector. Businesses in the “digital behavioral health” space raised $1.8 billion in venture-capital funding last year, compared to $609 million in 2019. In January, Talkspace announced plans to go public this year in a $1.4 billion SPAC deal. A presentation for investors managed to be simultaneously grim and upbeat in outlining the “enormous” market for its services: More than 70 million Americans suffer from mental illness, according to Talkspace, and the country has seen a 30 percent increase in the annual suicide rate since 2001. Talkspace says 60 percent of its users are in therapy for the first time. (...)
Much of what appears if you search “therapy” in the App Store does not provide the services of a human therapist. Some of it does not address mental health at all, in the strict sense: It is the digital equivalent of a scented candle, wafting off into coloring apps and relaxation games. Many services occupy an area somewhere in between professional care and smartphone self-soothing. Reflectly, for example, bills itself as “the World’s First Intelligent Journal” and promises to use the principles of positive psychology, mindfulness, and cognitive behavioral therapy to help users track their moods and “invest in” self-care. “Just like a therapist!! But free!!” reads one review. (Reflectly costs $9.99 a month.) Sayana, an AI chatbot, is personified as a pastel illustration with a dark bob and cutoff jeans; she also tracks the user’s mood and offers tips (“Observe your thoughts as they flow, just like the river”) to guide users on a journey through “the world of you.” “This is like your own little therapist and I love it!” reads one five-star review. Youper (mood tracking, chatbot, lessons) sells “Self-Guided Therapy”; Bloom (mood tracking, chatbot, lessons) is “the world’s first digital therapist.”
But chatbots and mood scores aren’t generally what people are imagining when they say, for example, that their ex needs therapy. “Therapy” here conjures an intervention to fix the personality and save the soul. Different people want different things from therapy. They want to break bad habits, work through trauma, vent about their boss, their boyfriend, their mom. They want to feel better (always easier said than done). They want someone to talk to, and they want some tools. When I resumed seeing my longtime therapist over video, I wanted her to tell me whether the problem was my brain or the pandemic — I needed someone I trusted to judge the situation. That is to say, I wasn’t sure what I needed, but I wanted the help of someone who knew better. And this — expert counsel in the palm of your hand — is what the high end of an emerging class of therapy apps claims to deliver.
“In 2021, mental health is finally cool,” declares a podcast ad for BetterHelp, one of the apps promising access to trained therapists that has promoted itself to consumers most aggressively. “But therapy doesn’t have to be just sitting around talking about feelings. Therapy can be whatever you want it to be.”
With a therapy app, more blatantly than in most health-care transactions, the patient is a customer, and the customer is always right. But this assumes patients know what they want and need and that getting it will make them feel better. These are not expectations most therapists would necessarily share — nor are they ones therapy apps are reliably prepared to fulfill.
A D.C.-area Talkspace user named Cait remembered getting off to a more auspicious start. “I was so excited because they give you all these therapists,” she said. “It was almost like a dating app.” Cait had signed up for the service after talking to a satisfied friend with a supportive Talkspace therapist who texted her all the time. Cait had recently started medication for depression; it helped, but she wanted to speak with someone regularly, and even with her insurance, she was worried about cost. She saw that Talkspace was offering a New Year’s deal at the beginning of 2021. If she used that and paid for six months up front, she could get half a year of therapy for $700. This seemed to her like quite a deal — far cheaper than paying out of pocket for conventional therapy but also far cheaper than what Talkspace might otherwise have been. While mood trackers and mindfulness apps can cost $10 or $15 a month, therapy apps like Talkspace, BetterHelp, Brightside, and Calmerry — ones that connect users to an actual licensed human therapist — cost hundreds of dollars. Without discounts (or subscribing for months at a time), a one-month Talkspace plan that includes weekly video sessions runs nearly $400. Particularly because the standard length of these visits is just 30 minutes, users are paying hourly rates that can approach those of in-person care.
Of course, many users aren’t paying out of pocket because, for many apps, users aren’t the customer at all. These apps, like Ginger and Lyra, focus on selling their services to employers or insurance companies.
by Molly Fischer, The Cut | Read more:
Image: Pablo Rochat
