App-based therapy platforms may well represent the next evolution of psychotherapy practice. I praised Talkspace a few years ago for offering access to mental health care for many who otherwise would never find their way to a therapist’s office. But the platforms — Talkspace, Betterhelp, and the like — have run into controversy over their confidentiality policies. Therapists using these apps may have little to no ready access to the client’s full name, address, or other information necessary in an emergency.
It’s a problem that has been described in detail at The Verge. (That whole article is well worth the read if you’re a therapist considering working with an online platform.) But there clearly is a market for therapy that protects privacy — including keeping basic information about the client private from the therapist. That market should lead therapists to re-examine the delicate balance between protecting the public and serving clients in need.
The anonymity problem
When a therapist provides services via email or text, it can be difficult to know for sure who the therapist is talking to. Best practice guidelines for online therapy recommend taking steps to verify client identity. But Talkspace, like some of its competitors, promises clients that they can remain anonymous. When a client is anonymous, the therapist may not be able to report suspected child abuse, or intervene when a client is dangerous to themselves or others. Failing to act in such a situation risks the therapist’s license, in addition to the obvious danger for potential victims. Many therapists rightly wonder whether they can meet their legal and ethical obligations without full and immediate access to a client’s information.
Rarely, though, do we take the next step, and ask whether those legal and ethical obligations may be holding the field back from a good and necessary evolution. Should we make allowances for clients to see licensed therapists with complete anonymity, or something close to it?
The risks and the rewards
When clients can reach out to therapists anonymously via Talkspace or any other app or platform, they may be more open and honest about their symptoms and struggles. They may not perceive therapy to be as shameful. And, freed from the concerns that would normally keep them from being open, they may be able to get more work done. Many therapists (myself included) can tell stories of clients who waited months or even years to tell their therapist about important or traumatic events in the clients’ lives, out of fear of judgment or other concerns. When the therapist doesn’t know who you are, you can take your chances on how the therapist might react to knowing the real you.
On the other hand, clients who are able to remain anonymous when consulting with a therapist could easily describe impending violence or recent child abuse in a manner that leaves the therapist deeply worried but without any means to act to protect the victims. While we normally guard client confidences closely, there is good reason why “the protective privilege ends where the public peril begins.”
We know that some people want to reach out for help or support, or even simply confession, in a manner that protects their identity. If licensed therapists cannot work with people wanting to remain anonymous, those people simply go elsewhere — to advice apps, to the dark web, or to any place else that will have them. When therapists set standards that make client anonymity impossible, we aren’t bringing reluctant clients out of the shadows. We’re preventing ourselves from being able to meet those clients where they are.