E-therapy Provider Talkspace Under Fire, Again

Talkspace, one of the latest attempts to try and provide online therapy (a modality available to people since 1996), is under fire yet again. This time it comes from Cat Ferguson writing over at The Verge, questioning Talkspace’s patient anonymity protections and the use of freelance therapists to staff their service.

The article, published last week, is based upon first-hand accounts of presentations, emails, and interviews with numerous Talkspace therapists. And despite Talkspace’s insistence that therapists are freelancers, the firm apparently forbade therapists from talking to the reporter — an odd directive if the company isn’t your boss.

Let’s see what The Verge discovered — and get exclusive responses from Talkspace’s CEO.

After reading The Verge’s article, I reached out to the head of Talkspace, CEO Oren Frank. He provided lengthy, thoughtful answers to my questions which helped put some of the issues raised by the original article into perspective. I include excerpts from that interview below. When asked about why he declined to talk to reporter Cat Ferguson, Frank replied, “We found clear written evidence [that the article was not being written in good faith] early on, and decided not to collaborate with a piece that re-told the false accusations of three anonymous therapists that were no longer on the Talkspace platform due to professional and ethical issues.”

Anonymity Brings Up Complicated Issues

The option of providing anonymity to clients in an online psychotherapy service is a brave one.1 However, such a policy must also bring a well thought-out plan for how to deal with crises and people in need of more immediate help than your service can provide. It’s not clear that therapists who use Talkspace understand how it all works:

Until recently, the four-year-old company’s recommendation for helping patients who were a danger to themselves or others was to contact a member of senior management, according to current and former therapists. In a message to a therapist, a clinical leader said that, in an emergency, the company could give the police a client’s IP address, which is not always accurate.

In several cases uncovered by The Verge, Talkspace therapists asked a Talkspace employee for client contact information after they felt obligated to report dangerous situations and were rejected. More than one case of possible child endangerment went unreported, after therapists were denied even an IP address.

Talkspace denies this ever happened because it simply doesn’t make sense that they would impede therapists’ access to such information if needed in a crisis situation. “[…] When a therapist decides they may have a “duty to warn,” we have, and will provide, the information we have about a client,” says Frank. “[…] The allegation that anybody at Talkspace would not go to great lengths to save somebody in danger of harm is appalling and offensive.”

I think one of the challenges is that it is reliant upon the therapist to collect this information independently from each client. Talkspace apparently doesn’t collect this information when collecting billing information from their clients and claims it is standard practice in the industry: “In order to minimize the collection of sensitive information, most modern companies pass financial data directly through to their payment provider and do not store it.”

While it’s true most companies don’t collect and store credit card information (what’s called PCI), it’s not at all true for basic identifying information about the individual, such as their name, address, and email address. Talkspace apparently doesn’t store this non-PCI information, although they readily could — which would go a long way to resolving the concerns about emergency and crisis situations.

Talkspace Realizes Its Therapists Might Be Seen as Employees

After their last round of funding, apparently someone at Talkspace wised up to labor laws and what types of things an employer can’t do in order to properly claim people who work for them are independent contractors, not employees. For instance, you can’t dictate work schedules, pay rates, or vacation time — many of which Talkspace was apparently doing right up until a few months ago:

“When I first started, you were expected to be logged in six out of seven days,” a former Talkspace therapist told The Verge, explaining that the company later bumped that down to five days a week. “After your client posted, there was a countdown timer. If you didn’t respond after eight hours it would flash.”

[…] “Regardless of if you are out of town or at home, you need to log on twice daily as agreed upon as a provider, to engage with your clients. Once you’ve been a provider for SIX MONTHS then: Talkspace will allow one week off each year.” Therapists were also required to offer a free, 30-minute live session to every client, within a week on either side of the vacation time; many therapists have dozens of clients.

These policies have since been revised to be in more in keeping with a company simply offering a technology platform for therapists to use (versus a company employing therapists to provide psychotherapy on their website). “Psychotherapy is delivered by licensed professional therapists on the Talkspace platform, so you’re right, and the “care” is therapy,” noted Frank. “However, it is not Talkspace or its employees that deliver that care, but independent licensed therapists that use our platform to deliver it.”

Conflicting Privacy Claims & Procedures

For at least part of the company’s history, it appears Talkspace has operated under some dubious privacy claims. For instance, its homepage in 2014 offered a “privacy guarantee,” which, when clicked on, took you to the company’s length, legalese-laden privacy policy that included the surprising statement:

We do not guarantee that talkspace.com will be safe or secure.

The “privacy guarantee” on the homepage was later removed without comment and replaced with the even worse claim, “You can message your therapist anytime and anywhere, from your smartphone or the web, 100% safe and secure” (emphasis ours).

Safe and secure?

When asked about these clearly contradictory statements, Frank responded, “No government or agency or company can legally offer a guarantee of total security in their Terms of Use or Privacy Policy and security may be affected by client behavior we do not control. The homepage text refers to the security of the platform versus an unsecured cell phone or other mode of communication that cannot be used safely with private medical information…”2

The privacy policy statement above remains a part of the service — an odd disclaimer for the 300,000 people using their service expecting some expectation of safety and security. Especially where the homepage, in large text, proclaims that the service is “100% safe and secure.”

This disconnect between what the company says they do, and what they actually do can be seen in one incident from earlier this year. Apparently one of their senior management copied a set of their patients on an insecure email communication sent to them regarding their therapist. The senior management person apparently failed to use the blind copy feature of email, meaning each client saw one another’s email address — violating each client’s privacy and confidentiality. This vice president also apparently sent the communication in clear text email — a medium generally considered inappropriate for most patient communications (outside of appointment notifications).

“The insecure email was a single human error; an employee simply hurrying to properly respond to what she perceived as a reckless message from a therapist to her clients,” said Frank, who also said that they apologized for the error and clients were compensated. “I’m thankful that most of them have decided to stay with Talkspace.”

You would think that a company that prides itself on its secure messaging platform would use that same platform to contact clients using it, but that’s not the case for Talkspace. “Client communications are handled through a variety of channels — in-room messages, push notifications, phone support, and email — depending on the message,” noted Frank.

“All client communications are standardized for the situation at hand, and sent through the appropriate channel depending on the nature and the sensitivity of the communication.” Clearly, in the case of this email from a member of the company’s senior management, that did not happen. You would also hope that companies working in such a sensitive business would employ senior management who are well-trained and experienced in communicating issues in a secure, appropriate manner.

Should You Use Talkspace?

The choice to give online therapy a try using an app or service like Talkspace is always going to be a personal decision, based upon what you know of the company and its reputation in the industry. Personally, I wouldn’t be as interested in using a platform where they make certain marketing claims about their safety and security that contradict their actual policies and legalese. I also wouldn’t be happy that although they could choose to capture more personal information about their customers that could help in times of an emergency or crisis situation, they decline to do so, leaving it up to every one of their therapists to fill in that self-created gap.

When you walk into most real-world therapy clinics or group practices, a secretary or administrative assistant has you fill out basic information forms, including payment information. (In sole practices, this might be done by the therapist themselves.) You’d think that, like most companies offering a service platform online, Talkspace would collect such information and pass it along to the therapist — just like a good administrative assistant. Instead they wash their hands of such information, and lay all of the responsibility on each of their freelance therapists.

It’s not clear to me that the company understands the value and importance of this information. After all, offering psychotherapy services isn’t like offering psychic services or selling shoes online. For me, I’d value a company run by mental health professionals who appreciated why their service needed to be designed and marketed a certain way. These are complex issues, and ones that I don’t think Talkspace or its top executives fully understand.

 

Read the original article: Breakdown: Inside the messy world of anonymous therapy app Talkspace

Read Frank’s response: Response to false accusations against Talkspace

Footnotes:

  1. One that I actually embraced back in 1999 when I helped run one of the first online e-therapy clinics, Help Horizons. []
  2. Frank went on to say, “(Skype is a good example), and contrasts us with other services that do not have licensed therapists and do not encrypt their client communications (there are a few ‘listening services’ out there, and the stories we hear from clients that tried them are frightening and reinforce the need for professional online therapy.)” []