Why BetterHelp is a Risk to Our Collective Mental Health

The world’s largest online therapy platform is a juggernaut. BetterHelp’s proliferation across every conceivable marketing medium (podcasts, especially) is sure to appear as a case study in marketing courses for years to come. Never has therapy existed on such an immense scale, and with the company spending $900 million in 2023, there’s zero chance of it slowing down. 

At first glance, that might come off as a positive. Millions of people attending therapy! Accessible therapy for all! It’s therapy, but as convenient as swiping through Tinder or ordering a kitchen scale from Amazon! 

Well, the reality is a bit different. BetterHelp has been the subject of numerous controversy and cases around patient privacy and confidentiality, going back as far as 2017. 

But let’s put those controversies aside and pretend they’ve been 100% remedied. Google “BetterHelp reviews” and you’ll see a pretty nice picture! But add one word to that search (“reddit”), or talk to real humans who have used BetterHelp, and that picture changes very quickly.... 

BetterHelp Reviews and Experiences 

A few weeks back, we sent out a survey asking folks about their experience with BetterHelp. You can view and complete that survey here.

I’ll fully admit, this was partly driven by curiosity.

I’ve heard hundreds if not thousands of BetterHelp podcast ads. One thing that’s always bugged me is that “switch therapists any time!” value proposition. There’s some bias there, sure — I founded First Session on the entire premise of finding the right “therapist-client” fit, the first time— a concept that’s proven to result in longer term progress and change from therapy. 

But having talked with hundreds (thousands?) of therapists and professionals over the last 5 years, my interest and suspicion of “convenience first” platforms like BetterHelp has continued to grow. 

So, we created a simple survey asking about folks experiences with BetterHelp. 

It revealed a few stats that didn’t surprise me — and a handful that highlighted the growing concern that I (and others) have had about BetterHelp and similar platforms for years.

But those stats prompted a deeper look into the platform and how real humans have experienced it. Because, yes, Trustpilot and other online review databases might report a 4 star rating, but those platforms rarely reflect reality (more on that later). 

BetterHelp Survey Results and Takeaways

So, let’s dive in — a few key stats and takeaways from our survey.

70% of respondents had a negative experience with BetterHelp.

35% of respondents report trying multiple therapists.

80% of respondents who tried multiple therapists report having a negative experience with BetterHelp.

48% of respondents describe the process of switching therapists as “painful.”

30% of respondents report that BetterHelp negatively impacted their view of therapy and their likelihood to pursue it in the future.

Full disclosure, the sample size here was not massive. On top of that, we surveyed individuals who are “subscribed” to First Session communications. So, there’s likely bias inherent within the audience.

Still, for me, these early findings reinforce a few thoughts myself, therapists, and others in the mental health and wellness space have been talking about for years: 

BetterHelp’s value proposition of “switch therapists as many times as you want” results in a negative experience for patients. 

BetterHelp has come under fire for paying their therapists well below the market rate, and as a result, creating a roster of overworked, burnt out, or otherwise "green" therapists. The takeaway? Patients hoping for long-term growth with BetterHelp will likely have to go through an extensive and frustrating process of “therapist client fit” trial and error. Given that just under half of respondents found the switching process “painful,” I find that unacceptable and troubling.  

The overall quality of therapy via BetterHelp is low 

While there were exceptions in the survey, the majority of responses highlighted that sessions were rushed, surface level, disengaged, and generally unhelpful. Advice and insight given from therapists was, in many cases, non-existent or generic. 

On the topic of “matching,” several respondents highlighted how the therapist they matched with did not feel like a good personality fit, or lacked the expertise and background they were looking for.

Therapists were also frequently late for appointments and took weeks to respond to client messages (BetterHelp touts that you can “message your therapist anytime, from anywhere). 

BetterHelp hurts an individual’s potential for long-term change

With seemingly unlimited marketing dollars, the reach and awareness of BetterHelp far exceeds anything we’ve seen before in the therapy and mental health space 

Because of that, BetterHelp will be the first experience many folks will have with therapy. As per our findings, 70% of those people will have a poor experience, while 30% will be less likely to pursue therapy in the future. 

Again, this is conerning. Mass awareness of therapy and the importance of mental well-being is at an all time high, and more people are likely to seek therapy now than ever in human history. That’s an amazing thing! But, massive tech companies like BetterHelp with millions of advertising dollars and unthinkable reach hold a lot of power. Because of that, many of that “first time” cohort will experience BetterHelp’s unproven and sometimes unethical approach to therapy 

Therapy is work. It’s hard. The very process of being honest with oneself and saying “okay, I’m going to therapy” is a huge step. The amount of friction in the process of “deciding to seek therapy” and “finding therapy that works” is staggering. Sure, BetterHelp might win on the “find a therapist ASAP” point — but the potential for emotional stress, frustration, and disillusion with therapy in general is extremely high and worsened by BetterHelp’s practices. 

Therapy seekers are brave. They deserve the benefits that come with long-term therapy and the right patient-therapist fit. 

Again, this is a limited dataset. So, we have to face the possibility: the results of this survey are pure coincidence and do not reflect reality. That’s entirely possible (and also why, if you’ve ever used BetterHelp, you should fill out our survey). 

So, let’s ask the question: 

Do BetterHelp reviews reveal something different? 

This is a tricky one. Full disclosure: I will sound like I’m wearing a tinfoil hat in a few of these points. But having worked in and around marketing for over a decade in the tech industry, I have a strong grasp on the ins and outs of marketing and “social proof.” 

Type “BetterHelp reviews” into Google and you’ll quickly come across review sites like Trustpilot or Capterra. 

Taking a look at Trustpilot, the reviews look pretty good. A 4.4 out of 5! With over 7800 reviews, that’s a powerful score. 

But I’m wary of that data. For one, companies are often selective about who they ask to review their products on platforms like Trustpilot. Meanwhile, the practice of paid reviews is not unusual (“Rate us 5 stars for an Amazon gift card!” emails), while “TrustPilot raters for hire” is another problematic tactic. 

Do we have any evidence that BetterHelp undergoes these practices? Nope. But the takeaway is that, especially with large companies, TrustPilot reviews may not be the most trustworthy source of information — there's good reason to be sceptical.

So, where do we look? Well, if you’re anything like me, the process of Googling for a product or service involves adding a single word to your search query: “reddit.” 

The truth is out there (on BetterHelp reddit)

Simply Googling “BetterHelp reviews reddit” reveals a wildly different outlook and set of experiences. 

“Steer far away from this service if you're thinking about getting help with any issues going on in your life,” recounts one review, where a patient paid hundreds for four weeks of BetterHelp and worked with four separate therapists who were either late, unresponsive, or both. 

Another post details BetterHelp’s problematic monthly subscription model. They highlight how BetterHelp charges clients when matching with or switching therapists (in this case, it took a week to match the client with a therapist, and another week to finally meet). They report an unhelpful and unresponsive experience, and paid $1280 in just four months thanks to that monthly subscription model. The worst part? BetterHelp is not covered by any insurance in the United States or abroad — it’s 100% out of pocket. 

The anecdotes, subreddits, and contributing comments are endless and in stark contrast to what you’ll come across on Trustpilot. 

Do they offer the definitive view or objectively conclude that BetterHelp is inherently problematic? Of course not — Reddit is not a peer-reviewed academic resource (nor is this blog post). But what they do support is that the results of our survey are not the stuff of pure coincidence. 

Whether the actual number is 55% or 80%, the percentage of individuals who had a negative experience with BetterHelp looks to be significant when digging beyond the surface level of TrustHelp or Capterra reviews and endless podcast ads. 

BetterHelp therapist quality and working conditions

All of this prompts the question: who or what is to blame when it comes to these negative experiences? 

On one hand, yes, the subscription and payment model is problematic. But in 2024, monthly subscriptions are not unheard of with software as a service monetization models (basically, any monthly or yearly subscription service — Netflix for example). Point being, BetterHelp’s payment model could theoretically work. 

Instead, the issue looks to be the quality of therapists offered by BetterHelp. Or, more precisely, the quality of BetterHelp’s treatment of their therapists.

The first comment in this reddit thread gives a glimpse into the issue — low therapist pay and no mandated or formalized “exit process” between client and therapist. In that same thread, another commenter who worked for BetterHelp for four months relays how they were paid $30 per hour and constantly bombarded with client messages, but were never compensated for time spent responding to those messages. The result was poor pay, zero boundaries between client and therapist, and a very short term gig. 

Low pay is one thing, but unethical practices that put therapists at risk are another. 

In his thread, a respondent highlights how BetterHelp will match therapists licensed to work in a specific state with out of state patients — a practice that poses significant risk to any therapists license in the United States. In short, working for BetterHelp comes with deep professional risk. 

That precise concern was raised by a therapist currently working for First Session (they chose to remain anonymous). Licensed and practicing in Canada, they inquired about working for BetterHelp but were denied because of their location in Canada. 

However, BetterHelp claims that they provide therapists licensed to work in Canada — which is simply untrue (therapists must reside in Canada and the province where they are licensed to practice). The result is that if a Canadian client ever wished to file a formal complaint, they would have zero legal recourse since they were working with a therapist not licensed to provide services in Canada. Whether it’s insurance coverage, client privacy, or your legal rights as a patient — you’re on your own with BetterHelp. 

The above notes are deeply troubling and unethical, and highlight a practice that I and other therapists seriously oppose:

‍BetterHelp takes advantage of therapists in difficult circumstances. 

To work with BetterHelp you have to be willing to be overworked, underpaid, and at risk of losing your license. To phrase that differently, you have to be desperate.

Becoming a therapist isn’t easy. The education required is extensive. The associated costs (beyond education) add up quickly (insurance, licensing, continuing education, etc). I can’t say with certainty why therapists decide to work with BetterHelp for $30 an hour, but my hunch is that they aren’t exactly “thriving” when they decide to make that move. 

All of this results in a massive network of exhausted therapists who are simply unable to provide the care and attention their patients deserve. And the result after that? A growing cohort of therapy seekers disappointed, disillusioned, and potentially permanently “turned off” from the therapy process and their own potential for meaningful change altogether. 

Do I blame these therapists? No. Times get tough, and therapists like anyone else need to make money to live. Many of us can surely relate to that feeling of anxiety and desperation that accompanies economic uncertainty. 

Is BetterHelp worth it? Not for me

It might seem like I’m really ganging up on BetterHelp. And I guess I am. I have no doubt there are thousands of people who had a positive experience with BetterHelp — and I’m happy for them, genuinely. I want BetterHelp to succeed in providing ethical, quality therapy for millions of people. But that’s not exactly what our survey, countless experiences andreviews, and my own perception of BetterHelp reflect. 

BetterHelp is a huge company, and the above article is just the tip of the iceberg in terms of understanding the depth of its impact on collective mental wellness and therapy more generally. 

Given that BetterHelp is no stranger to controversy, I think it’s important to increase the volume of that critical conversation about the growing, heavily advertised presence of massively online “convenience first” therapy platforms (TalkSpace is another major player). Why? Because, quite literally, millions of people’s mental health depend on it.