Text therapy could breakdown socioeconomic boundaries…but what about state laws?

A new web-based venture hopes to democratize access to therapy. The potential downside: prison time.

In the therapy world, technology is nothing new. Many therapists use Skype as a way to communicate with clients, and there are even mobile apps that can identify if a user is depressed and needs to seek treatment

But the text therapy startup Talkspace has radically reimagined the practice of therapy and in doing so made it accessible and affordable for anyone…in theory, at least. But therapy provided over the internet may come at a different price.

Katherine Glick is a licensed professional counselor working three jobs. By day she runs a mental health and addictions clinic in New Jersey and teaches a course for therapy students. By night she returns to her North Philly apartment to snuggle with her two cats, Bo and Wilma, and chat with 25 of her clients.

Glick is one of 200 therapists using Talkspace, a platform that offers on-demand text messaging therapy. For $25 a week users can communicate with an experienced, licensed therapist like Glick in a private, secure chat room on the Talkspace website or mobile app.

Tonight Glick is speaking with a gentleman who is struggling with some behavior issues that don’t align with his strict religious beliefs. He’s been her client for over a year (the average user spends around 6 months on Talkspace), but Glick has never seen his face, and only knows his first name. Glick says the anonymity that the website offers allows her client to really open up.

“He doesn’t have to sugar coat it, he doesn’t have to lie to me about it because he’s feeling shameful because he sees me face to face,” says Glick.

A user can post to the chat room whenever they like, as often as they like. Talkspace therapists are encouraged to respond when they can, usually at a rate that amounts to an hour of therapy a week. The format is especially good for users like Glick’s client, who can’t commit to a weekly traditional therapy session.

“His life is jam-packed,” she reasons, “so if he had to go see someone face-to-face, he probably would not be able to make those sessions consistently and after a while he would probably just drop out.”

Roughly 45 million Americans suffer from mental health issues each year, but nearly two-thirds of them are not receiving any care. Research suggests that at least half of them don’t get treated because they don’t have access to therapy, can’t afford it, or find it too stigmatizing.

Most mental health providers have come to agree that online therapy has the potential to remove those barriers, but whether the world is ready for it to exist in the form of something like Talkspace is a much more challenging question to answer.

“So many industries were democratized by digital platforms and it just doesn’t make any sense that psychotherapy, the only profession that is based only on communication, remains completely traditional,” says Talkspace co-founder, Roni Frank.

Frank launched Talkspace in 2012 as a website that could help you find and schedule a face-to-face session with a therapist, but it wasn’t very popular. Instead people were using the website’s link to customer support to send Roni long, personal emails about the issues that had brought them to site.

“I was amazed! I was like ‘How come they’re coming to me?’ There are many therapists on the site with nice pictures and bios and everything,” said Frank. “They’re just writing to customer support about their problems. And this is how we started realizing that people want to come to the site and just start messaging with a therapist without scheduling a session.”

Frank says the new Talkspace website has nearly 120,000 users and has raised $13 million in funding to date. But while the company basks in the glow of its early success, it still faces some significant challenges.

Online therapy may be as good as traditional therapy in treating depression and anxiety disorders, according to some studies. On the other hand, treating a patient anonymously online can also be dangerous if a person threatens to harm themselves or others.

But the thing that truly threatens the long-term viability of Talkspace—and online therapy in general—is therapist licensing.

Each Talkspace therapist is licensed to practice in their own state. But when a therapist treats a client from another state online, the question becomes, “Where are they practicing?”

Jason Zack, a Miami-based attorney with a degree in counseling psychology, says many states don’t specify whether a therapist in their state can treat clients in another state online.

“So if there were a dispute to arise, a client committed suicide or something like that, what law would you look to?” said Zack. “And I think a good plaintiff’s attorney would probably look at both states and see whichever state’s laws were most favorable.”

When it comes to regulating therapy over the internet, Zack says, it’s sort of like the Wild West. The penalty for practicing psychology without a license can range from hundreds to thousands of dollars in fines and even jail time.

Nicole Amesbury, head of clinical development at Talkspace, knows that the risk involved in online therapy is going to scare some therapists from joining the site.

“Some people would want to shy away from that and say, ‘Well, this is a horrible idea,'” said Amesbury. “But then the loss there is so incredible, because it’s a crisis that so many people aren’t getting help.”

As Glick finishes up her day back at her Kensington apartment, she acknowledges the risk. It’s one she’s willing to take if it can help fulfill the Talkspace mission of making therapy accessible and affordable for all.

“Even though I was sort of very hesitant about online counseling and therapy, that spoke to me on a deeper level.”