Our last look at counseling by telehealth was back in June of 2022. Overall, our impression at the time was favorable, and in most ways, remains so. Telehealth was a godsend to treatment programs during the pandemic and the lockdown that followed. Nobody denies that.

Still, since then some concerns have emerged that bear watching. Mostly, they have to do with teletherapy services when offered by very large, for-profit commercial businesses. The Vox website covered some of these concerns in an article that appeared in February of this year. A link:

Teletherapy can really help, and really hurt

From privacy breaches to bad providers, teletherapy services often come with a hidden cost.

With the pandemic over, the further expansion of teletherapy has largely been motivated by a growing national shortage of qualified credentialed practitioners. Along with the need to provide services to rural and frontier areas where distance is an obstacle. It’s difficult to get clinicians to move to out-of-the-way places, even with financial incentives. After all, 80% of America lives and works in urban areas, and for the most part, would prefer to stay.

Our State, New Mexico, is an example. “Telehealth saved our bacon,” confessed a clinic director. His nonprofit was an early adopter, setting up their own secure remote connections to provide sessions, both individual and group. That worked well. But some things have changed in the past year or so.

Now, many services are provided by large commercial enterprises, funded by investors and operating nationally. Would quality suffer? It’s a legitimate question that’s being asked by clinicians.
Research does appear to confirm one real advantage of telehealth: higher rates of retention in treatment than we see with in-person care. It makes sense — if we eliminate the expense, inconvenience and overall hassle involved in getting to and from appointments, clients are less likely to drop out.
But there are other ways to measure performance, too, beyond continued enrollment. The Vox article examined some of them with respect to one of the nation’s largest commercial networks, and found that:
  • The provider had shared sensitive client data with their advertisers —  without bothering to get their clients’ permission. That of course is a no-no in the world of behavioral healthcare. Those pesky confidentiality provisions.
  • Compared to behavioral health as a whole, clinicians at Big Telehealth were frequently underpaid. That’s from Bloomberg News, where they track such things. I imagine the clinicians were not too pleased to find that out.
  • Those same clinicians reported feeling pressured by the company to meet the expectations of clients who had been attracted to the services by an aggressive marketing campaign on social media. The clients had been led to expect quick, seamless access to all sorts of services, including medications. Not surprisingly, they were disappointed.
  • And then there was the marketing issue: online customer reviews showed signs of having been manipulated, to favor the company.
  • Finally, once they were enrolled, dissatisfied clients found it quite difficult to cancel their subscriptions.

These are frequent complaints from customers who purchase entertainment and other services streamed over the Internet. That’s far from ideal in the context of a therapeutic relationship. Therapy requires trust, and such practices could easily undermine it.

Quote from the article: “Mistakes happen. But when services in something as vital as mental health go wrong, people get hurt.”

Indeed they do.