ROXANNE KHAMSI This is On the Media, I'm Roxanne Khamsi. This year, almost half of Americans reported experiencing medium to high levels of distress. And according to a survey by one poll, around 17 percent of Americans sought out therapy for the first time during the pandemic. But accessing therapy is an elusive process for many people. How do you even begin? Many of us are increasingly turning to our phones for an assist. Some of the options on the App Store are, according to Molly Fischer, features writer at New York magazine, and The Cut, quote, "the digital equivalent of a scented candle." And then there are the apps that vow to connect you not only to a real person, but to a real therapist.

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BETTERHELP My New Year's resolution, get happy. Start therapy today. Sign up for Betterhelp and get matched with a licensed counselor. [END CLIP]

ROXANNE KHAMSI A competing company, Talkspace, pledges unprecedented access to your very own mental health professional and also an end to misery.

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TALKSPACE Finding happiness is not a privilege of the few. With our unlimited messaging therapy, you can write to your therapist whenever it's convenient for you. It's almost like your therapist is always with you. You can hear... [END CLIP]

ROXANNE KHAMSI But do these apps deliver on what they're selling? Fischer, author of the article The Therapy App Fantasy in The Cut, has her doubts. Welcome to the show Molly.

MOLLY FISCHER Thanks for having me.

ROXANNE KHAMSI One of the things that you write is, unlike many of the problems tech startups have set out to solve, this one actually exists. It's hard to find a therapist.

MOLLY FISCHER There are all kinds of ways to break that down and quantify exactly how grave the shortage is. I mean, if you're looking for a therapist of color, if you're looking for a therapist who speaks Spanish, it's going to be much, much more difficult to find someone who meets your needs. Even in a place like New York City, where there are plenty of therapists in comparison to other places, it still is really difficult to find someone who takes your insurance, who you can afford if they don't take your insurance, who has openings in their schedule. The idea that there could be a better way to find a therapist is very enticing for a lot of reasons, and I think it's in some ways no surprise that apps have set out to solve it.

ROXANNE KHAMSI Could you explain a little bit about how these apps actually work?

MOLLY FISCHER A comparison that came up with a number of the people I spoke to, both therapists and clients who had used these apps was to dating apps. The matchmaking aspect is actually not super impressive. I, to sort of get a feel for the technology, decided to go through the process of signing up for Talksspace. So, you know, I completed this questionnaire. I think I said that I had anxiety, which was and is true, and that I was hoping to be matched with a female therapist. I click the button and waited for the thing to whirr along and kind of spit out some names. And at the top of the screen, when it presented me with results, it said we've prioritized female therapists who specialize in anxiety and below that were three men. So I think that the idea that this is super sophisticated, matching algorithmic technology is pretty questionable.

ROXANNE KHAMSI On a practical level, am I texting with my therapist or how does that actually work?

MOLLY FISCHER While this is often described as text therapy and it's really a lot more like email, because it's asynchronous, which means that you're sending a message and then probably sometime in the next day or so, your therapist is responding. In some cases it is possible to sign up for scheduled live text sessions with a therapist. For the most part, what you're getting is something more like a running email exchang,. And I think it shouldn't come as a surprise that that's pretty far afield from what most therapists are trained to do. A lot of their skills have to do with having a conversation with someone. And all of that kind of goes out the window if you're doing back and forth email exchange. But I think it makes a lot of sense that companies are trying to make it viable anyway because it's the way to make therapy more scalable. I think the hope is that if you are exchanging text messages with your clients, you'll be able to take on a higher caseload than you would if you were seeing them all for hour long weekly appointments.

ROXANNE KHAMSI So you write that a report last year from the Centers for Disease Control and Prevention found that people of color, essential workers and unpaid caregivers were disproportionately hard hit with mental health issues. You know, this last year that we've been in, particularly. Does this new technology make access to mental health more equitable?

MOLLY FISCHER This is one of the things that I found most upsetting in working on this story was that these apps do really want to present themselves as offering a solution to these problems of equity and access. You know, I think Talkspace's tagline is therapy for all.

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TALKSPACE You have to show up for yourself. Therapy works. It helped me and I can help you too. Brought to you by talk space. Therapy for all [END CLIP]

MOLLY FISCHER But at the same time, they're really expensive. A talk space plan that would provide you with four video visits a month, although I should say also they're half hour long, as opposed to hour long, which is generally standard in the real world. It would cost almost $400 dollars a month. These aren't services that are designed to help the people with the most need. Their services that, like Uber, or like Caviar or Doordash or something are making amenities more available to people who are already people who have pretty decent access.

ROXANNE KHAMSI Something that is in your story is that the mayor of Reno, you know, a mental health app user herself convinced council members of her city to put 1.3 million dollars in CARE's act funding toward giving all residents older than 13 access to Talkspace. By late March, more than 1300  Reno residents had signed up.

MOLLY FISCHER In my conversations with the mayor. It is really clear is that, you know, I don't think she was naive in proposing the Talkspace plan, that she was having a difficult time. She had lost a couple of family members in close succession and was having trouble finding a therapist and happened to see a Talkspace ad with Michael Phelps.

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MICHAEL PHELPS Online therapy is not about time and place. It's just as easy as joining a video call or texting with a friend. Don't wait to feel better. Get started with a single message. [END CLIP]

MOLLY FISCHER She signed up and ended up having a good relationship with the person she found and who she was texting with. So she had a positive experience, but I think she also, when she talks about the plan and what you hope to achieve with it, saw it as sort of a first step and something that would be better than nothing for the people of Reno. Her hope was that people who might not otherwise have gotten therapy at all would have a chance to try it out in a kind of low stakes, low risk, non-threatening way.

ROXANNE KHAMSI The mayor of Reno felt this was better than having nothing. Right. And you mentioned in your article, you quote one of my favorite tech commentators on the planet, Sherry Turkle, and her bill has told us that technological solutions often start out as being regarded as better than nothing, and then over time, they begin to supplant the traditional options. So once the traditional options disappear, the technological solutions come to be treated as better than anything.

MOLLY FISCHER I think it's too soon to say that they've followed that trajectory, but it does worry me and it does feel like the kind of path we're on. The apps don't really solve the underlying problem of access, the fact that there simply aren't enough therapists for all the people who need them. They really just paper over it. In the time between when I started writing the piece, reporting it and actually published it, Talksspace went public in a 1.4 billion dollar deal, so they're expanding, they're growing. They're becoming more permanently enmeshed with our healthcare system and with the way people get mental health care in this country. And I think that the more companies do that and the more they become part of the ecosystem of employers and insurance companies and just ordinary people trying to get a therapist, the harder it's going to be to turn back to a world where we could have tried to kind of improve the way people access therapy in the real world.

ROXANNE KHAMSI I think that's a really great place to end this session.

[BOTH LAUGH - its a therapy joke!]

ROXANNE KHAMSI Thank you, Molly.

MOLLY FISCHER Thank you.

ROXANNE KHAMSI Molly Ficsher is a features writer at New York Magazine. And The Cut. 

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