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talkspace therapyTalkspace therapy claims were challenged in an August 7, 2020 article published in the New York Times. Writers Kashmir Hill and Aaron Krolik raised several concerns about “text therapy” as offered by the online employer of behavioral professionals called Talkspace.  Issues of concern outlined in At Talkspace, Start-Up Culture Collides With Mental Health Concerns include:

  • Whether or not text therapy is therapy as claimed by Talkspace
  • Whether the Talkspace therapy model has clinical effectiveness
  • Confidentiality issues within the company
  • Examination of the content of therapist/client text conversations to develop marketing strategies and unethical marketing practices

Is Talkspace Therapy Really Psychotherapy?

The free-flowing format of text therapy is at odds with the traditional “frame” of psychotherapy with its regular, scheduled meetings that have a clear beginning and ending with which to measure progress. Texting historically has been used primarily for social purposes, is short, and often has a time gap between responses. Up to 2018, the Talkspace user agreement stated: “This Site Does Not Provide Therapy. It provides Therapeutic conversation with a licensed therapist.” Although that statement has since been dropped, the services are still advertised as “ text therapy.” The evidence base related to the clinical benefit of text-based therapy is sparse. Much of what exists is based on client satisfaction surveys, according to a representative from the American Psychological Association.
The Clinical Social Work Association (CSWA) has also made a number of observations that question the types of interactions offered by the Talkspace text therapy app. In her article, LCSWs and the Use of Texting in Mental Health Treatment: Responsibilities of the LCSW Providing Text Therapy, Laura Groshong, AM, LICSW, Policy and Practice Director of CSWA, discussed the question of whether or not text therapy is actually psychotherapy given that psychotherapy is “a continuous process based on an established emotional relationship and ongoing dialogue between two people in real-time about complex issues with deep emotional content.” She asserts that texting is not consistent with a dialogue based on emotional meaning. She suggests that texting can be useful because it is highly popular with a large part of the population, but it might be better conceptualized as “text assessment or text coaching.” She stated that it might also be a way to start an ongoing relationship that could be converted to in-person video sessions if continued therapy is warranted.

Talkspace Text Therapy’s Corporate Use of Client’s Confidential Information

The New York Times article questions the services offered by the Talkspace text therapy app, and asks if those services are more driven by profit than clinical assistance. More specifically, concerns are raised about the confidentiality of client information contained in text conversations with therapists and  Talkspace’s use of the information to drive marketing practices. The article’s authors point out that some employees told them of the company engaging in “questionable marketing practices and regard treatment scripts as another data source to be mined.” An employee reported that he used the text therapy app service and was asked by the company to use transcripts of his messages to share at a staff meeting, with the understanding that his identity would not be revealed. He agreed, and somehow other employees did find out the shared information was from his own text therapy.
While users of Talkspace therapy app are promised their conversations will be safe and confidential, “users can’t delete their transcripts and the privacy policy states the information may be used by the company for the design of the website and in research and analysis.” Former employees and therapists reported to the article’s authors that individual user’s conversations were reviewed and scrutinized for “insights.” A former therapist reported she was surprised that the company contacted her after she gave a client a resource link outside of Talkspace and was told to keep clients within the app. Clearly her conversation was being viewed.

Questionable Marketing: Mixed Messages to Therapists and Clients?

Talkspace offers a service that allows clients to demand a response to their text-based question within a specified amount of time. In essence, a therapist is on call throughout the day, and their pay can be docked if they don’t respond in a timely manner. Former employees contributing to the New York Times article reported that they were not informed of such penalties ahead of time.
Further, several employees stated that in 2015 and 2016 the company asked its employees to write positive reviews, and in fact, one employee was asked to compile “100 fake reviews” so that other employees could submit them to app stores. Supposedly employees were given “burner phones” to use to submit the reviews or to give 5-star ratings. Talkspace lawyer Mr. Riley was cited by the New York Times article as stating “To be clear: We have never used fake identities or encouraged anybody to do so. There is no event involving burner phones….”

Talkspace Therapy App Founders Respond

The founders of Talkspace, Roni and Oren Frank apparently responded to the above-mentioned article. In Talkspace Founders Respond to a New York Times Article, the founders claimed that the employee whose chats were the basis of the dramatic reading in a staff meeting gave explicit permission for it to be shared, and he revealed his identity to many others. Further, they deny the existence of  “ burner phones “ for faking reviews, although they acknowledge that they did ask their employees to review Talkspace since the service is offered to employees. The Franks also confirmed that they analyze encrypted and de-identified data to look for risk-related language or inappropriate behavior. They acknowledged that there are other keywords or phrases that are searched, for example, to identify therapists who may be trying to solicit clients away from Talkspace.

Questions to Ponder

  1. How confidential are messages sent between clients and therapists during text sessions?
  2. How is client/therapist information used by companies offering this service…. for improving company profits through marketing strategies or enhancement of client service?
  3. Is texting an adequate mechanism for delivering ongoing therapeutic services given its nature of being short and intermittent communication between a client and therapist? Where’s the research?

Talkspace Validity Studies?

From our perspective at the Telebehavioral Health Institute, despite our best efforts to carefully consider the few journal articles published about the Talkspace model, or to speak with Talkspace staff directly about the veracity of their claims regarding the efficacy of their text therapy app, we found their claims to be suspect. When speaking with the Talkspace Quality Control Managers about an invitation to moderate a panel featuring one of the Clinical Directors of Talkspace at an American Psychological Association convention, the Quality Control Manager was unable to explain how Talkspace clinicians are trained to collect informed consent. To be clear, the definition of legal informed consent is that it is a discussion that leaves the clinician reasonably assured that the client/patient understands the risks and benefits of the treatment being undertaken. Any paperwork exchanged simply documents that the discussion took place, and is not a replacement for that essential discussion.
Furthermore, we found the Talkspace staff to be defensive in multiple conversations, and unwilling to give details of, for example, how many of their clinicians actually use the video options claimed to be at the clinician’s disposal. Our position is that if such is the case, the natural next question would be how many of the clinicians are actually using video vs texting. Answers to this question were not available.
Last we looked, in 2019, we found three published articles related to Talkspace text therapy app’s model. Two described their populations as “mixed.” Definitions of “mixed” were missing. While these feasibility studies exist, we have been unable to find any validity studies. However, being open-minded, we now formally are extending an invitation to anyone more familiar with their studies to provide citations for validity studies in support of the Talkspace claims. Also of interest are the models offered by Better Help or other such text-based behavioral companies offering their interventions to consumers and employers through the Internet. If anyone has supporting evidence for either of these models, please paste in the comment box below for community review.
Let’s have a community discussion of the literature.