Finding the right mental health counselor or therapist can be a long, frustrating process.
Without a recommendation from a trusted friend, it means sorting through internet or insurance listings of therapists, figuring out whether one would be a good fit for your needs, contacting them to see if they’re taking new clients, and possibly waiting days or weeks for an appointment.
Talk and text-based therapy apps promise to streamline this experience, often connecting users to a therapist within minutes. Starting therapy that quickly can be critical for some people, particularly during challenging times. It’s clear, for instance, that the pandemic has prompted people to reach out for help.
While apps can make therapy more accessible, they are a fairly new way to get professional help and it’s hard to know how to compare different products. There’s much more to consider than just user ratings in Google Play and the App Store. That’s why we’ve reviewed several candidates below: Amwell, BetterHelp, Doctor on Demand, MDLIVE, ReGain, 7Cups, and Talkspace.
While these apps make it easy to begin therapy, there are certain questions to ask before downloading any therapy app:
1. What is the matching process like?
In general, talk and text-based therapy apps match you with a provider. It’s worth noting that companies operating these apps market themselves as therapy solutions but in the fine print make clear they’re a platform that connects two parties, not a source of medical advice. In other words, if you have serious complaints about your counselor or therapist, the company is not necessarily liable for their behavior or conduct.
Some companies use an algorithm that takes into account your needs with a provider’s expertise and availability. BetterHelp, for example, considers hundreds of data points based on the app’s intake survey and the therapist’s past success with similar clients. Algorithms like these are proprietary, though, so it’s impossible to know the specific matching criteria they use.
While an algorithm may sound like an effective way to get the perfect match, there’s no evidence to suggest that’s true, says Lynn Bufka, senior director of practice, research and policy at the American Psychological Association.
“These technologies are new, relatively speaking,” says Bufka. “We don’t have nearly as much data on how the matching works, and what’s the best algorithm for it.”
Many of the apps ask you to fill out a questionnaire in advance of being matched with a counselor or therapist. They may ask about your mental health history, issues like substance use and chronic pain, what you hope to get out of therapy, and preferences for what type of therapist you’d like to see (think male or female, non-religious or religious, skilled in working with certain populations).
How honestly you complete an intake survey will presumably affect how the algorithm matches you with a therapist. If you don’t yet feel comfortable acknowledging self-harm or binge drinking, for example, the app might not identify therapists with expertise in those areas.
Bufka says such hesitancy is typical in therapy — and understandable. Some clients wait to see how deeply they can trust a therapist before revealing everything that’s troubling them. That may be easier to do with an IRL therapist, whose expertise you can assess in real time, along with their personality. If you decide to withhold certain experiences or concerns from an app that matches you via an algorithm, just keep in mind how that might affect your pairing.
Doctor on Demand and MDLIVE, which offer a wide array of health services in addition to mental health treatment, provide users with a list of therapists from which they can choose. That is more similar to the IRL experience of sorting through internet search results, but the providers’ bios are all in one place, and their availability is readily visible.
Talkspace and 7 Cups both ask users to select a plan and collect credit card information before pairing them with a therapist, so we were unable to experience the final step in the matching process.
Rest assured, though, that no app can claim their roster of therapists is better than a competitor’s.
“From what I’ve seen, no one app has more providers or higher quality providers,” says John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center, in Boston. “I’ve definitely not seen any evidence that says we should all be using app X.”
2. What should I look for in a counselor or therapist?
No matter which app you choose, perhaps the most important part of selecting a counselor or therapist or proceeding with a match is reviewing their expertise and credentials. Ideally, you’d want someone who’s skilled in addressing your most pressing issues, because not all clinicians receive the same training.
Before diving into therapy, it’s worth reflecting on whether, for example, you’re looking to develop better coping skills for sudden stressors, need help processing past physical or emotional trauma, assistance managing ongoing depression or anxiety, or maybe even all of those things. Don’t be afraid to be picky about the therapist you choose, because they should have some expertise that’s directly relevant to your needs.
If you are experiencing suicidal thoughts, Bufka recommends considering in-person therapy before trying an app. Some apps decline to match suicidal patients with a therapist because of the heightened risk, but also a local therapist will know best how to connect you to other providers for specialized treatment. They can also quickly assess your mood and behavior and prompt a local emergency response if it’s needed, something that a remote therapist, who likely won’t be familiar with the health care options in your community, might not be able to do as efficiently. While it’s important to keep this in mind, Bufka says to use an app if the alternative means not seeking help at all.
Therapists’ education and skills can vary widely; they may be social workers, family and marriage counselors, psychologists, or psychiatrists. Some people prefer their therapist to have a doctoral degree, which psychologists and psychiatrists earn by attending graduate school for several years, but it isn’t necessary to receive quality mental health care. You want to instead be sure that the counselor or therapist is licensed, preferably in the state where you live.
Until the coronavirus pandemic, all psychologists providing care via video, text, or telephone were required to be licensed in a client’s state. That regulation, which is meant to help protect consumers, was temporarily waived during the crisis. If you are working with a therapist in a different state, Bufka says to ask them about their license, credentials, and how comfortable they feel about practicing across state lines.
In order to feel certain about whether the app you’re using vets its therapists’ credentials, review its terms of service and look for details about how it verifies that providers are qualified and experienced. Be sure to also check when those terms were last updated.
When we first reviewed the 7 Cups’ terms of service, they hadn’t been updated since May 2018 and told users that the company didn’t actually verify the “skills, degrees, qualifications, credentials or background of any Listeners or Therapists” on its platform despite advertising that its therapists were licensed. When we contacted 7 Cups to clarify the discrepancy, founder Glen Moriarty said the terms were outdated and were currently under review. They should soon include details about how the company verifies its therapists’ licenses and expertise.
Besides their credentials, Torous says a therapist’s “webside manner” is an important factor when pursuing therapy via an app. That’s because therapy, whether it’s online or in person, is more successful when there’s a strong “therapeutic bond,” or a positive, warm, and trusting dynamic between the client and therapist. There’s evidence that you can build such a bond over video, but that requires more non-verbal communication, eye contact with the camera, and other subtle signals that foster a stronger rapport.
“People who are really good at webside manner are very good at forming strong relationships via video,” says Torous.
“You should expect privacy and confidentiality,” he adds. “Visits should be equally thorough and professional, equally engaging. The quality of care and attention shouldn’t be different [from an in-person therapy visit].”
3. What features should I look for?
Some talk therapy apps offer certain bells and whistles alongside video counseling sessions. Talkspace includes independent exercises meant to help improve your coping skills as well as a goal-setting tool, among other free add-ons. BetterHelp’s advice section contains numerous articles on mental health issues and treatment. 7 Cups offers free access to its large community of users who support each other based on their similar interests and needs.
The option to instant message your therapist outside of set appointments is a popular tool, though it may not be as effective or useful as in person, video, or phone sessions. Numerous studies of synchronous communication — talking to a therapist in person or via video or telephone — show benefits for patients, but we don’t have the same convincing evidence for asynchronous therapy like messaging, which may be cheaper. (Talkspace has published small studies on asynchronous therapy that showed positive outcomes for users.)
“We actually don’t know how effective that is, or who it’s going to work for,” says Torous.
While add-on features might enhance your perception of a certain app, Torous says two common factors that do determine the quality of your experience, according to his research, are whether you can access and see your data and whether the app comes with human customer service (versus an automated responses or a bot) that can talk to you about how to use the app. Basically, you’ll have a better experience if you can access your data, particularly to review your progress, and get assistance from support staff.
Cost is also an important factor to consider. While talk therapy apps are generally free to download, visits and messaging with a therapist range in cost and are often billed on a monthly basis. The price is meant to be less than or competitive with in-person therapy.
Torous says to assume insurance will not cover app-delivered therapy unless you have a written policy proving otherwise. If you do have insurance that covers in-person therapy, your co-pay or deductible might be considerably more or less than using an app.
4. What are the privacy and terms of service policies?
It’s no fun to slog through an app’s privacy and terms of service policies, but Torous recommends doing so before deciding to use it for therapy.
While the legalese can be hard to parse, Torous says you should look specifically for information about the company’s data encryption and retention practices, whether the company sells or trades your data, and if you can access your data, just like a medical record, and ultimately delete it. That data may include diagnoses, notes from your conversations, and chat transcriptions.
“Let’s just be honest: it’s really hard to read the fine print,” says Torous. “Information is buried or hard to find, and it’s not fair.”
Still, you’ll want to know if your data is secure and if it can be sold to a third party that might use it for marketing purposes. App companies may also anonymize your data and use it for research purposes or to sell insights about mental health trends to a third party. None of the apps we’ve reviewed trade or sell user data, according to the companies that operate them.
If you cannot access or delete your data, Torous says it’s worth reconsidering that app.
It’s also important to know that there is no privacy or security certification that therapy apps universally seek.
Doctor on Demand, MDLIVE, and Amwell were once accredited by the American Telemedicine Association, which evaluated whether online, real-time patient health services met key operational, clinical, and consumer standards. However, the ATA itself has not offered such vetting for years, so that stamp of approval, which Wirecutter used in its ratings of therapy apps, is outdated.
Amwell and Doctor on Demand have accreditation for their therapy services from URAC, a nonprofit organization that charges a substantial fee to independently evaluate the standards and policies of healthcare programs, including telehealth offerings.
MDLIVE and Doctor on Demand have been accredited to credential its providers by The National Committee for Quality Assurance, a nonprofit organization that also assesses standards and policies for a fee. NCQA and URAC accreditation however, are not yet viewed by many therapy apps (or consumers) as essential to guarantee user privacy and security.
Once you settle on an app and a therapist, it’s important to remember that you’ve just begun a journey — not finished one — that requires trust, candor, and often hard work.
“No matter what you do with therapy, honesty is really critical and it’s not easy,” says Bufka. “You’re usually asked to be thinking about and talking about and looking at things you would rather avoid. Whether it’s by app, telephone, or sitting in someone’s office, expect that there’s going to be a good amount of effort.”
7 therapy apps to consider
Doctor on Demand
Doctor on Demand provides treatment via video for a wide range of health issues, including mental health. Providers are licensed psychiatrists and psychologists.
The app prompts a user to schedule an appointment either by looking for a time or for a psychologist, which allows you to prioritize matching by urgency or provider personality and expertise. If choosing by provider, the app leads you to a directory of therapists working in your state. You then review biographical information and credentials for individual therapists and see their availability. When selecting an appointment by time, the app offers a calendar so that you can choose based on a time slot. You’ll then see whoever is available during your preferred window.