What App-Based Therapy Is Really Like
Without an IRL connection, can treatment still work?
I was wide awake at one in the morning, scrolling through my contacts. My life felt impossible and bleak, like a movie I didn’t want to watch. I knew I needed to talk to someone, but I also felt cagey and vulnerable — even if I called someone and they actually picked up, I wasn’t sure I could explain what hurt.
I’d stopped therapy over a year ago, when my graduate program ended and I lost access to the university’s free counseling center. On days when my depression and anxiety felt unbearable, I’d research therapists and counseling centers in my area. I’d get overwhelmed by the intake evaluation, expense, transportation, and the possibility of a waitlist. As a freelance writer, my work schedule is as unpredictable as my ACA insurance is terrible. After a few days of searching, I’d feel marginally better on my own and decide to forego help. I’d get along fine until nights like this, when everything caught up to me.
That night, in a last ditch effort to calm down, I searched the phrase “internet therapy” and found a promo code for $45 off a month of Talkspace, a mental health platform that connects clients like me with licensed therapists in their state (subscriptions cost between $260-$396, depending on the frequency of video therapy sessions).
I subscribed to the basic Talkspace plan. For $260 a month, I can send my therapist voice and text messages whenever I feel the need to talk. She replies with validation, coping methods, and further questions. It's not a real-time back-and-forth conversation; I receive exactly two responses a day, five days a week. The best way to describe Talksapce is like an interactive journal where I can organize my thoughts and receive feedback. I can also star and refer back to old conversations, which is helpful for charting my progress.
Talkspace and its competitors — including BetterHelp, ReGain, and Breakthrough — are not online counseling centers or unregulated public chatrooms. Rather, they’re platforms that provide private, HIPAA-compliant channels for clients and therapists to communicate. Talkspace was founded in 2012 to meet a growing demand for mental health services in the United States. According to research done by the National Alliance on Mental Illness, nearly 21 million Americans have mood disorders, and less than half have received professional help within the last year. Apps like TalkSpace provide a lower cost solution, especially for people who would otherwise not pursue in-office therapy.
“We serve a wide range of individuals seeking therapy,” said Neil Leibowitz, MD, Chief Medical Officer at Talkspace. “We have individuals who are balancing busy careers or family obligations and therefore have challenges finding time to schedule and travel to appointments. Another group who frequents the app is first-time therapy goers. This particular group has indicated that stigma was an initial deterrent from seeking face-to-face therapy. The ability to connect with a therapist via asynchronous text, audio, or video messaging makes the ability to start therapy easier."
Even though it was the middle of the night, I was able to begin an intake evaluation on Talkspace immediately. In a live chat, a therapist asked about my reasons for seeking help, and my past experiences with therapy. I was able to request someone who was familiar with LGBTQ issues. The next morning, I was matched with three potential candidates, and watched a brief video where they introduced themselves and their counseling philosophies. Although I could see myself working with each of them, I ultimately chose the one who didn’t emphasize mindfulness and meditation, as that approach hasn’t worked for me in the past.
When I started online therapy, I didn’t realize how much being able to work around my own schedule would aid my therapy process. To access mental health services through my college and graduate university, I had to book my appointments one at a time, or wait two weeks between sessions. My appointments often fell in the afternoon, a time when I usually feel distracted by my day. With Talkspace, I can wait until my work day is over. I can take time away to process, or use it as an outlet on hard days.
My other prejudgement about internet therapy was that it might feel depressing to tell my secrets to an app. But it doesn’t feel robotic, it feels like I’m messaging my therapist. Admittedly, I’m also someone who likes to write. I’ve kept a journal for years. Nina, a 25-year-old who asked that her real name be withheld for privacy, also finds comfort in being able to message her therapist at any time.
“When something bad happens or I need to talk about something, I'm not great at bottling it up. I need to feel like it's off my chest and like an answer is coming soon. Right after I started Talkspace, I was at a restaurant and something set me off. I had a kind of epiphany about something in my childhood that was still affecting me, and the realization that I was able to immediately text my therapist and tell them was so cool.”
Nina came to online therapy after several years of traditional, face-to-face therapy. She’s been working with her current therapist on the Talkspace app for over a year.
“With Talkspace, I really like that aspect of being able to constantly dump my problems on my therapist when I need to. I know she's only going to respond twice a day, but I'm allowed to throw whatever I want into the chat and she'll help me figure it out from there. The only thing I miss from face-to-face therapy is that it kind of forces you to go places you might not be comfortable. If I don't want to talk about something with my therapist now, it's pretty easy to change the subject. But that's also something I recognized and now we're working on, to stop me from shutting down when things get tough.”
And she’s happy with that progress for now. “I did consider going back to traditional therapy if only to work on the harder, deeper issues I've got going on,” Nina says. “But at the end of the day, the hassle of finding someone who is close by, who takes my insurance, and who I like talking to is just not something I can functionally handle right now.”
When you’re considering therapy, everyone from the internet to your therapy-hip friends will tell you that it’s essential to build a strong relationship with your therapist. Just like any other relationship, you might not mesh with the first person you meet. For instance, I once met with a woman so cheerful and Vera Bradley-esque, I felt like a ghoul in her presence. Online therapy, however, removes body language and other non-verbal communication from the equation. There are times when I send my therapist a wall of text and she responds with a succinct, organized paragraph. I know she has to keep the conversation focused and on-topic, but it can feel a little dismissive. If we were in the same room together, however, I would see her nodding and actively showing interest as I spoke.
For some people, online therapy does feel impersonal and isolating. One woman I interviewed for this article, who asked that her name be withheld for privacy, described feeling distrustful toward her BetterHelp therapist. She felt unmotivated to build a relationship that was purely virtual.
“I just don’t like texting. I couldn’t open up to an app,” she said, “It felt weird to take all these painful, dark things and put them into a text bubble. It was too easy to just ignore my therapist and not engage.”
For me, indirect contact and self-pacing are part of Talkspace’s appeal. It’s easier for me to be vulnerable when I’m not sitting across from someone. Talkspace removed the hesitation and logistical barriers so that I could actually start therapy. And once there, I found a therapist with an amazing gift for drawing connections that help me navigate my life with more awareness and joy. Given the option to see someone in real life now, I’m not sure I would.