No shortcuts to change: Psychotherapy vs the aspirational business model  

The tech industry is impacting the mental health industry as it has impacted most industries. There isn’t a month that goes by where I am not asked to review or use a new mental health app that purports to “transform” how I work as a clinician.  Whether it is the creation of new mood tracking apps, internet based therapist matching systems, teletherapy platforms, or mental health startups re-branding therapy for the consumer, the influence of technology is here to stay.

From a financial or startup investor perspective, there has always been some interest in  “scaling up” and creating therapy services for the mass market.   Due to poor insurance coverage or reimbursement for psychotherapy, accessing good therapy can be a challenge.   But there are a few important reasons why psychotherapy doesn’t “scale up” via technology well.

  1. Tech companies that hire therapists en masse to do remote therapy are likely to face quality assurance, therapist turnover, and significant financial challenges that can make it an ineffective business model long term.  There is a surge of startup funding for mental health startups, but this should not be confused with being a financially viable and ethically strong business in the long term. 

  2. Some tech companies are expending efforts to re-brand therapy by choosing to use broader words for their services such as  “coaching”  “wellness” “empowerment” , etc.  You should not assume you are receiving the benefits of individual psychotherapy with a licensed therapist if that is not actually acknowledged. The importance of working with a licensed clinician whose expertise and ethical guidelines are well-documented should not be underestimated.  Unethical working arrangements are often ineffective or in the worst case, directly cause harm.

  3. People seek psychotherapy to change. But aspiration alone isn’t change. Knowledge alone isn’t change.  And increased organizational skill isn’t change (unless the change you seek is increased organizational skills!). The bulk of mental health apps offer one or more of these potential benefits. These apps certainly can support and even inspire thinking about change, but they don’t actually replicate the relational benefits of therapy or the hardest work of change.

  4. The truth is that change is hard work and we should not minimize that when we set goals for ourselves. One of the reasons good therapy works is that the therapeutic relationship between client and therapist is an unusually trusting partnership with the client’s goals at the center of the relationship. The therapist is “neutral” in the sense that she holds no personal agenda in her client’s goal-setting.  Very few situations or relationships replicate this in life,  and it is indeed powerful. But why does a relationship with a licensed therapist matter? Because for most goals if you could have done it easily alone, you would have.  And most goals are complex and would benefit from more concentrated effort and personalized expertise than a mental health app can provide. Licensed therapists are trained change experts and operate under strict ethical guidelines.  Together, a therapist and client can maximize the therapist’s expertise in service of the client, and help the client to expand her perspective, motivation,  and sense of options. This is critical to staying committed to the complex change process. 

As much as there is a pull to scale up and make the benefits of psychotherapy available en masse at minimal cost,  the individual therapy model is unlike an aspirational gym membership model which can, in fact, scale up. The gym membership model is predicated on the premise that many customers sign up and aspire to change, but few actually show up after the January bump, and even fewer members demand individualized services, and yet the customers continue to pay the membership fees.  The failure of the majority of the customer base to commit and use the gym to change is how a gym “scales up” and maintains financial success.  Some mental health apps are moving in this “aspirational” direction - banking on the premise that the less personalized mental health services provided will hit a low enough bar that the customer continues to keep paying.   

It is common sense that commitment and work are the minimum requirements for maintaining lasting change. In fact, can you think of a time when you created change and it didn’t require consistent work and commitment? Commitment is the glue that keeps us consistently working on our behavioral and mental goals.  If you are interested in finding a therapist to partner with to help generate a change in your life, please reach out, learn more, and let us help!