The hidden cost of therapy apps

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Recently, Vanity Fair published an article on Silicon Valley princes Kevin Systrom, Travis Kalanick, Evan Spiegel, and Jack Dorsey, famous for their billion dollar startups and dubbed the “Rand Pack” because of their affinity for Ayn Rand’s self-serving philosophy Objectivism. All four of them, and many others, have created apps  — Instagram, Uber, Snapchat, and Twitter, respectively — that have disrupted industries for their own benefit regardless of consequential impacts.

Apps like TalkSpace, BetterHelp, and Psykee, which is in development, allow people to text or video chat with their therapist, as well as offer on-demand therapists to go to clients’ residences. Such apps often cut down on costs, which unfortunately is the main barrier to treatment for most people, but this comes at the expense of real human interaction.

For a lot of different reasons, 2016 has been a tough year for a lot of people. After the election, the Crisis Text Line and the National Suicide Prevention Lifeline experienced record increases in texts and calls. There is no shortage of people looking for support.

As a result, people need a dedicated time and space where they can heal and have their needs met. Regularity and commitment are intentional components of the therapeutic process. What ultimately influences wellness is the therapeutic relationship, and the attachment one has to their therapist. While some therapists of varying schools of thought may challenge that, the proof is in the research.

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American psychologist Saul Rosenzwig came up with the “Dodo Bird Verdict” in the 1930s, suggesting that many forms of therapy are all similarly effective. This claim has been challenged and modified over time. It is now suggested that some interventions may be more effective than others for certain presenting issues, however, the critical and consistent healing element across modalities is the relationship.

The therapeutic relationship is unlike other relationships because there is an intentional boundary to it. Unless it is a specific home-based therapy, the client comes to the therapy office, and as much as possible, is seen at a regular weekly time. The therapist knows about the client and only shares what is necessary about their self. Such a boundary is thoughtfully set for each client to create a holding environment where painful feelings and experiences can be carefully held each session, and then possibly left behind.

One of the intentions of this structure is to help people tolerate and regulate their feelings and emotions in between appointments. If therapists became on-demand clinicians, we would be feeding into maladaptive behaviors. Much of the work is helping people unlearn patterns that don’t serve them well, with the aim of establishing new ones that are more beneficial to their relationships and productivity.

Therapy apps, by their design, create a superficial, unsustainable sense of support that may in the long-run cost the client more, both financially and developmentally, due to inadequate care. Texting with a clinician is by no means comparable to meeting face to face. In fact, one of the primary reasons many clinicians won’t even do phone sessions is because there is so much information in non-verbal communication.

Additionally, people rarely free-associate via text. If one can curate a completely different persona behind a screen, how does the therapist really get to know the client through such a relationship? Where do the necessary boundaries begin and end? One user of the app BetterHelp stated that the text conversation with the therapist he was assigned  could theoretically go on forever if they both kept texting each other.

Regardless of the risks, these apps have arrived on the scene and they’re not going anywhere. I’d like to challenge the entrepreneurs and developers creating and hosting them to be less like the Rand Pack and to think more about the integrity of the field. I’d like them to consider that therapy works well when used properly. Go beyond the app and brainstorm other ways to make therapy more affordable and insurance companies more lenient. If they really care about mental health, ask therapists and clients what they need. Don’t just appropriate a technology because it’s been successful for other types of businesses.

It would be really unfortunate if therapy was upended the same way the cab industry has been by ride-hailing apps. As a psychotherapist, I know I may seem like the small, local bookstore afraid of being able to compete with Amazon.However, when it comes to therapy, we’re dealing with people’s health and well-being.

Peter Zook, is a licensed social worker in Philadelphia who practices psychotherapy at a group practice and privately.

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