Online Mental Health Therapy: Affordable Solution or Quick Fix?

Katie Fustich
Aug 22, 2017 · 6 min read

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Within minutes of logging on to 7Cups.com, an “anonymous emotional support & counseling” platform, I am connected to a “Free Listener,” one of the site’s network of “world-class…compassionate, caring individuals.” My listener, whose username is Eternaldenidchrist009, starts off our chat simply: “Hey. What brought you here?”

I reply that I recently quit a demeaning job, and while I’m happy to be free of my former employer, I’m having anxieties about my career. “Oh,” they reply. “You must be missing it badly.”

I stare at my screen, perplexed.

“No,” I write. “I don’t miss it. It was a bad job.” A notification indicates that my listener is typing for a solid two minutes. I start to wonder what they will say — what sort of revelation will our chat inspire? The reply finally comes: “Oh.”

Just in time, an automated message springs up: “You might not click with your first listener just like you might not love the first pair of shoes you try on. You don’t give up on shoes, so don’t give up on finding support :).” At least the robots are intuitive, I think. I say a quick thanks to my “world-class” listener and head elsewhere on the site.

Soon, I find myself in the “Compassion Corner,” a group chat room where a handful of individuals are discussing their love for the Moody Blues song “Nights in White Satin.” “Trust me you will love this one,” says a user whose icon is a tiny fox in sunglasses. The site’s 17 total chat rooms also include spaces reserved for specific focuses like “LGBTQ+ Support” and “School and College Support,” in addition to the seemingly more laid-back “Mega Member Room.” Yet even in the LGBTQ+ room, the conversation still seems wildly off-topic, with one member pretending to be a sleepy cat and others pretending to pet them.

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Evidently, this is the future of mental health care. The 7 Cups platform hit browsers in 2013 and appears to be growing, judging by the steady addition of new features like the active listening service. Rival platform Talkspace, which launched in 2012, encourages potential clients to join “500,000 people who already feel happier.”

In addition to the aforementioned listening service, both sites allow individuals to connect with licensed therapists and participate in text-messaging therapy for a low weekly fee ($32 for Talkspace; $37.50 for 7 Cups). Users remain completely anonymous and can share as much or as little identifying information as they choose.

This form of mental health care has obvious perks. As Talkspace co-founder Roni Frank told me over the phone, the virtual setting helps eliminate some of the most significant boundaries to traditional therapy: “Cost, stigma, and access.”

Ideally, the removal of these boundaries would lead to a democratization of therapy. No longer would it be an outlet solely for white, wealthy people, but for a variety of humans dealing with a constellation of issues. Judging by the fact that 65 percent of Talkspace users report that the platform is their first experience with therapy, one might assume they are individuals who have been, at one point or another, subject to some sort of boundary in receiving “traditional” mental health treatment.

With that in mind, online therapy is, in some ways, being beta-tested by the marginalized. This is potentially a positive — were it at all clear whether online therapy actually works. Yes, you may receive a response from a therapist within 15 minutes. Yes, you can avoid physical interaction with another human being. Yes, you can share a painful childhood memory via text while cooking dinner. But is any of this actually good for you?

Alas, Talkspace itself is behind one of the sole studies on the subject. Aside from the obvious complications of a company funding a possibly self-serving trial, the study in question used a sample size of just 58 individuals — that’s .0001 percent of Talkspace’s total user base.

Nevertheless, study results indicated that after an observation period of roughly four months, Talkspace users saw a more significant improvement in their “well-being” than traditional therapy-goers. But the study abstract fails to highlight user responses that ultimately deemed the platform “the same as” or “worse” than traditional therapy.

Another study, published in the Canadian Medical Association Journal, found similarly mixed results. It ultimately cautioned potential virtual therapy patients to be wary of the fact that these platforms seem designed for short-term symptom relief.

As Dr. Elizabeth Ochoa, chief psychologist at Mount Sinai Beth Israel, points out, the lack of “quality control” around sites like 7 Cups and Talkspace has the potential to heighten the consequences for already at-risk populations, “especially [if] they are possibly not as educated about mental health issues.”

Further, Ochoa notes that the apps’ emphasis on relieving “everyday stress and anxiety” may be effective for some, but it could lead to a skewed understanding of therapy for those who have “diagnosable mental health disorders” that would require long-term, in-depth treatment or more grave, imminent concerns like psychosis or suicidal thoughts.

Despite these risks, 7 Cups and Talkspace continue to market themselves on the basis of instant gratification. Ochoa notes that much of the interaction on these sites is more likely to take the shape of “advice” as opposed to “therapeutic intervention.” While this may be of aid to those in the midst of a small-scale crisis like a breakup, it remains to be seen if this same strategy is capable of reckoning with traumas and deeper identity issues. Unfortunately, those results come at the expense of people facing socioeconomic limitations to traditional therapy who are effectively forced to rely on this “advice” as a more legitimate form of care.

This is not to say that technology doesn’t have its place in the world of mental health treatment. Ochoa points to mindfulness and meditation apps as a method of tracking one’s mood and activity for later dissection in a face-to-face therapy session. The real danger comes when individuals and companies alike begin viewing actual psychotherapy sessions as but another element of mental health to be gamified.

“The bottom line,” says Ochoa, “is that [online therapy] is not a replacement for face-to-face therapy, but an adjunct.”

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I log back on to 7 Cups after a long day and seek out another listener. This time, I’m paired with user Letusmakeit123. Things start off similarly, with the faceless individual dropping a casual “Hey.” I jump right in, sharing my trials and tribulations as an unemployed individual.

“It’s not easy to find a job nowadays,” they console. Damn right! I think. “Do you live in Houston? I could get you a temp job,” they offer. Despite the ethical dubiousness of this question, I can’t help but appreciate it.

We continue the conversation, and though their responses are never more than a few words long, I find myself calmed. The thought that someone out there in the world can be brought to care about my particular problems for no apparent reason is strangely uplifting. If anything, I’m disappointed when I reach the maximum number of messages and am informed that if I want to continue to dialogue, I need to register for an account.

This disappointment conflicts, as I recognize that these kind words are but a temporary salve to life’s very real and persistent problems. Mental health apps may not be the solution to the psychological state of emergency — an issue that requires reckoning on a far larger scale — but they do make the world a slightly less lonely place.

pro sad girl. katiefustich.com

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