Mental Health Apps: The Therapist At Your Bedside

Istvan Banyai

What happens when you share your deepest anxieties with an app?

It’s deep in a New York City winter, and I’m holed up inside my apartment, seeking help from an online therapist I’ve never met and surely never will. Regardless, we have plunged right in: How, I want to know, can I continue to find meaning in my work in an age of such extreme political uncertainty? “I know that everything that is going on is scary and disheartening,” she texts me back, “but at its core the people of this country have good consciences and want good things for many people.” She ends with what I know by now is her trademark sign-off: “What do you think?” Answer: I’m really not sure.

The therapist with whom I am corresponding has been assigned to me by Talkspace, a subscription-based psychotherapy app that allows for unlimited texting with a licensed professional starting at $128 per month. Upon signing up, I was asked a series of questions and then paired with my therapist, a woman whom I shall call Maria. Despite the absence of a personal rapport, I surprised myself at first to find some small but real degree of comfort at having this source of encouragement and cheer, who was always only a text message away (except for Fridays and Saturdays). Yet because I happen to know what it is to actually sit in a room with a living, breathing psychologist opposite me, a person I see week after week, I registered all too glaringly the superficiality inherent in my Talkspace arrangement. To me, insight and advice are nice, but the relationship itself is the point.

Others see it differently. “Cost, access, and stigma,” Alejandro Foung explains. “Those are the three pillars of why people are interested in digital therapy.” Foung is the CEO of Lantern, another app-based service that offers help for “mild to moderate” anxiety and stress. As opposed to psychotherapy, Lantern offers what it calls “coaching,” providing users with mental techniques for changing thought patterns to feel better in any given moment, at a fraction of the cost ($49 a month) of traditional therapy. Foung says that Lantern now has thousands of active users.

Some companies are going farther than the Lantern and Talkspace models, aiming to eliminate the human factor altogether. For instance, Digital Therapy uses elements of IBM’s artificial intelligence program, Watson, to engage with its users via algorithms, no flesh and blood therapist required. The program, called Sam, is currently in beta testing. For now, its emphasis is on weight loss: Users log in to combat a specific craving in the moment they’re having it or to work on their long-term dieting plan. In the former scenario, CEO Dr. Roger Gould explains, they are prompted to consider the state of their current “mental load”—the various stressors that can compel people to eat as a coping mechanism. “Most people find out that the load they were carrying that they thought was too much was manageable 24 hours later,” Gould says. “It’s effective because it’s there at the moment they’re making a decision, not days later, or a week later.” In fact, Gould says, a 2001 UCLA study indicates that ten sessions with a computer-based therapy program can be as effective as ten with a real live clinician. I would be curious to know if that remained true after 30 sessions, or 50, a long enough time span for a real relationship to form.

The online therapy movement, which emerged over the past decade, has provoked plenty of skepticism. Justin Shubert, a psychologist in Los Angeles and the director of Silver Lake Psychotherapy, questions the very selling point of many of these programs: the instant access. “When a therapist is on demand, that’s reinforcing an immature way of relating for a lot of people, where the therapist is there to gratify the client’s needs wherever and whenever they want,” Shubert says. “That’s not how real relationships work.” He’s also suspicious of promises like the one made by Talkspace to “give the gift of happiness.” To that, Shubert retorts, “the goal of therapy is not to make you feel happy in each given minute but to help you deal with problems.”

As for me, I soon realized that I was hesitating to reveal anything truly personal, anything to do with, for example, love. First of all, Maria and I were communicating by written text—and patient-therapist confidentiality laws don’t exactly stand up against Russian hackers. But equally problematic was that I couldn’t see Maria in the moments in which she was attending to me. For all I knew, she was composing her responses while standing in line at Trader Joe’s, toggling back and forth between a hundred different versions of me. Was I really going to discuss my intimate life against such an uncertain backdrop? Our exchange began to wear on my nerves on or around day six. “I wonder if it would be worth considering journaling about the current events,” she texted me. “What do you think?” Suddenly, I found I had come to dread the whole communication. So I did the only thing I could think to do: I ghosted my online therapist. I must admit, I feel somewhat guilty about the whole thing. Know any good robots I could talk to for that?

App-iness

Talkspace
Using a subscription model, Talkspace assigns each user to a psycho- therapist, who is available to respond to text messages once or twice a day. The question remains: How much impact can loosely defined conversations between two people who’ve never met have on one’s mental health? Starting at $128 a month.

Lantern
Rather than therapy, Lantern offers “coaching.” Users share problems via text and receive highly structured strategies for feeling better in that moment, such as guided meditation or breathing exercises. This isn’t the medium for exploring childhood memories. Starting at $49 a month.

Sam
There is no psychotherapist involved, no coach—no human. Using artificial intelligence, Sam provides users with instant access anytime, helping them battle powerful cravings. Still in beta testing, Sam is currently focused on weight loss, but its parent company, Digital Therapy, intends to expand. talk2sam.com.

T2 Mood Tracker
This free app enables its users to track their own mental health, helping them to identify patterns and triggers by which they might gain greater insight and control over changes in mood. It doesn’t include a psychotherapist’s feedback, but it’s praised for its simple functionality.

Ginger.IO
This app combines the concept of smartphone-based fitness tracking with live human feedback and care from a coach or therapist and/or a psychiatrist to help with medication support. Works with text-message exchanges as well as videoconferencing. Starting at $129 a month.