BetterHelp

BetterHelp logo.

BetterHelp is a telehealth platform aimed at providing accessible, convenient therapy and counseling. Telehealth, or telemedicine, allows for patients to seek medical treatment and care virtually, or without going to an in-personal location. BetterHelp functions as a service through which clients and therapists can facilitate their communication using four different modalities: a chat feature, phone calls, video calls, and text messaging. Types of therapy provided include psychotherapy, Cognitive Behavioral Therapy (CBT), trauma therapy, group therapy, and more. BetterHelp was founded in 2013 by Alon Matas and Danny Bragonier, and in 2015 was acquired by telehealth company Teladoc Heath, Inc. The company is one of the largest telehealth online therapy providers, with over 20,000 licensed therapists and over 2.5 million users. Recently, however, it has been involved in various ethical debates after a series of scandals involving the quality of therapists provided and information-sharing with Facebook.

How It Works

Signing Up

To sign up for BetterHelp, users must go through a series of basic questions to match them to their ideal therapist. Users are asked to provide their gender, age, and general health information. Each question typically has many response options, at least one of which acting as an opt-out (such as “Other” or “I don’t know”). Questions get more personalized depending on a user’s answers. Some questions come with additional information to indicate why they are being asked. For example, one question is “How Would You Rate Your Current Physical Health?” Underneath is an information box that indicates a correlation between physical health and mental health. At the end of the questionnaire, users are asked to make an account, by providing a first name, email, and agreeing to the Terms & Conditions and Privacy Policy. Afterward, users are given an open space to explain why they sought therapy with BetterHelp, and then a detailed explanation as to what happens next, including a FAQ section, financial options, insurance information, and a cost analysis. Lastly, to complete their account, users are asked to provide credit card information. There is also an option to click “I can’t afford therapy,” at which point users are directed to financial aid information.

Finding a Therapist

The questionnaire required to complete in order to sign up for BetterHelp acts as a match-maker to a therapist. To begin, users choose from one of three options to indicate the type of therapy they’d like to receive: Individual, Couples, or Teen. After answering more general questions, users are asked to answer questions about their mental health, to specify which areas of focus they’d like their therapist to specialize in. They are also asked identity-related questions. For example, if a user indicates their sexual orientation is something other than straight, they receive a question asking if they would like to work with a therapist who specializes in LGBTQ+ issues.

Cost and Insurance

BetterHelp costs are ultimately based on location of the user and specifics such as therapist preference and availability. Users are billed every four weeks, with an average cost of $60-90 per week. Therapy on the platform is typically not covered by insurance, with no therapist provider accepting Medicare, Medicaid, and most insurances. However, this can vary between insurance companies, and some users can utilize partial coverage through their specific insurers.

Therapy for Teenagers

Teen Counseling logo.

BetterHelp operates a sister site for teenagers, called Teen Counseling. On BetterHelp’s homepage, users are prompted to indicate if they are looking for therapy for themselves, for themselves and their romantic partner, or for their child. The latter option is labeled “Teen,” and clicking it provides a pop-up that asks users if they would like to be redirected to Teencounseling.com, with the assurance that the site is connected to BetterHelp directly.

Teen Counseling functions very similarly to BetterHelp’s main platform. Users fill out the site’s questionnaire, and then are matched with a therapist according to their responses. There are two routes users can follow: “I’m a Parent” or “I’m a Teen.” Parents can choose to fill out the questionnaire based on if they are looking for therapy for their teen, for themselves in relation to parental advice, or if they are unsure. Questions on this questionnaire ask about the teen’s gender identity, school performance, therapy history, and more. After matching with a therapist, parents can then “invite” their teens to Teen Counseling’s therapy if they choose. At that point, their teens will receive an invitation code from Teen Counseling.Teenagers can also directly fill out the questionnaire themselves by selecting “I’m a Teen.” The website also features two separate Q&A sections: one for parents and one for teens.

Teen Counseling also operates under the same regulations and standards as BetterHelp. Cost, therapist qualifications, and platform modalities (chat feature, phone calls, video calls, and text messaging), and more, are on Teen Counseling as they are on BetterHelp. Certain questionnaire questions vary in topic according to this particular audience; for example, users are asked if bullying is a problem they would like to address in therapy.

Faith-Based Therapy

Faithful Counseling logo.

BetterHelp operates a sister site for faith-based therapy, Faithful Counseling. Though it is not directly linked on BetterHelp’s homepage as TeenCounseling is, it is connected to BetterHelp in the same way, meaning the same regulations and standards are practiced. This includes cost, therapist qualifications, platform modalities, and more.

Faithful Counseling exists to connect users directly with therapists that share a Christian background, specifically. This differs from the main BetterHelp website, in which users can indicate that they are Christian but not necessarily request a Christian therapist. Faithful Counseling asserts that the platform is not the best choice for those seeking help on specifically spiritual issues that would best be dealt with in pastoral counseling. It also does not guarantee that therapists will have the appropriate training to provide faith-based counseling. Instead, they are guaranteed to be a practicing Christian and to accordingly provide therapy with that in mind. This is an advantage for users who seek qualified counseling through a religious perspective.

Therapy for Businesses

Businesses can provide BetterHelp services to their employees. This includes typical for-profit companies, as well as universities, cities and communities, non-profit organizations, and more. Users match and interact with therapists similarly as in a personal BetterHelp subscription. They also have access to “groupinars,” digital tools for tracking progress and goals, and work-specific support. Employers are able to track utilization rates while still accounting for their employees’ privacy. Costs are provided at a flat rate, or varied depending on usage.

Controversies and Ethical Concerns

Therapist Quality

To become a therapist for BetterHelp, the company requires that every therapist is fully licensed with proper documentation provided, according to industry standards, and experienced in their specific field. On average, BetterHelp therapists have at least three years and 1,000 hours of experience in the field. Their licensure is cross-checked and available for users to see and evaluate on their own. Therapists are also required to complete a case study exam to be graded by a licensed clinician, and must partake in a video interview. According to BetterHelp, this means that only 25% of applicants move on to work as therapists for the company.

These qualification requirements fall in line with typical requirements to work as a therapist, though certain regulations may vary between states. Generally, therapists need master’s degrees in psychology or a related field, as well as proper certifications and licensure depending on where they practice.

Various reports have been made of therapist quality issues within BetterHelp. In late 2022, the hashtag #betterhelptherapyisascam began trending on TikTok after various videos questioning the platform’s quality and legitimacy went viral. One user described a therapist who arrived late to their first meeting, another in which a therapist didn’t focus on the user and instead promoted their own book, another whose therapist had messaged the user after missing two sessions saying they were at another job, and another whose therapist was meeting in a public space and violating privacy expectations. Some experiences were described as traumatic, with one user reporting that his assigned BetterHelp therapist recommended conversion therapy in order to reunite with his family.

Therapist Experiences

BetterHelp has also dealt with complaints from therapists themselves about their experience working with and for the company. Some therapists describe being initially interested in the platform for its accessibility, but ultimately put off by how it functions. Since BetterHelp exists to help facilitate therapist/client interaction, some therapists feel pressure under the expectation to always be available for their clients. One former BetterHelp therapist claimed her account was suspended if she did not respond to clients’ messages within 24 hours. Such a model exists to ensure quality care for clients, especially amid reports of unresponsive therapists, but for therapists it can cross a common therapy boundary.

Many BetterHelp therapists report feeling burnt out or overwhelmed as a result of the platform’s payscale model. BetterHelp does not guarantee a specific minimum salary, but rather pays its therapists on an increasing scale. The more hours they work each week, and the more clients they see, the more their hourly rate will increase. The company’s website provides a scale to calculate average potential salaries depending on various factors. For example, a potential therapist can choose the option “Full-time,” and move the scale depending on how many hours each week they plan to work, between 30 and 50 (or between 5 and 30 hours, if they choose “Part-time”). From there, they are provided with an estimate of yearly earnings. (image!) A disclaimer is provided to inform therapists that results according to this model are only estimates; factors such as caseload and client engagement will affect the therapist’s final earnings. Some claims have been made that to earn the promised average according to this scale model, therapists must work with an extensive amount of clients. Though the payscale is hourly, each therapy session with a client is 45 minutes. This means that therapists would have to see between 40 and 45 clients per week, more than typical for traditional therapists, to reach the 30-hour minimum for full-time hourly rates. This 30-hour minimum is also required in order to receive a $650 monthly stipend for health care and insurance-related costs.

The ethical implications of BetterHelp, as an online therapy platform, are also of a concern. One therapist reported being recruited by BetterHelp therapists to work for the company, later realizing these therapists were paid to recruit other therapists. She tried to search for other online therapy jobs, only to find that many were sourced through companies like Guideline Healthcare, which specializes in recruitment of healthcare professionals specifically for other healthcare companies.

The online therapy model is seen as an advantage for many therapists, who enjoy the flexibility, both for themselves and their clients. Convenience in general is an advantage for many therapists at BetterHelp. Fees and paperwork, such as billing or general operations management, are handled by BetterHelp. This allows for therapists who would rather focus solely on therapy as their job, and delegate the operational everyday tasks to another party.

Advertising

BetterHelp utilizes many modern online platforms for advertising, such as social media platforms like YouTube, as well as many popular podcasts. Podcasts, for example, are a particular focal point of the brand’s advertising. In the first half of 2021, BetterHelp was the top advertiser across all podcasts, having spent at that point $35.7 million on advertisements.

Philip DeFranco, above, advertised BetterHelp in a now-deleted YouTube video.

Some of BetterHelp’s advertising methods have been called into question. Much of the company’s advertising is through social media influencer partnerships. In 2018, attention was called to various brand deals with YouTube influencers such as Shane Dawson and Philip DeFranco, who made videos detailing their personal mental health struggles and providing affiliate links to their subscribers. Some users were upset at mental health stories being used to sell a product. Others were dissatisfied with their subsequent BetterHelp experiences, after using influencer affiliate links. Some YouTubers began to retract statements and distance themselves from the BetterHelp brand, following the controversy. The YouTubers themselves were also accused of making money off their subscribers’ mental health issues, through their personal videos and affiliate links provided. One of BetterHelp’s founders, Alon Matas, responded to this controversy with a Medium post, insisting on the platform’s benefits and the high quality of its therapists.

In 2021, after the deadly crowd crush at Travis Scott’s Houston Astroworld concert, Scott partnered with BetterHelp to offer one month of free therapy to survivors. Critics online pointed out BetterHelp’s previous controversies over therapist quality and condemned the partnership, arguing that it exploited the tragedy and the mental health struggles of those who were there. BetterHelp responded by asserting that this was not a paid sponsorship with Scott, and that he would not be compensated. Rather, it was part of an initiative to help the public after a tragedy, as they had done with California wildfires, for example.

Celebrity-associated offers of free therapy are not uncommon for BetterHelp. The artist Lauv recently partnered with BetterHelp to provide $3 million worth of therapy to fans, in commemoration of World Mental Health Day. Similar initiatives have occurred with athletes as well, such as tennis players Venus Williams and Frances Tiafoe.

Privacy and Information Sharing

In 2020, a Jezebel investigation discovered that BetterHelp was sharing user information with Facebook, including messages between users and their therapists. Though BetterHelp argues it functions in accordance with HIPAA (Health Insurance Portability and Accountability Act), and information users share with their therapists is encrypted, Jezebel found that shortly after beginning the sign-up process BetterHelp began sharing their data to companies like Facebook and Google. Facebook specifically was alerted each time a user logged on to BetterHelp. The report also found that metadata from messages between users and therapists was shared to Facebook while a user was in-session, so the company could know when and where the appointments were taking place. Jezebel also found that MixPanel, a research and analytics firm, is sent information about users’ answers to the therapy intake questions during the sign-up process. Some of MixPanel’s clients include Uber and BMW. Later, in 2021, a Consumer Report investigation had similar findings, concluding that privacy statements made by telehealth companies like BetterHelp are often not clear or comprehensive enough to prevent data and information sharing. BetterHelp founder Alon Matas wrote, in a blog post, that the company is “not in the data business,” and is following all laws and regulations required of a therapy service.

Much of this data sharing is intended to allow advertisers to specify and personalize the advertisements they show users, which has caused an ethical debate especially in relation to the kind of personal information typically shared in therapy sessions and on therapy apps. Many see personalized ads as convenient and helpful, allowing them to save time finding products they’re looking for. Others believe that ad personalization has gone too far, and that using mental health information to sell products to users is exploitative.