Two key issues with large online therapy platforms

One of the first things I tend to ask new patients in a consultation is about their previous experience of therapy. Increasingly, I’m hearing that somewhere along this journey they have tried an online therapy platform – such as BetterHelp or Talkspace. 

This isn’t surprising. The advertising budgets of these large online platforms are enormous with promotions appearing across TV, podcasts, radio and social media. Having looked further into the way these platforms operate and present themselves, there are a number of issues I have with how they advertise their services and facilitate therapy. 

In this blog, I’ve outlined two of these concerns and offered some reflections on how psychotherapy might approach them differently. 

Therapist switching

Many of these online platforms promote the idea that if you don’t like your therapist, you can switch immediately, at no extra cost to you. In addition, some adverts even highlight users who switched five or six times before finding the ‘right fit’ – as though this should be a normal practice for someone looking for a therapist. 

For someone relatively new to therapy, this might sound like a real benefit. It fits neatly into a culture of swiping or upgrading at the first sign of disappointment. Whilst I do believe it’s true that not every therapist is the right fit for every patient, frequent switching is somewhat uncommon. And having a strong dislike towards – or discomfort with – someone very quickly, could more likely suggest there’s something within you that’s bringing out that emotion. Perhaps they remind you of a parent who you find dismissive or disinterested, for instance. This could become one of the key themes of your therapeutic work with them. And more broadly, doing so could be beneficial in helping you to address the reasons you have come to therapy. 

Alternatively, if your reaction isn’t so much dislike but uncertainty of the therapist, it’s possible that by cycling through different practitioners, what is unconsciously taking place is an avoiding of building a deeper connection with any of them individually. As you find yourself hopping between therapists, it’s possible that there’s something unconscious at play—perhaps an avoidance of forming deeper connections. This may perhaps reflect your dating history or difficulties with relationships or friendships, where you keep others at a distance to protect yourself from vulnerability or rejection.

Of course, it is important to feel comfortable with your therapist. But sometimes, feeling too comfortable can be more about avoiding vulnerability than creating real safety. Therapy is not always about liking your therapist, but rather gradually building a trusting relationship that can contain and explore your inner world; the good, the bad and the ugly. By constantly switching therapists, we risk reinforcing the very patterns that therapy is supposed to help us identify. And yet, the promotional messaging from these online subscription platforms seems to encourage it.

Messaging outside sessions

Large online therapy platforms also enable users to message their therapist outside of sessions, or schedule sessions as and when they want them, rather than having consistent appointment slots like in psychotherapy. These features are promoted as positives – encouraging users to reach out whenever they feel the need.

Again, this might sound like a plus – offering emotional support within a relationship where the other is available to you entirely on your terms, without any risk. However, psychological change rarely happens without some level of vulnerability and risk. 

Psychotherapy involves two people mutually coming together within the conditions agreed by each of them, in a consistent and reliable framework. It is set up in this way, as this is how life works. The therapy room becomes reflective of the wider world. The therapeutic relationship offers a place to to reflect on how we relate to others, and what we expect of from them, as well as how we manage disappointment and uncertainty. How can these relational patterns be seen or understood if the platform denies the user of these challenges?

In addition, many of the difficulties we bring to therapy involve struggling with frustration or boundary-setting. Having a therapist constantly on-call might feel soothing in the short term, but it risks bypassing the vital therapeutic work of sitting with discomfort, unmet needs, and complex feelings – until they can be thought about together in the next session. The space between sessions matters just as much as the sessions themselves, as it allows for internal processing and for unconscious material to surface. If we take away the frustration and boundaries within the therapy, these emotions have little opportunity to be expressed and explored. 

The illusion of risk-free change

The therapeutic relationship is not meant to be entirely free from tension or challenge and the discomfort that sometimes emerges can be some of the most important and useful material to explore for insight and growth. What these Silicon Valley type corporations seem to have done, is apply a customer service model to therapy, which risks taking these very experiences out of the therapy altogether.

While these online platforms may offer greater accessibility and immediacy, it’s important to be thoughtful about what kind of help we are seeking. There is therapeutic value in speaking about our difficulties with another person, but without a consistent framework, it’s unlikely to address these issues in a deeper and more meaningful way. 

That said, I return to what I said at the beginning: many people start their therapy journey after going through a process of trying different types of therapy, including online therapy platforms. There is no shame in this. These services can be a helpful entry point into thinking about one’s emotional world. And whilst the safety and convenience offered might not necessarily lead to long-term change, it can provide a gateway to something deeper and more sustaining.

For some, the anxiety around starting therapy can be significant, and perhaps requires a dipping the toe in before fully testing the water. And perhaps these subscription platforms do provide this. But if it’s insight, understanding and change that you’re looking for, I believe that the work of psychotherapy provides a more reliable framework to achieve this. 

Joseph Bailey is a psychodynamic psychotherapist, offering analytic therapy to individual adults in Brighton and Hove. He is registered with both the British Psychoanalytic Council (BPC) and the British Association for Counselling and Psychotherapy (BACP). Joseph is available at our Brighton & Hove Practice and online.

Further reading by Joseph Bailey – 

Why do we repeat past failures again and again?