What happens when the field that “fixes” is broken.

The therapy world has been co-opted by Big Money and it has created Big Problems.

The therapy field is experiencing its own existential crisis. I often speak to colleagues about the recent trends in the field that are quite concerning: how AI will impact treatment, how changes in the American health care system will continue to affect care, and how the field should respond to “TikTok therapy.”  Most of these potentially troubling issues are deeply connected to money issues—specifically, VC money.  The venture capital world is causing major changes to the current mental health landscape, but understanding the relationship Big Money has to the therapy world can help us all be better consumers of therapy and ultimately get what we want and need out of treatment.

In the wake of the pandemic, the field has been chewed up and spit out by the venture capitalist industry's drive to capitalize on mental health’s recent surge in popularity. As a psychologist who has been approached by venture capitalists to sell my practice, I am deeply aware that many therapists now essentially work for Big Tech companies that ultimately do not have prospective clients’ healing in mind. BetterHelp's recent legal trouble highlights how Big Tech created a “big therapy” problem. BetterHelp spends an inordinate amount of money on advertising. At one point, they spent more than twice as much as any other podcast advertiser. This has thrown therapy into the spotlight, perhaps to the detriment of the entire field and even to consumers.

In addition to advertising issues, the therapy landscape has shifted toward one of mass production, and therapy has become yet another commodity for consumption. This has resulted in therapists wanting and needing to stand out to attract clients, turning to social media (among other channels) to promote themselves or share opinions about major issues using blanket statements and broad, sweeping generalizations. The future of the field is most likely to be dominated by therapists promoting themselves on TikTok. While many viewers find the experience of hearing a clinician describing something they struggle with to be incredibly validating, others may not be able to ascertain what advice they should take in and what they should leave. Overall the trend of yet another field that values mass production and profit over quality care and actual healing.

Photo by Ravi Sharma on Unsplash

While many have considered this intensely mainstream attention therapy has received in the last several years to be a net positive—reducing the stigma of seeking services seems useful—there is a paradox to explore. There is a huge difference between encouraging people who are struggling not to sit in shame and insidiously promoting the idea that we all need therapy to work through things that are very manageable. Of course, companies like BetterHelp and other VC-backed therapy conglomerates want to attract people to seek therapy—this is how they will make money. But as many have discussed, perhaps not everyone needs therapy—or at the least, perhaps major corporations shouldn’t be the ones telling us we all need to be in therapy.

The “Therapy for All” issue becomes even more complicated when there are very real mental health issues intersecting with deeply troubling trends. Ultimately, it has becomew en vogue not only to be in therapy but also to advertise one’s need for therapy. The National Institute of Health just published their concerns over Gen Z’s tendency to glamorize mental health issues. (“Sadfishing” is the term coined to capture the growing practice of advertising just how bad one has it.) Culturally we have seen huge increases in just how many consider their experiences to be “traumatic.” Many experts have discussed the damaging effects of watering down such important concepts as trauma and given voice to the troubling trends in “Therapy Speak” and its growing popularity.

Photo by Anthony Tran on Unsplash

Another potentially sinister aspect of VC involvement in therapy treatment is the goal of keeping clients “happy” with the product. For tech-based companies this often means constantly surveying their clients. In the therapy world this has looked like assessing one’s progress in therapy—and rating therapy appointments. BetterHelp and Lyra consistently ask clients to rate their therapists and their sessions. This “Uberization” experience tells us we are to feel measurably better after our sessions, expecting to be “fixed” quickly rather than to be challenged, sit in our discomfort, and experience a full range of emotions.

The fact that therapy has become an industry where “the customer is always right” is deeply concerning. If we don’t consider the damaging effects of rating therapists or swiping through clinicians until we match with someone who is “just right,” we run the risk of not allowing for actual healing to take place. Therapy should not be an echo chamber where we are only meant to be validated. Therapists shouldn’t feel like they must keep their clients from feeling negative emotions. This defeats the purpose. The therapy relationship hinges on trust, and that trust is there so we can work with clients to uncover and unpack patterns, understand relationship dynamics, and create a space where people can develop tolerance for handling life’s inevitable difficulties.

With advertising dollars only increasing for therapy sites like BetterHelp, it is that much more important for clinicians without deep pockets to offer education around what to expect from therapy. It is crucial to highlight that these companies might not always have their customers’ best interests in mind; their actual healing is not the priority. Additionally, therapists should ban together to highlight how we can improve the field and not let therapy devolve into something it is not meant to be.