The program’s low price appealed to Beal. For people whose employers don’t cover the service, Joyable costs $99 a month, compared with about $200 a session for psychotherapy in a big city. “The whole issue of paying for mental-health services is such an obstacle to getting help,” Beal told me recently.
He applied, got hired, and was trained in Joyable’s cognitive-behavioral approach. In his calls with clients, Beal primarily used motivational interviewing, validating a client’s experience and affirming what they’ve achieved. He aimed to help people feel heard.
For the most part, clients talked about their work and relationships. But “we would talk about anything; it would be wide open to talk about whatever they were dealing with,” Beal said.
If someone complained about their boss yelling at them, for example, Beal would say things such as, “It sounds like you felt like your boss didn’t hear what you were saying and neglected your needs.” Then he might help the person come up with solutions themselves, by saying things such as, “Have there been any occasions where things went well, and this negative experience didn’t happen?”
About a year after Beal took the job, AbleTo acquired Joyable. But Beal’s job and that of the other coaches remained the same, he says. In all, Beal estimates that he coached over 800 people.
Though people can pay monthly for the Joyable app and coaching services (I did), over time most of Beal’s clients were receiving the service as a fringe benefit paid for by insurers or by their employers, which included companies such as Northwell Health, Pandora, and Costco.
A few months ago, Beal and his colleague say, AbleTo hired a team of part-time coaches based in Florida, who he says also did not receive health benefits, paid time off, or sick pay. “I spent a lot of time supporting those new folks, without realizing that those are the people coming in to take our jobs,” Beal’s colleague told me. Indeed, the part-time jobs that AbleTo offered Beal and the others were based in Florida.
But this part-time arrangement isn’t fair, Beal and his colleague say. If they are helping so many American workers stay sane in a pandemic, surely they deserve health insurance themselves. “It’s like Starbucks telling their baristas, ‘You can serve the coffee, but you can’t drink any,’” Beal said.
AbleTo isn’t the first company that has raised concerns that tech platforms sometimes put growth and returns ahead of patient care and therapists’ well-being. Some therapists who have worked for other virtual mental-health providers, such as BetterHelp and Talkspace, have complained of low pay and difficult working conditions. One therapist who offered services on Talkspace found that when she provided a client with links to therapy resources outside the app, a company representative contacted the therapist to say she “should seek to keep her clients inside the app,” according to a New York Times investigation from August. At one point, Talkspace reportedly introduced a button clients could press that required their therapist to respond within a certain time, or risk having their pay docked. (In an email, a spokesperson for Talkspace told me, “Any therapist that wants to refer a patient to a higher level of care, in or outside of the Talkspace platform is free and encouraged to do so ... The call button was introduced last year to ensure timely response and high quality care ... It’s been integrated into the client experience with no incident.”)