Online Therapy Apps

Online Therapy Apps

Curt and Katie chat about online platforms that hire clinicians to provide therapy through their apps. We look at how companies like Talkspace and BetterHelp operate related to their workforce, customer data use, and effective client care. We look at the potential for increased mental health access. We also talk about the risks as well as ethical and legal concerns that clinicians may face if they choose to provide services through these apps.

It’s time to reimagine therapy and what it means to be a therapist. To support you as a whole person and a therapist, your hosts, Curt Widhalm and Katie Vernoy talk about how to approach the role of therapist in the modern age.


Click here to scroll to the podcast transcript.

In this episode we talk about online therapy apps:

  • The different telehealth platforms that hire therapists
  • The boundary and privacy issues identified at Talkspace from a NY Times article
  • The use of customer data

“It seems like [TalkSpace] is very business focused, rather than clinical efficacy focused.” – Katie Vernoy, LMFT

  • Clinical efficacy
  • Risk and liability issues related to incorporating Artificial Intelligence into treatment
  • How the platforms work on the clinician side, how clinician gets paid
  • The packages that clients get on word limits, etc. where they may have to renew early to continue treatment
  • The potential clinical issues with how therapists get paid in these apps
  • What is incentivized for therapists on these platforms
  • The boon to mental health access and treatment flexibility from these apps, including text, phone, and video (synchronous and asynchronous communication)
  • The caution about these apps growing beyond their capacity to serve clients
  • The types of clients who are good candidates for these platforms

“But the anonymity piece of these platforms is something where you may never know where your client is located, what their full name is, how to get in touch with them in the event of an escalated emergency.” – Curt Widhalm, LMFT

  • The concern about clients being anonymous to their therapists
  • Managing escalating risk without sufficient information
  • “Counselor” versus “Counseling” services, which provides some cover related to requirements for therapy services and for employee concerns

“BetterHelp provides counselor services, not counseling cervices…this seems to be a distinction between actually being responsible as a company for mental health stuff versus giving something in the flavor of a mental health direction.” – Curt Widhalm, LMFT

  • The potential for practicing across state lines
  • The Talkspace memo about practicing across state lines and the app paying for legal fees
  • The legal and ethical risks for practicing across state lines, no matter the help from Talkspace
  • Rating manipulation – false reviews

Our Generous Sponsor:


Running a private practice is rewarding, but it can also be demanding. SimplePractice changes that. This practice management solution helps you focus on what’s most important—your clients—by simplifying the business side of private practice like billing and scheduling.

More than 60,000 professionals use SimplePractice —the leading EHR platform for private practitioners everywhere – to power telehealth sessions, schedule appointments, file insurance claims, communicate with clients, and so much more—all on one HIPAA-compliant platform.

Get your first 2 months of SimplePractice for the price of one when you sign up for an account today. This exclusive offer is valid for new customers only.

Go to to learn more.

Resources for Modern Therapists mentioned in this Podcast Episode:

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below might be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

Talk Space NY Times Article

Reddit Thread: Therapy Platforms

Reddit Thread: Better Help, Talk Space, Lyra

Psychotherapy Notes: Artificial intelligence isn’t ready to do therapy (yet) [Updated]

YouTube Video on BetterHelp from The Situational Therapist

Talkspace Memo: Practicing Across State Lines


Our Linktree:


Relevant Episodes of MTSG Podcast:

Toxic Work Environments

Making Access More Affordable

Who Gets to Have Therapy?

Therapy of Tomorrow

Who we are:

Picture of Curt Widhalm, LMFT, co-host of the Modern Therapist's Survival Guide podcast; a nice young man with a glorious beard.Curt Widhalm, LMFT

Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, former CFO of the California Association of Marriage and Family Therapists, an Adjunct Professor at Pepperdine University, a former Subject Matter Expert for the California Board of Behavioral Sciences, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at:

Picture of Katie Vernoy, LMFT, co-host of the Modern Therapist's Survival Guide podcastKatie Vernoy, LMFT

Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also Past President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at:

A Quick Note:

Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement:


Buy Me A Coffee

Podcast Homepage

Therapy Reimagined Homepage





Consultation services with Curt Widhalm or Katie Vernoy:

The Fifty-Minute Hour

Connect with the Modern Therapist Community:

Our Facebook Group – The Modern Therapists Group

Modern Therapist’s Survival Guide Creative Credits:

Voice Over by DW McCann

Music by Crystal Grooms Mangano

Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

… 0:00
(Opening Advertisement)

Announcer 0:00
You’re listening to the Modern Therapist’s Survival Guide where therapists live, breathe, and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

Curt Widhalm 0:15
Welcome back modern therapists, this is the Modern Therapist’s Survival Guide. I’m Curt Widhalm with Katie Vernoy. And we have had a couple of our listeners reach out to us and say, Would you guys do an episode on working with some of these online telehealth platforms: Talkspaces, the BetterHelps, the other various platforms that look like this. And this also came at a time right around August when we became aware of a New York Times article that we’re going to discuss here in a little bit about some stuff going on over at TalkSpace. And it also gave us a time to reach out to our modern therapists community and get a little bit of background information here about the ins and the outs of this. Now, I think it’s important to say at the top of this that neither of us have worked for one of these platforms before. That this is kind of a collection of data here. This is either information that we were able to source on the internet, we did reach out to a couple of people who spoke to us on terms of keeping their identities anonymous based on the some agreement stuff in the background. So we actually did some journalistic kind of stuff for this episode. But I want to start from, you know, kind of when we first got reached out to of some of the reputation stuff that I have been hearing all along about these places. And that kind of led some of the questions that that we have gone with. Now I have heard some of the reputation of goods and bads. These services have provided some opportunities for people who might not normally seek out mental health services to actually get access. But I’ve also heard some concerns of these platforms might not let therapists know all of the things that you might need to know about a client. Like the severity of their mental health needs, their actual names, their locations, and about…

Katie Vernoy 2:21
Those are things we’re supposed to know, right?

Curt Widhalm 2:23
Things that we would seemingly know and are supposed to know. And I’ve also heard that pay isn’t very good. And I think in being able to provide some of this information that was kind of the starting point of where we started looking. And boy, did we find a lot of stuff.

Katie Vernoy 2:46
Yeah, I think I think we can dig into stuff, I don’t have a lot of reflection as far as the reputation part. But I, I have heard some some positive things about access. I’ve also heard positive things from clinicians who have used it as a way to start private practice or start growing and having a little bit of income. I think it’s something where the sustainability and the the work just doesn’t line up for folks for too long. And so I think, you know, let’s dive into what we actually found. But I think that was the reputation that I had heard that it was a good tool at a specific time in someone’s career, it was a good mechanism for access for certain types of clients. But yeah, there’s other problems.

Curt Widhalm 3:28
So I’m gonna start with the New York Times article, this was published on August 7, 2020. And it’s titled ‘TalkSpace Startup Culture Collides with Mental Health Concerns.’ And this goes through a very fascinating read about a person who is a TalkSpace customer, and then eventually ended up working for the company. And during this time as a, quote unquote, training sort of thing, he was approached to have the transcripts of his sessions read in front of staff. And he agreed based on some, you know, keep this thing anonymous and it was overplayed and kind of, you know, bringing up some very intimate details.

Katie Vernoy 4:20

Curt Widhalm 4:21
And definitely led to a lot of embarrassment. He ended up suing TalkSpace for some discrimination, wrongful termination stuff that arose out of this.

Katie Vernoy 4:31
Actually, I want to correct you there because he stayed for another two years.

Curt Widhalm 4:34

Katie Vernoy 4:36
But there was there was was other stuff that they were trying to claim when he was terminated.

Curt Widhalm 4:42
Well, and they were pulling stuff from his sessions in backing up that his anxiety and his depression was impacted. So flags so far that we’re seeing is these conversations are accessible by more than just the therapist. These are things that the people in the tech end of things can just pull up. And that this is information that so far in this story seems to be being used against people when it’s convenient for the company. Now, this is a situation where somebody actually went and worked for TalkSpace.

Katie Vernoy 5:20
Well, and they argue that he had consented to having his sessions read in front of folks, and that he had told people, but he said, it was more than it had gotten out. And so then he just took ownership of it. But I think the piece that I that really sticks for me and in the whole article is that it really is about seeing clients as data.

Curt Widhalm 5:44

Katie Vernoy 5:45
Because I think there’s there’s use in relationship to potential, you know, kind of what does the data tell us? You know, what can we learn from the data, how we can, how can we, you know, create better products and services from the data. But there’s also this type of data that seems to have been used against an employee, which sounds like it might have been kind of a unique experience, but I don’t know. But there’s this other piece in that article about the therapist, who it was actually this guy’s therapist, but I don’t know if it was for him, had sent out a an anxiety worksheet, it was pinged. And she got notice that she should not be sending folks out of the data, out of the TalkSpace platform, which is a business practice like: Don’t, don’t lose our you know, don’t send them off of our landscape, you know, make sure you keep them in the app, you know, that kind of stuff. And it seems like it is very business focused, rather than clinical efficacy focus.

Curt Widhalm 6:45
So we’re, I want to come back to that point a little bit later in the episode, as far as worksheets and stuff through here. But I want to go back to your collecting data points. And this comes from Reddit user you slash false insights, and talking about the perceptions of what a company like this might be using data for. And this user imagines that their data mining is being developed for AI to potentially develop an app that kind of cuts the human aspect out of this therapy response in the first place.

Katie Vernoy 7:21
Oh, dear.

Curt Widhalm 7:22
Which, when you consider how much we all disagree on what the human experience is, and all of our various unique approaches, boiling this down to AI may not be the best thing, especially when we take into aggregate some of the other concerns of these platforms.

Katie Vernoy 7:38
The idea, and I think it could be a noble idea, but I think it’s a misguided idea is if somebody is texting at 3am I don’t think it makes sense that a therapist should have to respond within minutes at 3am. Whether that’s part of the model or not. You know, I’ve talked to a lot of DBT therapists that are like I don’t respond at 3am I’m sleeping and I wait till I’m and wise mind until I respond those kinds of things. Whereas an AI could read the comment and be able to, for example, send out emergency response or be able to, you know, do say words of encouragement or something that might be very beneficial to someone’s in a really dark place at 3am. However, what you just said about having a response from an AI at 3am that is built upon an aggregate of data from a hugely diverse population of people, and may not be aligned to a level of of clinical need that someone at 3am might have. It can make things worse. I mean, I think the liability for a company like this would be gigantic. So I just, you know, I get worried about those things.

Curt Widhalm 8:49
So our friends over at This is our good friends over at Ben Caldwell Labs, their blog sites had an article by Jeff Liebert in March of 2019, kind of on this AI stuff. And this was being showcased. This is a program called Mitsuku. But in testing out where AI stuff was done, this is two years ago, which is like eons in tech stuff. But Jeff Liebert, the author of this blog, wrote about trying this out and started with ‘I am suicidal, I want to kill myself.’ And the AI’s response was, but that would be stupid. There’s always a way to sort out your problems.’

Katie Vernoy 9:35
Oh, no.

Curt Widhalm 9:37
So Jeff tried again and said I’m thinking of death and the AI responded with that’s a bit depressing. Wouldn’t you like to discuss something more upbeat like celebrity gossip?

Katie Vernoy 9:48
Oh, no. Oh, no.

Curt Widhalm 9:52
So this AI thing can be potentially really, really scary. But there is so much more to cover in this episode. Because…

Katie Vernoy 10:00

Curt Widhalm 10:01
That is, that is kind of the the really big thing in here. But I think it’s important to talk about, like, what is being sold to consumers, and how that ends up playing out to the therapists who work for them who work on these platforms? Now, across many of these platforms, it seems that they have a monthly fee, you know, for certain dollar amount, you get certain access, you get, you know, either so many video sessions, or what seems to be really popular with a lot of people is these text sessions. There’s a YouTube video that we’ll link in our show notes at is from the situational therapist, he’s a MFT, that describes his experience working with BetterHelp. Now, and this is it corroborated by a couple of the other interviews that we have done with our modern therapists. But when a client reaches out to a therapist, they are only allotted a certain number of words per month, in order to tell their story and what’s going on. And situational therapist says it’s 7500 words a month.

Katie Vernoy 11:13
And this is on the client side or the therapist side?

Curt Widhalm 11:15
Both. And so if and therapists are paid by the amount of words that they write back, so there’s a motivation, especially early on in the month, to write a ton back to your client in order to get paid. But once you hit that cap, there’s no more responding, there’s no more sending from the client side more information to the therapist. And so you could potentially burn through 7500 words in just a couple of sessions. And then you can no longer contact that therapist for the rest of the month, or you have to upgrade your plan.

Katie Vernoy 11:53
Oh my gosh.

Curt Widhalm 11:54
Or you can find a new therapist and start all over.

Katie Vernoy 11:59
With a new 7500 words.

Curt Widhalm 12:02
With a new fee, that you now have to share your whole story again, thereby us using up a lot of the words. Now, all of the therapists that we’ve talked to and shared in this video, situational therapists describe this a little bit more concretely than anybody else did, but said that, as a therapist working for these, and we directly asked, What do you get paid working in one of these platforms? And most of the answers were this really pregnant silence of I’m not really sure how to describe it, and I’m not really sure that I understand it, because you get paid so much per so many words, that you respond back to a client. You have to have, like a certain percentage of the clients and this many words, like you can’t just like, you know, copy and paste a bunch of things, you know, you say, how are you? How are you today, and the client says, Good, you can’t send like, you know, 1000 word thing that you just have copied and pasted ready to go, like, you know, there’s some sort of, you know, limitations within the algorithms of appropriate level of responses. But you get paid so much per minute of video sessions, you get paid so much per minute of phone calls. But unless you meet a certain payments thresholds over the course of the month, they don’t pay you. That you have to have like, you know, you have to have earned like at least $100 a month on your client. So you can’t just like pick up one and like, you know, do just a couple of video sessions and you know, type a bunch of stuff back. Like you have to see enough clients to actually have them pay you out.

Katie Vernoy 13:41
So they don’t pay you. If you don’t hit a certain threshold.

Curt Widhalm 13:45

Katie Vernoy 13:46
I mean, was like 100 something you made up? Or is that a real number?

Curt Widhalm 13:49
That was just something that I made up just now. But it wasn’t…

Katie Vernoy 13:51
So it could be, it could be $500? It could be $400? It could be 50? It’s hard to know.

Curt Widhalm 13:56

Katie Vernoy 13:56
But, but so you could end up working for free?

Curt Widhalm 14:00
Yes. So if you make $99 in the month, they don’t pay you you start over the next month.

Katie Vernoy 14:04
Oh my gosh. Yeah.

… 14:12
(Advertisement Break)

Katie Vernoy 14:12
I mean, I think there’s, there’s, there’s different avenues to take this right. So there’s and maybe I don’t know, if you want to start with the worker issues. There’s also clinical issues related to this.

Curt Widhalm 14:25
Oh, yes.

Katie Vernoy 14:26
Where do you want to start with this? Because like I…

Curt Widhalm 14:28
Oh, the clinical issues are gonna come right back into the worker issue. So let’s start with the clinical ones. Go ahead, because I will share the stories of the people that I talked to.

Katie Vernoy 14:37
I’m just getting…

Curt Widhalm 14:38
Katie is, Katie’s doing that thing where it’s like, you pinch your nose and it’s just like, where do I go next with this like?

Katie Vernoy 14:48
Okay, so, so as a, as a clinician, I have a client who doesn’t talk very much and one word answers and it’s I don’t even know where to go with it. Like, we look at the clinical side being assessed on the number of words used, or the number of minutes in a session or whatever it is, like, the minutes in the session, like that’s billing in most formats, right? Like, I worked in a Medicaid system. So I know that we actually build by the minute, so, okay, that kind of makes sense. You know, obviously, there’s, there are people who do that in a legitimate way. They have a treatment plan that makes sense. And then there are folks who do it in a way and I think we joked about this in one of the burnout system burnout machine episodes around, you know, are one of the more toxic work environments, something where it was like, your crisis is my productivity and people would, you know, not create crises, but would you know, like, okay, great, I’ve got billing, you know, and so I can see that when a specific number of if it’s truly by the minute, if it’s truly by those those types of things. It can start to feel a little predatory at times when you’re looking for places where you can bill minutes. But that’s not a new thing. So this word thing, though, this is, this is so strange, because like I think about for myself, and for you, like I would be paid more, because way word-ier.

Curt Widhalm 16:14
I’m so verbose.

Katie Vernoy 16:17
I’m, like, super verbose, and like every once awhile, I’ll like send you a text, and you’ll like respond back like, Okay. I think like I think about clinician by clinician, it’s going to be different. People may start saying more, and using more of the words so that they can get paid. And really, you know, especially with the clients that don’t, that aren’t really wordy, you’re going to want to try to like, get paid enough. So then if you’re using more words, it could be really off putting for the client. I just, like I don’t understand that model. Especially if there is a, if there’s a basement and below that you don’t get paid. Like it just it sets it up for people to do work that is focused on getting paid versus focused on the clinical work.

Curt Widhalm 17:04
So getting into more of the complexities of the pay here. One of the things that one of our modern therapists was telling me is when they were working was when their platform had first started developing worksheets for clients to use within the platform. And this goes a little bit back to what you were bringing up earlier with it. So this was a couple of years ago, and this person admits that things may have changed since this time. But part of the payment structure is a worksheet is worth so many words towards your word count for the month. That you goes towards, you know, you’re alright, you’re using more words, you get paid more. But you also get to count within those worksheets, how many words your client is using in answering the questions on the worksheet towards the word count cap. So if you have a client that is extremely verbose in those questions, guess where that’s coming from? Their monthly word allotment.

Katie Vernoy 18:03
Oh, wow. It’s kind of like the pharmaceutical reps that are like here, here is medicine, and will incentivize you to give this medicine. I mean, it’s it’s also an access issue, if people are using extra words. And for therapists, how much easier is that? Right? You just give them a worksheet and they go off, they do something, hopefully, it’s helpful, but you get paid. Because there’s a whole bunch of words in that. But I’m thinking about is that the right worksheet for that client, like, clinicians can start walking a line on some ethics around and clinical efficacy around some of this stuff it’s just like, how do I get paid without burning out?

Curt Widhalm 18:48
So this goes to next the accessibility thing for clients, because we’re seeing these platforms being advertised everywhere. And truth be told, Katie and I were reached out to have one of our sponsorships by one of these platforms. By a company that they, you know, contract out to, yeah, wasn’t directly with the company. And we’ve had some of these concerns. And we said, you know, Hey, before we get into an agreement with you, we’d like these concerns to be, you know, answered. Is there a way that you can answer these concerns? And we never heard back from them.

Katie Vernoy 19:26
Well, we actually sent them a link to schedule time to meet with us. And like we actually give them our calendar link.

Curt Widhalm 19:32
Yeah, so..

Katie Vernoy 19:32
To talk about it.

Curt Widhalm 19:33
So this is partially where we, you know, look out for you guys that are our listeners and know that the people that we partner with are people that we vet. But we are you know, we have these concerns and they gave even them an opportunity to help clarify some of these concerns for us.

Katie Vernoy 19:54
To no avail.

Curt Widhalm 19:55
To no avail.

Katie Vernoy 19:56
But still, we’re keeping our will keep we keep an eye out.

Curt Widhalm 19:59
But speaking, they are advertising everywhere. And one of our modern therapists that was speaking to me brought up that these programs do actually provide good access. And there is a sizable chunk of the population who are accessing mental health services in ways that they never have before. And it’s for people who maybe have non traditional hours that can use the asynchronous versions of texting back and forth that have even personally received their own help very, very well. And it convinced them enough to actually become therapists on one of these platforms. But each therapist also gets rated and reviewed by their customers, or their clients, and amongst the myriad of things that they get rated on are responsiveness. And so those 3am clients that Katie was bringing up for DBT, that send five or six messages in the middle of the night, while people are doing reasonable human things like sleeping, that you’ll wake up in the morning, and you’ll have a zero star review from your client, because you didn’t respond in an appropriate amount of time to your asynchronous conversations to them, which then affects your availability to match with other clients.

Katie Vernoy 21:17
Yeah, and I actually went on the Better Business Bureau and looked at a couple of these platforms, and a lot of the consumer issues, which is, you know, clients, right, is about a lack of accessibility that they they sent messages, it was days and days, no therapists responded, their membership didn’t work, because they were not, you know, their, their clinician went on a vacation. Like, there’s just all these different issues around, I signed up, and I didn’t hear from my therapist or customer service for weeks. And so to me, you know, they are advertising everywhere. They’re providing access, sometimes or most of the time, but especially and I think there was in the, in the New York Times article, there was, you know, kind of this, well, the requests are going up, blah, blah, blah, you know, and it’s, I’m wondering if they’re outstripping their capacity by marketing to a whole bunch of folks that may have higher level of need than is appropriate to use this platform, these platforms.

Curt Widhalm 22:23
And I talked about this with one of the interviews in preparation for this, and the therapist that I was speaking to, described it as, this is a service that’s being advertised to a lot of people. And there’s many people who this ends up becoming the way that they seek out services. And they’re not good candidates for these kinds of services. They have a higher level of needs, they need more traditional therapy approaches, and run a greater risk. Now, from from the therapist side, you actually get a choice in who you match up with. And so if somebody is presenting in their initial questionnaire with things that you find questionable, you would have a reason or have a reasonable opportunity to not take them onto your caseload because of clinical concerns that you might have. But the anonymity piece of these platforms is something where you may never know where your client is located, what their full name is, how to get in touch with them, in the event of a escalated emergency. Now, there seems to be an opportunity to flag these kinds of situations up to the corporations that run this, and they would put things into the hands of local authorities or local psychiatric emergency teams that would be able to handle them. But only if it’s done through the system. And one of our therapists talked about being licensed in multiple states, and having the state authorities from one of the states that they did not live in, approach them, contact them and say, Hey, your client said that you’re providing services, we have a situation that we’re responding to here. And when the therapist reached out to the platform and said, Hey, did they get this information through you guys? And there was very little support from from the platform as far as being able to do anything about it. Hey, this is outside of our hands. This is you know, client must have given your information. The authorities can do this.

Katie Vernoy 24:40
And then I’m assuming still did not release information to the therapist on the client and the contact information and all those things. So the therapist has information, doesn’t know if it’s actually true, that they’re the therapist. It’s the same first name but could be that it’s not that their client doesn’t have any access in doesn’t have support from the platform that they use to work with this client.

Curt Widhalm 25:05

Katie Vernoy 25:06
Oh my gosh.

Curt Widhalm 25:08

Katie Vernoy 25:08
There’s just so, there’s just so many problems.

Curt Widhalm 25:11
And so this gets into another bit of the legalese, I’m gonna go back to the the situational therapist YouTube video, and as he talks in, in this video about the agreement that you sign up for as a therapist, and in in legalese based on all of the readings of, you know, going through all the fine tooth comb stuff that I’m sure we all do on everything that we signed up for… noted it, he was talking about BetterHelp in this situation, noted that better help provides counselor services, not Counseling Services. I’m not a lawyer. But I’ve done quite a bit of law and ethics stuff in my career. But this seems to be a distinction between actually being responsible as a company for mental health stuff versus giving something in the flavor of a mental health direction. The user agreement shared in this video goes so far as to say that if you need medical advice, or the counselor that you’re working with through our platform, gives you this advice, go ahead and ignore that because we provide counselor services, and that if you need an official diagnosis that involves an in person thing, you need to go someplace else.

… 26:33
(Advertisement Break)

Katie Vernoy 26:35
Is this kind of the same stuff that like Uber and Lyft and that kind of stuff are saying: that we provide an app that people can use to connect with folks, we’re not actually a driver driving service?

Curt Widhalm 26:49

Katie Vernoy 26:50
Okay. So this is also potentially because all these folks are contractors. And so they’re not employees, they’re contractors in a way, because we’re providing them with the capacity to, to meet with a client. However, they are taking on the liability of full name and all this stuff. So they’re there, they’re straddling some lines saying, well, there are customers who want to meet a counselor and have an ability to talk with a counselor, but we’re not going to give full we’re not going to let them pay the therapist directly, we pay the therapist, and we’re not going to give the therapist the full capacity to do treatment as they would do in their own private practice. Meaning information, blah, blah, blah, so So how it I mean, like that feels like, again, I’m not an attorney, either. But it feels like they are jumping through a lot of different hoops in order to be able to provide a service in this way. Without being able to I mean, like, like, it’s like, what does even the reason? I mean, I guess some people will want their anonymity, I get that. And that might be a big appeal to some of these platforms. But the issue is the therapist is unable to to comply with their own legal and ethical issues. But they’re also not necessary. Like, but they’re using a counselor app, not a counseling app. So so how does this even fly?

Curt Widhalm 28:23
Because these are tech companies that are matching…

Katie Vernoy 28:26
They just do whatever they want.

Curt Widhalm 28:27
…therapists with clients and kind of going off the judgment that therapists are going to end up being responsible for themselves.

Katie Vernoy 28:35
Without giving them the information.

Curt Widhalm 28:37

Katie Vernoy 28:38
Are therapists allowed to ask for that information?

Curt Widhalm 28:42
It’s up to the client to release this information to the therapist is my understanding of this.

Katie Vernoy 28:48
Got it. So the therapist is kind of stuck, and could potentially say, I’m not going to work with any clients unless I get all this information, but then they’re not going to get matched with any clients and not get paid.

Curt Widhalm 29:01
One of the questions that, you know, from the law and ethics side of things that I had also asked and was around, you know, this, is this being online stuff, is there ever any pressure to be matched with clients who are outside of the state that you’re licensed in? And this has been one of the concerns in the very robust and exciting psychotherapy, law and ethics worlds that is, frankly, Ben Caldwell, and I and a couple of other people having these conversations. We’re jurisdictional stuff really comes in, especially when it comes to these platforms. And I asked this in the interviews that I did, and to these companies credits, they ask for your license. They match you with clients, who are there at least in residency in the states, that during COVID times there was kind of this are you willing to take on now that there’s you know, some of these mandates being released to see clients in other places that gave therapists the option to enter into it. There didn’t seem to be a pressure to actually match out of states. One platform was described as also actually putting geolocation on both the counselor and the client side of things to ensure that there’s at least some sort of jurisdictional location stuff. So one piece that seems to be at least relieving my concerns in this is there at least respecting jurisdictional laws.

Katie Vernoy 30:29
So you say that, and it sounds like your your conversations with some of your modern therapists are very encouraging. But I just found this article on CNBC, and they were talking about an internal TalkSpace memo. And I’m going to read directly from this, and we’ll put it in the show notes, “online therapy provider talkspace, sent a memo to therapists asking if they wanted to join a group to work in many states, and offered to provide indemnification for denied insurance claims, and fund any legal appearances before state regulatory boards.” What does that actually mean?

Curt Widhalm 31:04
What? They’re, they’re given kind of this whole, like, go break the law and we’ll pay for it sort of thing.

Katie Vernoy 31:10
Yes, yes, that’s what I’m, that’s what I’m hearing.

Curt Widhalm 31:12
Don’t do this.

Katie Vernoy 31:14
No, no, don’t. No, I know, it’s bad. But you you understand the legal and ethical ramifications here. Like if someone were to do this, how would it impact them?

Curt Widhalm 31:26
So first of all, you’re, this might vary depending on which state you’re in or which jurisdiction but if you do get reported to a licensing board, you’re, you’re practicing in a potential other state without a license. Now, you can get in trouble in both states, you know, where you are licensed. And where you’re not for for doing this. But a you’re relying on TalkSpace, who actually follow through on paying for your defense, and whatever potential fines that you’re you’re going for here. But long term, this is also something where you have to check a box on every license renewal application and every malpractice insurance renewal that you have been investigated by a board. And that’s going to affect your malpractice insurance rates for the rest of your career. And if you don’t check those boxes, and they find out, you’re getting into lying to the government sort of penalties around, this could potentially affect you for the rest of your career. TalkSpace It seems like on this is banking on people not reporting their therapists for practicing across state lines.

Katie Vernoy 32:47
Yeah. Yeah. And I think it’s it’s difficult, right? Because I agree that there should be some sort of ability to to practice across state lines, if you’ve got clients who travel a lot, if there’s high need areas that are not well covered, even within their own state. This isn’t the way to do it.

Curt Widhalm 33:09

Katie Vernoy 33:09
And there’s, and there’s a lot of confusion there. And I think that, you know, even if people are not actively trying to skirt around this, these laws right now, you know, people are being inappropriately matched.

Curt Widhalm 33:22
Well, and I’m just also wondering about the precedent that this sets, you know, where, what if your employers just like, don’t worry about doing this, like, not just in this capacity of like, online platforms, but like, you know, go ahead sleep your clients will pay for your your defect.

Katie Vernoy 33:39
“We’ll indemnify you.” Like what does that even mean? How could they can’t do that? Are they gonna say like, oh, well, we made them do it. Like, I’m like, No, the Nazis were individually prosecuted. My employer made me do it.

Curt Widhalm 33:58
Stanley Milgram has a thing or two to say about this, right?

Katie Vernoy 34:02
Yes, yes. So in addition to this plan, I don’t know how to try to to, by force, change the laws or avoid the laws and help therapists to unsuspectingly put their licenses at risk and raise their malpractice insurance etc. for years to come. There are also issues and I was looking at the Better Business Bureau, there are also issues around people just being inappropriately matched. Therapists aren’t actually seeing these clients but clients are not being seen because they’re matched with somebody in a different state or that isn’t licensed in their state. And so they just keep getting pushed around. And there’s several different types of complaints in the Better Business Bureau around lack of access. That people are not getting seen by a therapist very quickly. And I get it it’s hard to navigate all those pieces and like you said, there’s some some things in place to help to ensure that the therapist is licensed where the person is residing. But I think that there are some big problems.

Curt Widhalm 35:09
And the last piece that I want to bring up because back to this New York Times article that talks about the reading manipulation that talkspace engaged in.

Katie Vernoy 35:18
Oh, yes, the false reviews.

Curt Widhalm 35:22
So when TalkSpace was first launched, it got some pretty middling reviews and la lot of three stars sort of aggregate averages. And the article goes on to describe how employees of company were given burner phones to manipulate the App Store and Google Store ratings of their app in order to drive the ratings backup. And, honestly, there was a question that Katie and I kind of looked at, as we were gathering information for this of like, we always appreciate your ratings and reviews and honest feedback from us. But you know, we’re two people, we have our little modern therapists community. But this is a company that seemingly gave out hundreds of burner phones and created…

Katie Vernoy 36:10

Curt Widhalm 36:11
…lots of free email addresses to have new credentials to log into these various appstore things. This is a very coordinated effort. And…

Katie Vernoy 36:22
Like, there was like a spreadsheet with potential reviews that people could use.

Curt Widhalm 36:26
Yeah, and instructions on how to not make these reviews seem like they’re all coming from the same place, sending people home to go do this so that the app stores wouldn’t flag it all come from coming from like, just the single office location that they had in New York City. So very coordinated effort there. And yeah, Katie and I talked about this like, are they gonna come after our ratings now. So that’s our call to action to you if you haven’t left us a rating and a review…so we appreciate your feedback. And but overall, the people that we’ve talked to said that these are platforms that are fine, if you are starting to end up, you know, going out launching on your own into a practice way of getting some revenue, while you might have some time, your time commitment is kind of set up for yourself. The pay is…

Katie Vernoy 37:19

Curt Widhalm 37:20
Not even not not even fair. The pay exists.

Katie Vernoy 37:25
Pay… there is pay you get paid.

Curt Widhalm 37:27
If you make enough money, you actually get paid. It’s a way of you know, taking on some some clients and being matched without having to do all the legwork of marketing your practice and that kind of stuff. But does the people that we’ve talked to have said it doesn’t seem to be a thing that you are going to fully make a income on solely working in this area. Obviously, Katie, and I have a lot of concerns about the data mining and the way that that information can be used.

Katie Vernoy 37:58

Curt Widhalm 37:58
It speaks to probably the next decade of where online psychotherapy is potentially going as it’s more and more in the interest of the tech world. We’d love to hear more of your thoughts and experiences with this. And you can always let us know on our social media. And we’ll include links to those in our show notes, and come join our modern therapists group over on Facebook, and we would love to hear those experiences there as well. And until next time, I’m Curt Widhalm with Katie Vernoy.

… 38:27
(Advertisement Break)

Announcer 38:27
Thank you for listening to the Modern Therapist’s Survival Guide. Learn more about who we are and what we do at You can also join us on Facebook and Twitter. And please don’t forget to subscribe so you don’t miss any of our episodes.

0 replies

Leave a Reply

Your email address will not be published. Required fields are marked *