Earlier today, an online outlet published an article about Talkspace that was based on misguided reporting. Unfortunately, the piece is heavily sourced from anonymous interviews with three therapists who were asked to leave the Talkspace platform for professional and ethical reasons, and does not accurately reflect Talkspace or the state of online therapy today.
I realize that for those people who are not familiar with our mission, or are rightfully cautious when it comes to their mental health, the accusations made in the piece raise questions about the quality of care provided by the Therapists that consult on our platform. In support of the approximately 1000 therapists that work on the Talkspace platform, and in the interest of transparency, these are the fact-based responses to the accusations made in the article:
False Accusation: “Talkspace’s policy of patient anonymity impedes the ability of therapists to report dangerous situations. Multiple therapists have been refused contact information when attempting to report behavior that poses a risk to patients or children.”
This is false, and the accusation doesn’t make much sense. For it to make sense, two outrageous things would have to be true:
a) Talkspace would have to seek out clinical leaders and mentors who would be OK violating their moral, ethical, and legal obligations to report clients in danger of harm.
b) Talkspace, a company born out of a commitment to improving the mental health of our clients, would have to implement a process by these supposed unethical and immoral members of the clinical leadership would intervene to prevent our clients from getting the help they need.
There are very clear rules for when a therapist has a moral or legal obligation to report a client to the authorities. Such cases are a tiny fraction of therapy users and of Talkspace clientele– but we have no hesitation in helping the therapists on our platform to contact the authorities when the law or the ethical codes require it.
We are constantly improving the tools that therapists on the Talkspace platform have available in crisis situations. In several isolated incidents, therapists incorrectly assumed that Talkspace was gathering and holding client emergency contact information on the therapist’s’ behalf. In order to make sure this doesn’t happen again, we added a field to the digital therapist notes so that the therapist can store emergency contact information in their online notes, rather than offline, if they believe it is necessary to safely continue treatment.
On anonymity as a concept in online therapy: Should we eliminate crisis lines because we don’t know who is calling? For a certain percentage of therapy clients, anonymity is a prerequisite to getting care– they give a fake name at the therapist’s office and pay cash, or they look for another solution to protect their identity. It is our belief that those clients still need, and still deserve care– as long as the therapist can do so with the confidence that the clients is not going to harm themselves or others.
Misleading Accusation: “Talkspace employees can read patient-therapist conversations for ‘quality control.’”
This accusation is misleading. Here are some clarifying scenarios:
a) During onboarding, and before treatment has begun, the client goes through intake performed by a licensed therapist. The notes from this intake conversation will be shared with the primary therapist matched to the client to make sure that the match is successful.
b) Here are the cases where a client-therapist transcript may be accessed by a senior clinician after treatment has begun:
- If a client asks us to review an issue and provides consent, the review can only be performed by a senior clinician that has ethical obligations and follows internal policies to access only what he or she needs. No other Talkspace employee has access to transcripts.
- If a client is being transferred from one clinician to another, the client has the option to either hide or show the transcript to the new therapist, depending on whether they would like to ‘catch up’ the new therapist or ‘start anew.’
- When Talkspace is alerted there may have been a significant safety risk for a client, or serious reason for concern for the quality of care, we may proactively reach out to clients to request their permission to access a transcript. Again, the access can only be performed by a senior clinician that has ethical obligations and follows internal policies to access only what he or she needs.
- Certain data about a transcript can be used to confirm or disprove complaints about long wait times for a reply, short messages, or MIA therapists. In order to do this, customer service can access the timestamp of every message in the transcript, who sent it, and how long the message was, without seeing any of the content of the transcript.
Misleading Accusation: “The company seems to keep close watch on patient attrition, and punishes therapists if too many patients leave”
Talkspace has seen from our client feedback and outcome measures that therapists with extremely slow response times, high incidence of confirmed client complaints, and high client attrition–especially those therapists that do not manage to keep clients for more than the first week– are not well-suited for the Talkspace platform. We have processes in place to help therapists succeed on our platform, as well as processes to remove therapists if they cannot embrace the technology.
False Accusation: Talkspace allows therapists to abandon their clients
- Leaving the Talkspace platform is a structured process by which a therapist can inform Talkspace that they are leaving the platform, stop accepting new clients, arrange to transfer clients if necessary, and choose to continue treating any clients they still have on the platform.
- In a few extremely unusual cases, we decided to remove therapists from the platform with short notice because their clients showed us evidence of serious ethics violations or potentially dangerous communications.
Misinformed and Misleading Accusation: “While claiming to be merely a platform for independent therapists, Talkspace exerts control over therapist scheduling and interactions with patients, even giving therapists mandatory scripts.”
This is misleading because it flips the whole purpose of scripts on its head. Scripts exist for two reasons:
- Give therapists the ability to choose the time and moment in the conversation that certain important messages are conveyed, so that the platform does not interject with a system message in the middle of an inopportune moment.
- Save therapists the trouble of typing the same information out over and over again– whether information about how Talkspace works, or their own personalized scripts that they may use during therapy.
This is misinformed because giving the therapists this tool does not somehow change the employment relationship between the therapist and our company. Licensed medical professionals can clearly and unambiguously hold contractor status, due to their professional education and licensure.
Accurate: “After pay changes, Talkspace made an official policy that therapists could no longer complain in Slack”
This one is accurate, although we were even more broad– we asked our therapists to use Slack much less in general. We had a large Slack channel with hundreds of people, and a small minority of participants were derailing the conversation over and over again. Despite inviting everybody to bring their concerns to us 1 on 1, the Slack channel kept getting out of control– as a chat room with hundreds of participants sometimes does– and it became impossible to keep up with the conversation.
Mixed: “It’s unclear which government agencies are responsible for regulating therapy apps like Talkspace”
This is mixed. Certain aspects are very clear– the therapy provided on our platform is performed by clinicians that are licensed by their state, and there is a wide array of legal and ethical code that they must abide by. Despite the misinformation in today’s article, the 1099 issue is clear as well. Other aspects, such as those where the line between improvements brought by technology and the importance of clinical traditions should lay, have not caught up to the modern day. Talkspace policy is to over-communicate with any regulators that approach us, and to help define the opportunities for government to step in and improve the quality of online therapy today, and in the future.
Talkspace was founded in 2012 with the mission of making mental health care accessible and affordable for the millions of people in need. It is born out of our own experiences with therapy, and from seeing the impact of mental illness on those around us. As we grow and succeed in helping more people, we have made missteps in how we communicate our priorities to the therapists on our platform. When that happens, we make sure we make each mistake just once. I’m a strong believer in ethical businesses, and that the way we treat each other, our employees, clients and partners must be fair and kind. I wrote this piece in order to set the record straight– I hope you found it helpful, and welcome your emails with comments and suggestions.
Thanks for your time,
Co-Founder and CEO