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Forbes Journalist Essig Challenges Talkspace Instant-Messaging Therapy

You may have noticed a recent rash of new websites and their behind-the-scenes business developers offering a new form of digital therapy via text messaging and other minimal technologies. Many such companies openly strive to be “disruptive” of traditional models of behavioral care and are adamant that their innovative therapy approaches can improve services to the behavioral health community’s multi-billion-dollar market. In the process, some groups seem to be sidestepping traditional behavioral health legal and ethical requirements such as:
  • licensing laws limiting practice over state lines
  • informed consent
  • intake processes
  • assessment processes
  • mandated reporting
  • emergency planning and handling
  • continuity of care
 Most of these companies quietly disclaim responsibility for the legal and ethical mandates of licensed professionals by claiming they simply serve as a conduit between consumers and the professional, much like the telephone company. These claims are often not visible without taking a conscious detour to the website’s “Terms and Conditions” page. Rather, consumers often only are asked to toggle a box that attests to their being 18 years of age to immediately speak with a licensed therapist. Several such businesses are also filling licensed clinician’s mailboxes  with employment “opportunities” that rival the income of in-person practices. 
 

Why Are Clinicians Agreeing to Work with Unknown, Unseen, Un-assessed Consumers Online?

The appeal to a financially strapped or uninformed clinician is clear: work from anywhere you please worldwide, slash office overhead, avoid pesky intake and assessment procedures, have a steady flow of clients who are anonymous, avoid uncomfortable mandated reporting and don’t worry about emergency situations. The problem is, it is often not supported by reality. While one may wonder about the judgement of clinicians signing onto web companies who offer anonymous mental health care, across state lines, and void of the many precautions we traditionally provide in our in-person, licensed practices, the truth is that such web companies seem to be able to attract hundreds of clinicians. Whether they realize it or not, these professionals are often agreeing to offer services that are not only illegal, but unethical.  Furthermore, text-messaging alone for psychotherapy is an area that has scant empirical support.

Many of you will recall that in February, we at the TeleMental Health Institute posted an article about a series of new websites offering such therapies in Text Messaging for Counseling, Therapy & Crisis Intervention. Just a few years back, we also posted articles discussing Google’s attempt to penetrate behavioral health and other market with Helpouts, a service that has since been abandoned by Google.  The position we took in a series of 2013 and 2014 articles titled, How Might Licensed Professionals Think about Google’s “Helpouts?” and Why Online Practice Can Be Harmful  about such innovation was this:

 How licensed professionals adapt to the challenges offered by the advanced technologies such a Google’s Helpouts is a professional issue and not a technical one.

Who Is Working to Change the Situation?

Although a number of media outlets carry press releases from new online therapy business with great enthusiasm, some responses are not as positive. In two articles released in June 25 and July by FORBES, Todd Essig challenged Talkspace, a company offering anonymous service to the behavioral health community. In his first article, Talkspace Argues With Talkspace: Conflicting Messages And Clinical Risk and the follow-up, Should Buyers Beware? Hidden Risks In Talkspace’s Text-Only Therapy, Essig offers a detailed analysis of the website service and makes clear recommendations.
 
Professional community response is starting to become visible. For example, the American Psychological Association (APA) released a statement addressing several related concerns, including the lack of empirical validation for using text messaging alone for psychotherapy . In their June 25, 2015 statement, the APA clearly reports that, “At this point, there is no research suggesting that texting alone is an effective modality for psychotherapy.” Disregard of professional requirements is also being noted by licensing regulators. As reported last week, Georgia is now advancing legislation to require professional training before licensed Georgia clinicians can legitimately work online. For counselors, recently updated CACREP standards also require graduate education related to technology in a wide variety of areas. Such training will help many unwitting clinicians become aware of legal and ethical mandates to deliver professional care online. These clinicians then will hopefully be pointed toward the many legal, ethical and evidence-based models now available for online practitioners. (See this list of courses available to shed light on opportunities.)

What You Can Do

Your review of Mr. Essig’s articles or the Talkspace website are invited below. If you find any websites that you’d like our colleagues to review, please also list them below so we can have a look at them for ourselves. For a list of detailed suggestions for all innovative behavioral health companies, practitioners as well as consumers of such services, you may also want to see the press release on this topic by the Coalition for Technology and Behavioral Science (CTiBS), for which I serve as President.

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7 comments on “Forbes Journalist Essig Challenges Talkspace Instant-Messaging Therapy

  1. Thank you Dr. Maheu. I grew concerned about a start up website a friend pointed out to me called joyable.com. This website claims to “treat” people with social anxiety online however the providers are “coaches”. The team consists of people who are MBAs and “coaches”; no one seems to have a mental health background at all. Seems Silcon Valley is eager to get into the “space” without the regard or concern for actual quality of care of vulnerable individuals.

    • I haven’t looked into the website you mentioned, but I do find it fascinating to see what websites manage to say to consumers.

  2. I think Marlene is always on top of the technical, legal and ethical changes occurring in our, now increasingly emerging online, profession. I like that Georgia wants clinicians to take a six hour course before embarking on tele-counseling, or any other form of online treatment. In the very near future, I’ll most likely want to take the same course from Marlene for practice in California.

  3. As the article mentioned, clinicians often have “financial disabilities,” especially in more rural areas. I am seriously considering signing up with TalkSpace. I am experiencing some anxiety about this. “How much of a risk am I taking?” I ask myself. The governing board in Texas is not very specific on the guidelines for online therapy.

  4. I spent exactly 14 days on Talkspace, I paid for 30, but quit after realizing it is a very poor platform for so-called “Therapy”. I was offered a choice of Social Workers. That’s it. These are not psychologist as I soon found out. They are not much better than talking to a friend. What makes it worse? Talkspace is texting therapy. It can be easily mis-understood. Have you ever watched a Facebook fight unfold? Yep, mis-communcation.

    I recommend Talkspace for only light situations. For example, I went to the store and someone gave me a strange look. Am I crazy? Or my 15 year old boyfriend broke up with me. These situations may be do-able on Talksapce, but anything more and you should probably pay money out to someone with some real skills.

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