In a culture where nothing is official until it’s on Facebook and our iPhones are essentially an extension of our palms, the latest trend in therapy should come as no surprise. It’s called messaging therapy, and it’s like the Uber of mental health.
Services like TalkSpace and BetterHelp connect clients with licensed therapists, and the two can message back and forth via text message and e-mail instead of weekly or bi-weekly appointments. For $25 to $50 per week, often less than a co-pay, users receive unlimited messaging with their therapists. No insurance is needed, and users can speak with their therapists at any time.
“We are all texting all day. This is how people communicate today,” said Roni Frank, who co-founded TalkSpace with her husband. “We wanted to adapt therapy to the way people live today and to the way people communicate today so it feels very natural and very easy.”
And people are signing up. BetterHelp and TalkSpace, which both started three years ago, boast a client base of about 200,000 with ages ranging from 18 to early 70s.
“It’s been around for a few years and it’s amazing the way that it’s grown,” said Nikki Martinez, Ph.D., LCPC, a Psychologist, Licensed Clinical Professional Counselor and therapist on BetterHelp. “I think a lot of it is positive feedback. I think in the beginning people were wary but people are seeing it does benefit them.”
The numbers indicate it’s becoming more mainstream, which could be a good thing. Studies show about 1 in 5 Americans suffer from mental health issues, and nearly two-thirds of them are not receiving care. Reasons range from the price to stigma to hectic schedules.
“People are defined by two things: time and money,” Martinez said. “It really opens it up to getting help.”
Though this can be a way for people to finally get the help that they need in a cost-effective, safe and convenient way, not all mental health issues can be treated with messaging therapy and the lack of face-to-face interaction can be a barrier.
Careful research of all options can help you figure out whether messaging therapy is a good fit for you.
Under the Affordable Care Act, most individual and small group health insurance plans, including plans sold on the Marketplace, are required to cover mental health and substance use disorder services. However, not all plans are created equal.
“Some policies are amazing and it’s a $20 co-pay, but some policies will only pay for 50 percent of the visit and people have to pay $75-100 out of pocket,” Martinez said. “In those cases what they would get for one to two sessions they get for a whole month [by using messaging therapy].”
TalkSpace offers plans that range from $12-49 per week, and BetterHelp from $28-40 per week.
And with messaging therapy, clients can get more than one hour-long session each week or couple of weeks. All of the plans offered on TalkSpace and BetterHelp are unlimited, meaning a patient may speak to a therapist for hours every week in different increments, depending on their needs, for about the same cost of a co-pay for a 60-minute session under even a good plan.
Being able to communicate with a therapist at all hours isn’t just a bargain cost-wise; it helps people with erratic work schedules that may not allow them to commit to seeing someone every week.
For many patients in New York City of high socioeconomic status who can afford traditional therapy or working or single parents, Frank said TalkSpace winds up being a better option because of the flexibility.
“They are always on the go, always traveling,” she said.
Therapists like Martinez can offer set times with patients to message back and forth in real time.
“I have people who do that because they like the structure,” she said.
Time to Reflect
In face-to-face sessions, responses are immediate, whereas in messaging therapy, a therapist may respond to a patient and a patient can reply back whenever or vice versa.
“It gives you time, what are you going to say on both sides,” Chalmers said.
In other words, rather than responding in anger if a therapist challenges a thought, the user can reflect on it for however long he needs.
“Some people are better in writing,” Martinez added. “They’re able to write it, look it over, edit it.”
BetterHelp also provides patients with transcripts of everything they’ve ever said, which helps them see patterns and progress.
“The visuals of it are beneficial to them. They’re able to see the progress and say, ‘Wow, when we started I thought this and I’ve really changed my thinking and I’ve really worked hard at this,’” Martinez said.
The stigma of going to therapy prevents some from getting the help they need.
“There is still a lot of shame associated with mental health issues, even very common mental health issues like depression and anxiety,” Frank said. “Therapy is still therapy, even if it’s messaging, but people feel much less judged when they text with a therapist rather than sitting face-to-face and looking into a therapist’s eyes, which can be intimidating.”
In messaging therapy, the patient retains some anonymity. He isn’t waiting in an office with others and the therapist doesn’t know what he looks like or even, perhaps, his real name.
“Online, you can give just a first name, a nickname, a made-up name,” said Helen Chalmers, LPC, a psychotherapist from Dallas, Texas who provides messaging therapy on BetterHelp but still sees other patients face-to-face in her private practice. “You can get help without having to reveal too much of who you are.”
Martinez, who still does some face-to-face therapy, has noticed that has helped people open up more quickly.
“There’s something about the anonymity to it,” she said. “I have people who tell me that they went to face-to-face for years and never shared as much because they’re in their own space, not someone else’s space.”
The Big Con
Though we communicate via text message, email and social media in our daily lives, there is still value to face-to-face interaction during the therapy process.
“The human connection is always going to be one of the most important things when it comes to therapy. It’s so intimate,” Martinez said.
Patients may feel judged when sitting in a room with a therapist, but the set up allows the therapist to receive non-verbal cues like facial expressions.
“If I’m looking at somebody in my office, I can tell if they’re nodding their head at something I’m saying like, ‘That is how I’m feeling, nobody has been getting that,” Chalmers said. “Online I don’t know if it’s bringing up a lot of emotion for you or not. I’m just counting on what the person tells me or writes to me. You just deal with it. It’s just a different way of doing therapy”
Types of Patients
The service has its benefits, but it’s not for everyone. Martinez and Chalmers carry a caseload of patients with anxiety and depression or who need help coping with life changes like divorces and quitting a job.
“People who would not be appropriate for the site are people who are actively suicidal because you want someone who can see them face-to-face and be local, someone with a serious mental illness, let’s say they’re bipolar [with psychosis] or they’re schizophrenic” Martinez said.
People who are suicidal do not always disclose that when they sign up for the service, and it isn’t always easy to assess via messaging therapy.
“Suicidality is something I can more easily access in the office,” Chalmers said. “Sometimes, you can tell by what they write, so I’ll say, ‘You sound like you’re depressed, I need you to tell me what’s going on.’” In a traditional face-to-face setting, she could help them get to a hospital immediately if needed but online she said she texts, “I’m counting on you to help if you need it.”
Martinez said when she identifies someone who is actively suicidal, someone who self harms and/or has a plan, she can give them resources, like the suicide hotline, and tells the patient he needs face-to-face therapy. Customer service sends them a letter with the same resources and again explains why the decision has been made to end messaging therapy with them. This is also when therapists can get their contact information from customer service and call the user’s local ER and authorities.
“I’ve had one case where I actually had to have someone check on someone to have them hospitalized but usually we can take care of the situation before it gets to that point,” she said.
Despite the cons, messaging therapy is growing.
“I think that the whole profession is going to move online. I’m positive,” Frank said.
TalkSpace recently launched a couples therapy option as well as asynchronous audio and video messaging features. Users can show their therapists how their kids look or a video of monumental occasions in their lives like weddings. Frank said it also aids people who have dyslexia and struggle with texting.
“Text is not sufficient sometimes,” Frank said. “I still think text-based therapy will rule the platform due to its convenience, however the audio and video messaging videos will enrich the experience by adding depth to the relationship between the therapist and patient.”
It’s not conventional, but if it’s helping people get help, perhaps that’s all that matters.
“I am still an advocate for face-to-face but if you need help and this is the way you can get it then that’s a good thing,” Chalmers said.