While Talkspace describes its encryption as “industry standard,” not all counseling practices can provide that level of protection. For example, some private practices, including small local "mom-and-pop" counseling centers, simply use email. In fact, the American Psychological Association has noted a threefold increase of “service delivery” through email between 2000 and 2008.
“It’s hard to imagine that all the mom-and-pop shops really have a clear sense of all the technical and administrative safeguards that are part of the federal health privacy and security rules,” says Frank Pasquale, a University of Maryland law professor who studies health law and privacy.
In addition to having privacy concerns about online therapy, some counselors worry about the quality of care in these digital sessions.
“Some important aspects of counseling are lost when the services are not provided face-to-face,” says Joyce Marter, the president of the Illinois Mental-Health Counselors Association. “Therapy is an interpersonal process, based on a trusting therapeutic rapport, that may not be able to be facilitated in the same way through a virtual medium.”
In an online session, counselors may not be able to pick up on important aspects of non-verbal communication (such as telltale body language or the smell of alcohol) when they are not physically present with the client.
“From a clinical and ethical perspective, my position would be that face-to-face counseling should be the preferred medium for counseling for clients with significant mental health issues such as clinical depression,” says Marter, who will also serve as president of the Illinois Counseling Association beginning in July 2016.
But perhaps the most challenging problem of online counseling is confusion over licenses. Even in the offline world, it is difficult to understand a mental-health professional’s credentials. There are psychiatrists, psychologists, licensed marriage and family therapists, licensed mental-health counselors, licensed clinical social workers, and many more types of accredited counselors. Sessions with any of these mental-health professionals can be covered by insurance.
Determining the qualifications of a potential counselor is not as simple as asking whether he or she accepts health insurance. Some mental-health professionals in private practices, including certain psychiatrists and psychologists with doctoral degrees, deliberately choose to operate outside of a health-insurance network.
This variability, combined with a sprawling list of acronyms and degrees, opens up the possibility for deception and opportunism as counseling sessions move online.
Although BetterHelp is currently receiving positive reviews, its own website illustrates the confusion over what constitutes counseling. The top of its home page says, “Online counseling is effective, affordable, and discreet.” But a disclaimer in the FAQ section says that while the service “may sometimes have similar benefits” to counseling, “in most cases it does not constitute ‘therapy’ or ‘counseling.’ Please note that your provider won’t be able to make any official diagnosis, to fulfill any court order or prescribe medication.”