Earlier in August, the NYT published a longform investigation into the data and marketing practices of the mental health therapy provider Talkspace. It hit home for me.
So many of the NYT’s discoveries dismayed, even horrified me. I have sought mental health therapy myself several years ago, and about three years ago contemplated working on a different approach for a text-based service for people with anxiety and mild depression. We will talk about the specifics some time later. However, I thought in detail about, and spoke to mental health professionals about the technology, the ethics, the right audience, among other such issues. The way I thought about all of these was so very different from Talkspace.
The first is the way the service is marketed to potential customers and to therapists:
Talkspace is advertised to users as unlimited, “24/7” messaging therapy. “Your therapist will see your messages and respond to you throughout the day,” the company says. Therapists get a different pitch: “Set your business hours, and check in on your clients daily, five days per week.”’
This immediately reminded me of the worst of Groupon, which pitched to users that they’d never have to pay full price for anything again, while pitching to businesses that a single one-time mass discount would convert to loyal users willing to pay, well, full-price.
But Talkspace went beyond, adding this:
Talkspace introduced a new feature: a button that users could press after sending a message that required the therapist to respond within a certain time frame. If the therapists don’t respond in time, their pay can be docked.
Some therapists on the platform were alarmed, in part because the function required them to work on demand, rather than on their own schedule. More significantly, they asked: Is it harmful to give clients with anxiety and boundary issues a button to press for immediate gratification?
First, this reminded me of the worst of Uber. I have been told my more than one driver that they could only turn down a limited number of rider assignments a day, and had to be online at least a certain number of hours a day. After the rollout of the feature where drivers are assigned their next ride towards the end of the ongoing one, those drivers said they couldn’t even take time out to visit the restroom, leave alone lunch and snack breaks, because they also had to reach the next pickup in the time that the Uber app had estimated for the waiting rider.
Troubling as this is, these constraints are worse in the context of mental health because they introduce added anxiety for both the therapist and the patient, the former needing to be equanimous and the latter already suffering from some anxiety/depression.