• American online therapy platform BetterHelp has been criticised by UK therapists in The Financial Times

  • Unethical workloads, low pay and subsequent burnout are cited as concerns not just for therapists but for clients, too

The Financial Times is not somewhere you might expect to read much about therapy and mental health, but it was in their pink pages that this headline appeared on the weekend: Therapists sound alarm on BetterHelp’s rapid UK expansion. 

The American online therapy platform whose advertising is now ubiquitous in the UK, was roundly critiqued in an article which questioned its recruitment process, pay structures and lack of support staff to ensure client safety.

FT journalist Ian Johnston talked to seven therapists about their experiences of recruitment and work on the platform. The fees charged are set by BetterHelp, and vary according to how many sessions are done by each therapist in a week, with additional increments for therapists who have in-between sessions text communications with their clients.

Andrew Flynn, a Hartlepool-based counsellor who joined BetterHelp in September 2022, told the FT, “Their pay structure is very unethical.” Subscribing UK clients pay between £40 to £70 per week — a similar rate to Flynn’s fees for private clients. But BetterHelp paid him around £18 per session. 

The system encouraged “burnout” claimed Flynn. Within weeks of joining, he was working six sessions a day but soon started to feel overwhelmed and reduced his hours. “You could get [£100,000 a year] if you did 45 hours a week. Honestly, I think you’d die,” he added. Due to the psychological pressure of the job, the BACP used to recommend that therapists do no more than 20 hours a week though they have now left it up to individuals.

In an article in September 2022 in Therapy Today, the BACP professional journal, Janine Hayter reported on her short experience with BetterHelp. After four months she stopped taking on new clients as it does not allow therapists to choose not to see a client.  “If you realise during the first session [with a new client] that you are not a good fit for each other, you can’t refer on – the work can only be terminated by the client. To me this felt really uncomfortable and unprofessional.”

Not all therapists agree; many appreciate the reliable flow of work and as Therapy Today reported, use the platform to fill up empty slots. But it does not answer the question of the rates that therapists are being paid for their professional service. Clients appreciate the affordability and ease of booking and paying online, but do they know how little their therapist is receiving?

Therapy Today editor Sally Brown summed up the quandary about BetterHelp here: "Many of us have concerns about what seems to be the increased consumerisation and commoditisation of therapy. Many UK therapists have signed up as an easy way to ‘top up’ income from private practice, and some have found it works for them. Others have reported concerns over the appropriateness of some of the case work they have been allocated, and the payment scheme that seems to encourage practitioners to prioritise quantity over quality. 

“Ethical, clinically-driven online therapy platforms can be a win‑win for practitioners and clients, offering a hassle-free way for therapists to reach new clients and get paid, while also removing many of the barriers that stop clients accessing help when they need it. But I think the question we are now asking is whether any platform can scale up to the extent of BetterHelp and still ensure minimum standards of clinical care.”  

Training to be a therapist is expensive and complex. To start off there will be 3-4 years of part-time study, made up of a foundation or certificate year, followed by a diploma. At this point the student needs to have done a minimum of 100 client hours (often done unpaid in a range of placements) to become a member of the BACP or National Counselling Society. Membership of the UKCP requires further training, the minimum being a Masters, and more client hours.

During training, therapists have to pay for their own therapy, and once they are seeing clients, they have at least 1.5 hours of supervision per month. Continuing professional development, insurance, marketing costs, office hire if not strictly online — being a therapist has lots of hidden costs. One of those is to their own mental health; training and working as a therapist is psychologically and emotionally demanding and requires a lot of personal effort and commitment to self-reflective practise. The therapists who spoke to the FT felt that BetterHelp did not take this into consideration,  both in pay and in support.

Mass advertising campaigns mean that clients are in good supply. In addition to online ads, since 2020 the American startup, which was founded in 2013 and now has revenues of $1billion, has been the biggest podcast sponsor in the world. In the UK its roster includes renowned psychotherapist Julia Samuel’s podcast Therapy Works and mental health advocate Alastair Campbell’s Rest is Politics. 

However, its rise and popularity has not been without controversy in the tech sphere. In March the US Federal Trade Commission came to a settlement of $7.8m with the platform because it had shared more than 7m customers’ health information with social media companies including Facebook and Snapchat.

Further reading

Why are therapists in therapy?

Compassion fatigue in the caring professions

Does it matter whether a therapist has a professional membership?