Corporate Tech Monopolies are Going to Ruin Therapy

by | Mar 6, 2023 | 0 comments

Last weekend BetterHelp, the online subscription therapy company, settled with the FTC for almost 8 million in fines for selling therapy patient’s confidential information to Facebook and Snapchat. This isn’t justice, so hold your applause.

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The company, whose name really is the word better and help smashed together with no space between them has had issues before. A quick google search reveals customer reviews claiming the company is as good at delivering therapy to paying customers as it is at punctuation. Real patients seeking a cure from BetterHelp have reported getting hit with recurring subscription fees, therapists that repeatedly no show and charge you anyway, as well as getting slammed with hours of paperwork that takes up all the allotted time. BetterHelp’s model is to make you pre-pay for packages that include a certain amount of sessions a month. Many people reported that therapist refused to schedule them because they were full AFTER BetterHelp was paid for the packages.

If true, these are shady practices but not illegal. The company previously faced controversy for allegedly paying youtube influencers to v-log about exaggerated and invented mental health conditions that they claimed the company’s treatment had “cured”. Since these influencers have an audience of children and young adults who look up to them, these potential attempts to mislead are especially worrisome. Some of these influencers purportedly received thousands of dollars in compensation for the alleged lies.

You can watch ex BetterHelp patients talk about experiences where BetterHelp therapists pressured them to buy their books and services, ate in sessions, hosted teletherapy in public places where patients could be seen and heard, and congratulated patients treating anorexia on loosing weight. Perhaps this is why BetterHelp’s terms of service also make it the patient’s responsibility to “exercise a high level of care and caution in the use of the Platform and the Counselor services.” This is inexcusable. Better help should exercise a high degree of caution in who they hire and pair with vulnerable people.

So why is the sale of data such a big deal? BetterHelp would have you believe that they didn’t sell the data, they just use it to target ads at the kinds of customers that they profit off of the most. Unfortunately that is not how companies like Facebook operate. When they acquire data through a partnership they own and use that data forever. Companies are incentivized to data trade so companies like Facebook can build the best algorithms to extract the most money from the most likely to spend. In this case the target was vulnerable and mentally ill people needing help. This algorithm is not designed to figure out the best way to care for these patient’s or determine the best provider. It is not designed to make sure people at risk for relapse or suicide receive the right kind of provider for them. It is designed to get the most money out of them possible by using information that it is illegal for advertisers to access. These laws were put into place to stop healthcare information from being monetized in this way AND to insure that healthcare workers, not advertisers determine the care that patients receive .

Put simply this is a big deal because if I did this to one patient I would lose my license and potentially get sued. The FTC has just set a precedent that big companies can now do this to millions of people with impunity. Fines, like the 7.8 million that BetterHelp is returning to consumers is a cost of doing business for these companies. They take the risk because they make more money breaking the law than they pay in fines. If you had money wouldn’t you pay 8 million in fines to make 1 billion in profit? That sounds like a pretty good investment and now our government is allowing it at the expense of privacy and exploiting the mentally ill.

This is a big deal because if a smaller practice did this they would be barred from providing care and likely be in court for a long time. The government is now making the call that companies with a large market cap are above the law as long as they pay the occasional parking ticket.

When you go to therapy there is more than just an expectation that what you talk about will be kept private. HIPPA laws mean that if your therapist knowingly discloses information about you they are breaking the law. You can pursue legal action, their board can take their license, insurance panels can drop them and you can sue them civilly. This is if one therapist knowingly shares the data of a single patient.

Here it happened to millions of people. This was not an accident either. BetterHelp intentionally did this WHILE telling customers specifically that they would never do the thing that they were secretly doing. 

BetterHelp removed all of the links I posted to news articles containing their press release from their social media in an effort to not have to be associated with their own behavior and statement. That is strange since BetterHelp also claims that they did nothing wrong in their press release about the settlement. Why cover up something that you do not view as a problem?

“This settlement, which is no admission of wrongdoing, allows us to continue to focus on our mission”.

You read that right. Either BetterHelp misspelled “I’m sorry” or they really think they did nothing wrong. Let’s hope they are as bad at spelling as punctuation. People with antisocial personality disorder have no regard for right and wrong despite getting caught and experiencing consequences. People with this disorder need therapy but here a possible inference is that they appear to be providing it.

BetterHelp also goes on to say in their statement that all the information sold to Facebook was encrypted and non-identifiable despite the fact that they released the emails of users. My email address, [email protected], is pretty effective at letting someone identify who I am.

Betterhelp released emails of users. If they are using BetterHelp, they are seeking mental health treatment. They also released information regarding prior mental health treatment. According to the complaint:

Some of the intake questions that BetterHelp sold to Facebook identified whether patients had been in therapy before. Below is from the official complaint:

“For example, though an affirmative response to the question “Have you been in counseling or therapy before?” was coded as “AddToWishlist,” the analyst revealed to Facebook that this event meant that the “user completes questionnaire marking they have been in therapy before, thereby disclosing millions of Visitors’ and Users’ prior therapy to Facebook.”

BetterHelp claims this is not protected information because it didn’t come from actual sessions, just the intake to an app that gets you therapy. This is absurd. I am not allowed to tell you who comes into my waiting room or who emails me about therapy because it is readily apparent that those people are trying to receive healthcare. Their information is private from the minute they reach out to a healthcare provider. HIPPA is very clear about this and not open to interpretation. For some reason it is left to the FTC to pursue this as an advertising issue and not the justice department to pursue it as a criminal one. Do you think that I would be afforded that courtesy if I sold all of my patient’s information on the dark web? Do you think the feds would tell me to give some of the money back and we would be all good?

While the legal burden of responsibility lies with the seller, the buyer bears some ethical responsibility in my mind. Facebook and Snapchat knew what the data was they were buying. If you knowingly buy stolen goods you are culpable. If you get caught stealing you get a punishment in addition to having to give back what you stole. Here the FTC has merely made BetterHelp return the ill gotten gains but there are no consequences. There is no punishment that any single other therapist would face.

AND THEN after all this leniency BetterHelp released a statement saying they didn’t do anything wrong. Is that justice?

These corporate monopolies are ruining therapy and it is not talked about enough. The parent company of BetterHelp is another giant monopoly, Teladoc. Even if this gets publicized, even if CNN and Fox News deign to care about potentially criminal invasions of privacy, the parent company can just dissolve the brand and use the same practices under the larger corporate umbrella. This is increasingly worrisome as insurance companies are making moves to make Teladoc the mandatory go between software for patients to receive teletherapy.

As a patient, as a provider, as a legislator, refuse to participate in these things. They are a bad precedent taking the industry into a bad place.

Anyone who wants to say that this is wrong and condemn these practices has to make the intellectual leap that the only way to make it stop this kind of corporate behavior is to force these companies to face legal consequences. Not fines. Fines are baked into the cost of doing business. If you say you care about this then you have to accept that the only way to stop these companies is to break them up and send people to prison.

Companies like this can make more money breaking the law than they have to pay back in fines IF they are caught. Executives who signed off on this deserve jail time and these companies need to be taken apart. Let’s see how frequently this happens when people start looking at prison time.

Many podcasters pretend to be allies for mental health yet shill for these companies. If you listen to an influencer who shills for BetterHelp it is your responsibility to hold them accountable.

I am not making this post to condemn BetterHelp therapists. I know several who are good people and talented. I do not believe these practices are their fault. No one becomes a social worker to get rich and finding ethical employment is a luxury that comes secondary to paying your mortgage. Good therapists work at BetterHelp. Imagine making an empathetic connection with a well meaning employee and then reading that their company sold your information? How likely would you be to trust or ask for help again. Responsibility lies with the people with power not those subject to power’s whims. Social workers and LPCs at BetterHelp did not do this or know about it. Their corporate overlords did. Although, you should know if you work for BetterHelp that your contract makes you personally liable for patient outcomes, even outcomes caused by following company policies. 

Even if you don’t believe the negative reviews take a loo at how BetterHelp talks about their own therapists in their intake forms:

“We cannot assess whether the use of the Counselor, the Counselor Services or the Platform is right and suitable for your needs. THE PLATFORM DOES NOT INCLUDE THE PROVISION OF MEDICAL CARE, MENTAL HEALTH SERVICES, OR OTHER PROFESSIONAL SERVICES BY US.”

and

“You should never rely on or make health or well-being decisions which are primarily based on information provided as part of the Counselor Services.”

and

“THE PLATFORM IS NOT INTENDED FOR DIAGNOSIS, INCLUDING INFORMATION REGARDING WHICH DRUGS OR TREATMENT THAT MAY BE APPROPRIATE FOR YOU, AND YOU SHOULD DISREGARD ANY SUCH ADVICE IF DELIVERED THROUGH THE PLATFORM.”

Isn’t therapy a term protected by law. Can you really say “we are doing real therapy but the therapy you are paying for does not include all that stuff that real therapists do”

These therapist have licenses but BetterHelp is telling you that even though they do, they are not doing therapy. At least for social workers like me that could be a major ethical violation. From the perspective of your board you cant turn your license off. Anything that you are doing in the realm of mental health is requires you to treat as a medical and mental health service, but here your employer is telling your client that the therapy you are calling therapy ISNT a mental health service and essentially isn’t real. “THE PLATFORM DOES NOT INCLUDE THE PROVISION OF MEDICAL CARE, MENTAL HEALTH SERVICES, OR OTHER PROFESSIONAL SERVICES BY US.”  That seems like an opportunity for a lawsuit that your contract says you will be solely responsible for.  That is potentially against the law in all states where “therapy” and “mental health services” are regulated terms. Put simply you cant run ads that you provide therapy and mental health services and then write in your paper work; actually this isn’t therapy or a mental health service.

This is absolutely not characteristic of industry norms. I’ve been careful to limit my own liability in this article and without going through any more specifics, if you are a patient or a provider I am happy to guide you through how to succeed in this industry. The vast majority of people who contact Taproot Therapy Collective receive a high quality personalized referral to another local provider. We refer and advertise other providers because we are part of a community and unconcerned with shareholders needing us to make a stock go up.

We genuinely want you to get therapy at the best place for you. We recognize that we are not the right provider for every need. We treat the therapists in our collective well even though I could make more money if we didn’t.  We call every person who contacts us back even when we are full. We don’t do that because it makes us money. We do it because providers of mental health services have a responsibility to ethical behavior even when our legislators have decided there won’t be legal consequences if we act against our ethics.

Every part of the structure of these app based therapy companies is something that any other therapists office could be investigated for by their board. Paid testimonials, selling data, electronic tracking, influence peddling, alleged bribes for dishonest testimonials, using healthcare data for advertising, etc. I don’t know what is less ethical; paying actors and celebrities to pretend to be patients or paying actual former patients that happen to be actors and celebrities. What would you think if you saw my patients on TV as paid representatives of Taproot? This is a violation of dual relationship standards. Again this is not the therapists at BetterHelp’s fault and they don’t make these decisions, but this wouldn’t fly anywhere else in the therapy world. It would make customers at any other firm wary.  Why do we make an exception to all of these rules just because a company is backed by venture capital and delivered through an app.

Sadly BetterHelp is not alone in these practices. A recent consumer reports study tracked data in the top five most popular mental health apps and saw that they all send data to Facebook in some capacity. Amazon’s recent expansion into healthcare will be a new test of how ready legislators and boards are to enforce rules over tech conglomerates. There will be more companies that do things like what BetterHelp did and we need to set a precedent that the same rules apply to therapy everywhere without exception. Is it too much to ask that these companies just make money by getting paid for doing therapy and not selling therapy related data?

Choosing ethical behavior is not something that should be up to the therapist. Our legislators should enforce existing laws even if it means sending their campaign donors to jail. We are in a mental health crisis and practices like these give people valid reasons to be afraid of getting mental health care. We need to make people more comfortable with mental healthcare not give them reasons to be afraid.

Bibliography:

Fagan, K. (2023). BetterHelp Settles with FTC for $7.8 Million Over Alleged Data Privacy Violations. The Verge. https://www.theverge.com/2023/3/2/23623191/betterhelp-ftc-settlement-data-privacy-facebook-snapchat

Goodman, J. (2022). The Darker Side of Online Therapy: Lessons from the BetterHelp Scandal. Psychotherapy Networker. https://www.psychotherapynetworker.org/blog/details/1661/the-darker-side-of-online-therapy-lessons-from-the-betterhelp-scandal

Hafner, J. (2023). BetterHelp Settles with FTC for $7.8 Million Over Allegations It Shared Sensitive User Data. USA Today. https://www.usatoday.com/story/tech/2023/03/02/betterhelp-ftc-settlement-data-privacy/69959022007/

Holterman, J. (2022). The Troubling Truth About Online Therapy Platforms. Vox. https://www.vox.com/the-goods/23098501/online-therapy-betterhelp-talkspace-mental-health

Keller, M. (2023). BetterHelp Therapy App to Pay $7.8 Million FTC Fine Over Alleged Data Sharing. NBC News. https://www.nbcnews.com/tech/tech-news/betterhelp-therapy-app-pay-78-million-ftc-fine-alleged-data-sharing-rcna72654

Further Reading:

American Psychological Association. (2017). Ethical Principles of Psychologists and Code of Conduct. https://www.apa.org/ethics/code

Becker-Blease, K. A., & Freyd, J. J. (2006). Research Participants Telling the Truth About Their Lives: The Ethics of Asking and Not Asking About Abuse. American Psychologist, 61(3), 218-226. https://doi.org/10.1037/0003-066X.61.3.218

Coyle, D., Doherty, G., Matthews, M., & Sharry, J. (2007). Computers in Talk-Based Mental Health Interventions. Interacting with Computers, 19(4), 545-562. https://doi.org/10.1016/j.intcom.2007.02.001

Gamble, N., Boyle, C., & Morris, Z. A. (2015). Ethical Practice in Telepsychology. Australian Psychologist, 50(4), 292-298. https://doi.org/10.1111/ap.12133

Mattison, M. (2012). Social Work Practice in the Digital Age: Therapeutic E-mail as a Direct Practice Methodology. Social Work, 57(3), 249-258. https://doi.org/10.1093/sw/sws021

Recupero, P. R., & Rainey, S. E. (2005). Informed Consent to E-Therapy. American Journal of Psychotherapy, 59(4), 319-331. https://doi.org/10.1176/appi.psychotherapy.2005.59.4.319

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