A Psychologist Weighs in on the Youtube + BetterHelp Controversy

Oh goodness y’all.  There was some drama this week on YouTube.  And while I’m not usually one for drama, this drama is directly related to mental health.  So as a psychologist, I’ve got to weigh in.  Watch below to learn what all the drama with YouTube and BetterHelp is about.  Plus, hear my take on the whole thing.  Let’s go!

In recent weeks, there’s been an uproar on YouTube about ongoing collaborations between various YouTubers and a company called BetterHelp.  BetterHelp is a website that claims to be “the world’s largest e-counseling platform.” In the last several months, it’s been reported that nearly 100 YouTubers have done sponsored collaborations with BetterHelp.  In these videos, YouTube personalities open up about their own mental health struggles.  Then, many of them give a plug for BetterHelp, sharing about how they used the platform to feel better.

At first glance, this seems like a positive, right?  Well known YouTubers are being more transparent and authentic about their mental health concerns.  This seems like a great way to help destigmatize mental health concerns on a larger scale.  And in general, I think anything we can do to destigmatize mental health is awesome.

But where this gets tricky is that many YouTubers are reportedly getting paid for each person that signs up for BetterHelp through their unique link.  And apparently, they’re sometimes making up to $200 for each person that signs up.  This leaves many people concerned that YouTubers are essentially profiting off their viewers mental health concerns.  It’s also called into question how authentic many of the YouTubers were being when they shared their mental health issues.  Were they being honest about their issues?  Were they exaggerating them to get people to connect?  Did they even use BetterHelp to deal with their issues, and did it really help to the degree they said?

Sponsorships in social media aren’t new.  They happen all the time.  And that’s part of the game.  But things change when we talk about mental health.  The stakes are higher, and the issues are more nuanced.  Ethics are different when we’re talking about mental health.  Ethics are different when we’re discussing depression, trauma, anxiety, and abuse.  They’re more subtle and nuanced.  And when we’re talking about mental health, transparency and careful consideration of all implications are critical.

When we’re talking about mental health, I deeply believe that online personalities have a responsibility to be more thoughtful about these delicate lines.  They have to be more transparent about how they benefit or profit from mental health sponsorships.

Now, prior to all of this drama on YouTube, I’d never even heard of BetterHelp.  But once I did, I wanted to know more about the company.  So I started looking into them.  And once I did, I was deeply concerned about the platform, their practices, and their terms of conditions.

The Issues

On their website, BetterHelp describes their mission as, “Making professional counseling accessible, affordable, convenient – so anyone who struggles with life’s challenges can get help, anytime, anywhere.”  The platform gives you unlimited access to a counselor through messaging, video chats, or phone calls. In turn, you pay a monthly fee, much like a subscription. And at first glance, it seems like an accessible way to get affordable therapy.

But when you read the terms and conditions, you can see that the platform isn’t what it seems to be.  It doesn’t offer the mental health treatment it portrays.  It’s not therapy like so many YouTubers describe.

In the terms and conditions, it clearly states, “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.”  So, to be clear, BetterHelp does not offer mental health services.  The terms and conditions go on to say that the services “are not a complete substitute for a face-to-face examination and/or session by a licensed qualified professional.”

Later, BetterHelp warns, “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.”  This distinction continues.  “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.”

But wait, if you’re seeking out counseling, don’t you want to use the information you receive to make decisions about your health?  If you’re seeking support for mental health issues, aren’t you expecting the professional to help guide you toward greater well-being?

When you sit down with a licensed mental health professional in a more traditional, face to face session, you’re likely going to have a thorough assessment of your issues and mental health history.  You’re likely going to be provided with a diagnosis, and this diagnosis, along with several other factors, will help you set goals for treatment.  Your therapist will make recommendations for treatment, guiding you along the way.  Your therapist will also provide appropriate referrals and resources if you need them.

If you’re working with a licensed mental health professional, if you’re going to therapy, you absolutely deserve to have these things with confidence.  You deserve to know that you’re getting solid, competent, and helpful direction that you can follow. And while you don’t have to follow all these recommendations, you won’t be instructed or encouraged to “disregard” them.  If that’s the case, why seek out counseling in the first place?

BetterHelp advises users “to exercise a high level of care and caution in the use of the Platform and the Counselor services.”  I found this language and this idea to be deeply concerning.

So often, when people are struggling with depression or anxiety, they have a hard time thinking clearly.  Energy and mood can be low.  Memory and concentration can be impaired.  It’s tough to evaluate things objectively, and many people question their judgement.  My hope for anyone seeking counseling is that they can enter into a trusting and supportive relationship with a professional, feeling confident in the guidance and direction they’re given.  They shouldn’t have to exercise “a high level of care and caution” during such a vulnerable time.

Countless YouTubers are touting BetterHelp as therapy, but there are so many things about the platform that are different from therapy.  The website even says that the platform is “not a complete substitute for a therapy.”

BetterHelp allows users to choose how they communicate with their counselor, and if a person wishes, they can do all their communication through messaging, without ever seeing their counselor’s face or hearing their voice.  As someone who has dedicated much of their life to the practice of therapy, that is mind boggling to me.  Could texting with someone when you’re struggling be helpful?  Of course.  But is that therapy or counseling?  No.

As more and more online counseling sites pop up, it’s important to look carefully at what’s offered.  Many of these sites, including BetterHelp, emphasize the the cost-effectiveness of their services.  They claim that they’re often more affordable than traditional therapy.  They quote that traditional therapy sessions often run between $150 and $250 per session.  But this is misleading.

For many people in the US, especially those that have health insurance, therapy is more affordable than that.  Most of my own clients have a small copay, somewhere between $5 and $35 per session.  These rates are consistent even for most Medicaid and Medicare plans.  So even if clients saw me twice a week, that’s still cheaper than most of the online platforms.  There’s no doubt, financial resources and access to healthcare are linked in our country, and it’s a problem we have to continue to address.

So while cost is certainly a barrier for some people, the idea that therapy is astronomical in price is misleading.  The suggestion that online platforms are the most affordable and cost-effective treatment option isn’t true.  And I worry that this narrative deters people from even looking into more traditional therapy.  They see that $150-250 number and just assume they can’t afford it.

In addition, many of these online platforms use a subscription model.  They have you pay upfront each month, often giving discounts if you subscribe for longer periods of time.  It incentivizes using the platform for money, and as a psychologist, I disagree with this model.  You should be using and paying for what you need, when you need it.  You and your treatment goals should be guiding the treatment, not how much of a package you have left.

If you’re watching this video, thinking that I’m just worried that online counseling platforms are going to steal my business and put me of work, I assure you, that’s not the case.  My practice is full; I’m not even accepting new clients right now.  This isn’t about that at all.

I’m going to do a video soon on online therapy versus face to face therapy, but here’s the takeaway about BetterHelp.  This platform is being packaged and pitched as online therapy, but it’s not.  It’s different from therapy in so many ways.  And those ways, as highlighted above, are described in almost mind-boggling detail in their terms and conditions.

My biggest issue with all of these YouTube and BetterHelp collaborations and sponsorships is that it sends a message that BetterHelp is the primary, the best, or the cheapest option for treatment.  And I worry that people who are really in need of help will turn to these online platforms, not knowing all of their options. I worry that people in need won’t get connected with qualified mental health professionals who can help and provide treatment in a more complete context.  BetterHelp is one option for getting help, but it’s certainly not the only one.  And I certainly don’t think it’s the best one.

I love that we are talking more openly about mental health in today’s world.  I love that more and more people are considering treatment.  We need more of this!  But we’ve got to do a better job with ethics and boundaries around mental health collaborations.  Companies have to be more transparent about what they offer.  YouTubers have to be more thoughtful when they’re holding their readers mental health in their hands.  And as a psychologist, I vow to be more active in helping people know the differences in care and treatment, helping them see all of their options and the merit of each.

What are your thoughts on all this recent YouTube + BetterHelp drama?  Do you have concerns about the transparency of creators or the services of online counseling platforms?

PS: Ready to try therapy, and wondering how to find a therapist?  Click here for 5 simple steps to help you with your search!