Recently, after complaints from several of its members, the American Psychological Association abruptly canceled advertising from a web-based therapy platform, TalkSpace. Psychologist Todd Essig, Ph.D. has written several articles (the latest is here) critical of the company's actual and potential ethics violations, as well as how it represents itself.

For example, at the current time, their website boasts, "Therapy for all." However, in their terms of service, they note: "This Site Does Not Provide Therapy. It provides Therapeutic conversation with a licensed therapist." At the same time, their practitioner handbook* addresses insurance and medical necessity.

Another advertiser that has been criticized by APA members is BetterHelp, a platform which similarly provides the infrastructure for therapists to work with people online. They claim to match people with counselors that fit an individual's needs.

However, in their terms and conditions, they state: "We do not control the quality of the Counselor Services and we do not determine whether any Counselor is qualified to provide any specific service as well as whether a Counselor is categorized correctly or matched correctly to you…While we may try to do so from time to time, in our sole discretion, you acknowledge that we do not represent to verify, and do not guarantee the verification of, the skills, degrees, qualifications, licensure, certification, credentials, competence or background of any Counselor."

Most people do not read through the terms of service, so they have no idea about the limitations of what they're signing up for.

BetterHelp also has some troubling language in their counselor terms and conditions. For example:

  • The Provider will not diagnose, treat, test, advise, counsel, recommend a course of treatment, or otherwise provide or perform any services that require an in-person meeting with a User or examination of a User.
  • The Provider agrees to never engage in the practice of medicine or enter into a physician/patient relationship with any User through the Platform.

In other words, although Betterhelp advertises "online counseling," they do not permit therapists to diagnose or treat, nor to form a doctor/patient relationship. The terms of use for clients also state that "THE PLATFORM IS NOT INTENDED FOR DIAGNOSIS" (all caps as written). This disclaimer appears to be a clumsy attempt to protect themselves from legal liability.

Nevertheless, when people sign up for online counseling with a therapist who is licensed to diagnose and treat, it is reasonable to expect that they are in a professional relationship with the therapist, and that diagnostic information is part of that relationship. It may take a lawsuit to determine whether the disclaimer holds the company harmless.

Know what you're getting into

Both Talkspace and BetterHelp have received many positive reviews from people who have used their services, and they are actively recruiting therapists to join their networks. They offer referrals and ready-to-use technology, which is especially appealing to clinicians who want to get started in providing web-based services without investing time, money or marketing in setting up their own teletherapy practices.

There are downsides, however:

You won't know how much you will be paid until after you have submitted a detailed application, which itself can take a long time. Many complaints posted by clinicians at (e.g., here and here) state that the pay is low, and that the management is either unsupportive or overly demanding.

You may be required to provide unlimited texting with clients, which can be quite time-consuming. If you have 5 online clients who each send you 3 messages per day, that's 15 messages you need to respond to, giving careful thought to how you word each one.

Your ability to work with people in a professionally ethical manner may be impeded by the company's rules and procedures.

  • You don't get to do the intake. Clients fill out a brief questionnaire on the company portal, and are assigned to therapists based on the information they give. The company websites urge people not to use their services if they are in crisis, but this warning is at the bottom of the page and on their terms of use pages, which nobody reads. Thus, you may be assigned clients who are not suitable for this mode of help.
  • Client enrollment and all conversations between clients and counselors take place on the company platform, and as noted in BetterHelp's terms and conditions, you may be restricted in what you advise.
  • Clients can remain anonymous. You may not have access to client information, such as direct phone number or emergency contact. Instead, you need to involve the company to intervene.
  • In their practitioner handbook, Talkspace Network "reserves the right to access and review all client interactions to ensure quality of care and service." Similar language is buried in the public terms of use page, and includes their right to review transcripts.
  • The company may terminate you at will, without giving you the opportunity to wrap things up with the clients they have provided.
  • The company may solicit clients to give testimonials, which is unethical for most mental health practitioners to do.

In summary, while platforms such as Talkspace and BetterHelp provide you with ready access to working with clients online, they also limit your control over your relationships with your clients and in how you work with them.

Before signing on with such platforms, read the terms of service thoroughly. Search online for lawsuits against the company you're considering working with, and read reviews that are not on the company's website.

Also, talk with the risk management consultant provided by your malpractice insurer, who can alert you to legal or ethical liabilities. For your maximum legal protection, hire an attorney who specializes in mental health services to review the contract that you will be signing. The contract will most likely be geared to protecting the company, not your or your license.

Note: Terms and conditions, as quoted above, appeared on the linked pages at the time of this writing. They may have been changed since then.