The rise of telemental health has given clients the convenience of therapy sessions from the comfort of home and flexibility to access mental health services they need on their own timeline, and at affordable rates. Despite the potential benefits for accessing affordable therapy, there are some issues that can be detrimental for those seeking help.
Recently, the telemental health company Headspace laid off 15% of their therapist workforce overnight, leaving therapists with no access to their clients (https://telehealth.org/headspace-health-lays-off-181-therapists). This left clients feeling abandoned, having to suddenly stop therapy, and raised concerns about ethics and practices of these companies.
Therapists who become employees for a telemental health company relinquish control over every aspect of the therapeutic relationship. The article referenced above highlights some of the hiring contract details that clients may not be aware of:
Digital employers place liability for clinical issues squarely on the therapist
A thorough intake process is often overlooked
Assessment tools may be inappropriate for the clinical situation or for the therapists’ level of training
Clients are paying for access to therapy, the payment is not for the therapist
Records are not in the control of the therapist
Coordination of care among therapists and other providers is discouraged or not allowed
Termination of the therapist’s contract severs ties with clients immediately, which does not allow for proper closure of the therapeutic relationship
These practices bring up haunting memories of managed care, where insurance companies dictate diagnosis, how many sessions are “allowed”, how much the therapist is paid, etc. Even in the well-intentioned quest to provide affordable, flexible mental health treatment, both clients and therapists lose. Therapists who don’t play by the rules are fired, leaving clients wondering what happened and creating a troubling ethical landscape for those working for these companies, not to mention making mental health therapy and therapists look unprofessional.
Questions also remain about how the therapy and therapists on these platforms are regulated. Clients and therapists work together to create a sound therapeutic relationship and it can be quite traumatic when their therapist is suddenly fired and disappears. Therapists should be able to work within their scope of education and professional practice without the fear of being stripped of their autonomy or asked to engage in unethical practices to keep their job. While telemental health has a lot of potential benefits, more needs to be done to regulate this. The bottom line is, therapy costs money and may take more than a few sessions. Both clients and therapists are worth the investment in self-care.
