Therapy app Talkspace accused of ethically questionable practices

By Jonah Comstock
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Chat-based therapy start-up Talkspace was accused of a number of ethically questionable practices in an extensive investigative piece published yesterday by The Verge.

Citing internal memos and emails and numerous interviews with anonymous therapists on the platform, the Verge reported several troubling findings including that Talkspace monitored conversations between therapists and patients, required therapists to insert scripts into their chats promoting Talkspace services, and didn't have a comprehensive or adequate plan for handling situations where patients (who are anonymous on the platform) were in danger. Talkspace CEO Oren Frank, who largely declined to comment in the article, penned a lengthy response on Medium denying most of the charges.

Talkspace is a leader in the telebehavioral health space, with $28 million in funding and 300,000 users according to the company. It's involved in clinical validation studies of its platform with Columbia University. However, the company's business model and treatment of its therapists has raised concerns in the past. In August, Forbes reported that a Talkspace therapist has filed a HIPAA complaint against the company and, in a rush to save face with the therapist's clients, Talkspace had sent them all an email without blind-copying their addresses -- thus likely doubling down on the alleged HIPAA violation.

The Verge piece touches on a number of different claims of misconduct, many of which revolve around the legal and regulatory grey area the stratup seems to inhabit: it bills itself as a platform where therapists operate as private practicioners, but operates more like a clinic with therapists as employees in some ways.

Talkspace can lock therapists out of the system abruptly, depriving them of the chance to end a therapeutic relationship responsibly. Talkspace has also apparently sent therapists who leave the platform emails threatening them with legal action if they try to form relationships with old clients off the platform. In his response, Frank said this option was only employed in "a few extremely unusual cases" where therapists' "clients showed us evidence of serious ethics violations or potentially dangerous communications."

The fact that the platform allows clients to remain anonymous is also problematic, the report says, because it prevents therapists from doing things they're ethically bound to do, like reporting threats of suicide or homicide. In some states, therapists can even be sued for failing to report certain things said in sessions, but at Talkspace, therapists have to request any identifying information about their client from the company and in at least some cases, according to the Verge's sources, Talkspace has refused to comply. Frank patently denied the claim in his response.

"There are very clear rules for when a therapist has a moral or legal obligation to report a client to the authorities," he wrote. "Such cases are a tiny fraction of therapy users and of Talkspace clientele – but we have no hesitation in helping the therapists on our platform to contact the authorities when the law or the ethical codes require it."

The notion that the company can read the chats – and isn't entirely clear about the circumstances in which it does – raises concerns about privacy and confidentiality and may have spurred the August HIPAA complaint by a therapist on the platform. It also threatens to undermine the trust relationship between patients and therapists. So does the notion that a therapist might be required to insert a script into a therapy session, promoting or advertising additional Talkspace services – a practice The Verge says Talkspace has engaged in.

In his response, Frank detailed the situations in which the company can read chat logs, suggesting they are more limited than The Verge implied. He also commented on the scripts, saying they were a tool provided to assist therapists, but didn't comment on the assertion that they were mandatory and therapists could have their pay withheld if they didn't use them.