Betterhelp is a website that matches people with a licensed counselor they can communicate with via chats, messaging, or through phone or video sessions. Betterhelp subscriptions range between $35-$80 per week and are not covered by most health insurance plans. The convenience, flexibility and anonymity of Betterhelp make it an appealing option.
However, there is insufficient evidence that it is as effective as in-person options, or even other online counseling options.
What Does Betterhelp Offer?
Founded in 2013, Betterhelp is one of the most recognized names in the online therapy industry. According to their website, they have 8,000 licensed clinicians in all 50 states and claim to be the largest online counseling platform in the world.
The company’s stated mission is to make counseling “accessible, affordable and convenient.”1 In 2015, the company was acquired by Teladoc, a dominant corporation that has a stronghold on the industry and continues to acquire smaller businesses in the telehealth sector.
People who sign up for Betterhelp can pay weekly or opt for discounts on a longer subscription. Based on the results of a short questionnaire, they are matched with a therapist licensed in their state. The registration process does not require people to provide identifying information, and users are allowed to choose a nickname if they do not want to disclose their identity.
Once registered and matched with a therapist, Betterhelp offers four different methods of connecting with a therapist: online messaging, live chats, phone sessions and video sessions. It can be used on any computer or laptop, as well as through an app that is accessible on smartphones, tablets, or any other mobile device.
Betterhelp advertises itself as a 24/7 service because certain aspects of the service (like messaging) are accessible to users at any time, though scheduled appointments with counselors generally occur at more usual times. Individual counseling is the primary service offered but counseling for couples or teens also is advertised on their site, although these options redirect to separate websites of sister corporations.
Who Is Betterhelp Right For?
People with issues like depression, anxiety or substance use are not prevented from seeking counseling on Betterhelp, but the company is careful to not market itself as providing “treatment” for these disorders. According to the information on their website, Betterhelp is for those looking to “improve their quality of life” and can help with “anything that interferes with happiness” or prevents someone from “achieving goals.”
This is open to interpretation, but generally, this kind of counseling could be helpful for:
- Those going through transitions or experiencing high levels of stress
- Those feeling stuck or generally unhappy in one or more area of their lives
- Those struggling with self-doubt, low self-esteem or a lack of confidence
- Those struggling with relationship conflicts or communication issues
- Those with mild symptoms of depression or anxiety
- Those looking for healthier, more effective coping and stress reduction skill
In addition to the particular issues bringing someone into counseling, an online option lke Betterhelp is often used by those with limited access to other counseling options.
Circumstances that might lead someone to consider an online option include:
- Cost barriers
- Being uninsured
- Nontraditional schedules
- Lack of transportation
- Physical limitations or mobility issues
- Lack of childcare
- Living in a rural community
- Lack of local services available
- High anxiety about leaving home
Who Is not Recommended to use Betterhelp?
People with more significant levels of stress or symptoms are not advised to use Betterhelp, and are recommended for in-person treatment options. The site has some built-in screening protocols to help identify some of these more serious issues.
Those who report having recent thoughts of suicide, for instance will be prohibited from registering, receiving this message:
People who might need more support than Betterhelp could provide include:
- People with thoughts of harming themselves or others
- People struggling with drug or alcohol addiction
- People experiencing symptoms of withdrawal from a substance
- People who are hearing or seeing things that other do not
- People who need or have been recommended to seek intensive outpatient, residential, or inpatient treatment
- People looking for prescription medications or to change their medications
- People recently discharged from intensive outpatient, residential, or inpatient care
- People who are mandated by courts or other authority figures to get treatment for a mental health or substance use issue
- Children or those seeking family therapy
- People diagnosed with Bipolar, Schizophrenia, PTSD or a personality disorder
- People who feel unsafe or are in need of immediate help or crisis services
- People seeking treatment for existing diagnosed mental health or substance use issues
In addition to the issues and concerns bringing someone into counseling, other factors that might make a service like Betterhelp ineffective include:
- Having poor or unreliable internet access
- Not having access to a quiet, private place in their home
- Being unfamiliar or uncomfortable with technology
- Not having enough money to pay for a subscription
Betterhelp Pricing and Cost
Betterhelp operates on a subscription basis, with prices based on the length of time you commit to using the service. The subscription offers members unlimited free counseling sessions via messaging, chat, phone or video.
As of May 2020, the current subscription options for Betterhelp subscriptions are:
- $80 per week when billed weekly
- $260 when billed monthly ($65/week)
- $540 when billed quarterly ($45/week)
- $1820 when billed annually ($35/week)
One drawback of Betterhelp’s pricing structure is that people who commit to longer subscriptions get discounted rates, as opposed to traditional therapy which is generally paid per session. Someone subscribing to Betterhelp may not be able to forecast how long they will need the service, and may lock themselves into a longer commitment than they need.
Cost Comparison: Betterhelp Subscription VS Paying per Session
Cost comparisons between Betterhelp and traditional in-person counseling depend on a variety of factors, including where a person lives and what type of counseling they are looking for. Costs can range anywhere between around $50 to $250 or higher. These fees are set by individual therapists and agencies, depending on a number of factors including location, cost of living, overhead costs, market comparisons, and variance in the experience, specialties, and types of counseling offered.
Some counselors will offer sliding scale fees, meaning they are willing to provide discounted rates to those unable to afford to pay full price. If the listed price is out of budget, it is worth asking about sliding scale fees, even if they are not advertised. Betterhelp also advertises some financial assistance programs for people unable to afford the full price of a subscription. The details of who is eligible are not clearly outlined and the website states it is determined on a “case-by-case” basis.
Health insurance coverage is also a major factor in determining whether Betterhelp is more or less affordable than other options. Because each plan is different, the only way to verify the cost for outpatient counseling is to call the insurance company or use their online portal to look up the details of your plan. You can also find in-network providers this way.
If you have insurance, it might be more affordable to see a therapist who is in-network with your plan for in-person sessions. Because of the recent COVID-19 pandemic, most insurance plans have extended coverage for online counseling, but this would mean working with a therapist not on the Betterhelp platform. Betterhelp does not identify its services as treatment, so is not considered a medically billable service.
How to Sign up For Betterhelp and Schedule the First Appointment
The signup and registration process for Betterhelp is relatively straightforward, taking only a few minutes. The steps to starting Betterhelp services are:
1. Complete the Questionnaire
Betterhelp requires new members to fill out a questionnaire which asks questions about their reasons for seeking counseling. There are questions about symptoms of depression, anxiety, and susbtance use disorders, as well as screening questions about certain risk factors like suicide. In addition, new members are asked to disclose their gender, age, religion and sexuality.
2. Fill Out the Registration Form
This short form asks for a name (or nickname), an email address, and a password. Once created, you will receive a confirmation email asking you to click a link or enter a verification code to finalize your account registration.
3. State Counselor Preferences
Once you have verified your account, you are asked to indicate any preferences you have about your counselor’s gender, age, sexuality, religious beliefs, or race. You can also choose specialties that you want your counselor to have, including experience helping people with depression, anxiety, substance use, grief, as well as non-clinical issues like intimacy, career issues or even executive coaching. You are then asked to summarize your reasons for seeking counseling in a few sentences.
4. Review Terms and Enter Payment
The next page you are directed to provides an overview of the services included in the subscription. It also provides answers to frequently asked questions about the process and what to expect. You are now prompted to enter in payment information and select whether you want to make a weekly, monthly, quarterly or annual commitment. You can skip the payment information and still get matched, but cannot move on to the next step until payment is made
5. Wait for a Match and Begin Counseling
The next step is to wait until you are matched with a therapist, which the site states can take “a few hours or a few days.” Once matched, you will be notified via email and usually, the counselor will also message you on the platform. You are then able to communicate with your counselor in a dedicated chat room, as well as schedule live chat, phone or video appointments with them.
After connecting with the counselor, a client can decide if they want to schedule another appointment or not. If the client is not satisfied with the counselor they have been matched with, they are encouraged to switch, which can be done easily via a request sent through the system. Members are also able to choose their own counselors, but are encouraged to go through the process of being matched (or re-matched) by the system.
Confidentiality and Privacy
Betterhelp has taken measures to protect private and confidential information. One unique aspect of this system compared to other online counseling platforms is that members are not required to disclose their identity. They are able to choose a nickname, which is all that will be released to the counselor.
Aside from this, other security measures taken include encryption on the site, including encryption of all messaging and databases. Users are also able to delete messages using the “shred” option if they want to remove sensitive information. Video sessions occur through the Betterhelp platform, which complies with federal HIPAA regulations.
Reviews of Betterhelp: Pros and Cons
There are pros and cons of online counseling, and more specifically, of a subscription-based service like Betterhelp.
|Pros of Betterhelp||Cons of Betterhelp|
The Better Business Bureau’s website indicates that the business is in good standing and has an overall rating of A+, but anecdotal reviews found online are mixed. Some report positive experiences and find that the platform helps make therapy convenient and affordable, while others have encountered hassles or found the quality lacking.
Some have even reported being matched with an unresponsive counselor, and feeling frustrated with not seeing the value of their subscription. Some of this variance is unavoidable and is also experienced by people who seek traditional counseling.
Overall, initial research on people who have done online therapy report that the online format is not a barrier, and can be just as effective as in-person therapy,1 though more research is needed to validate this. It is more likely that the efficacy of a Betterhelp subscription would be based on several factors, including the skill level and personal style of the therapist a person is matched with, the functionality of the platform, and even things like internet speed or ease of use.
Aside from these more individualized factors, Betterhelp members have also lodged complaints about the customer service. This is especially true in billing matters, with many online reviews posted about being unable to get refunds when they cancel after already being billed, even if they haven’t used the platform.
The company has also come under fire for some of its advertising tactics, especially related to prominent youtubers advertising Betterhelp. In 2017, several complaints were filed and articles were written describing these advertising techniques as being predatory, targeting people who are struggling with mental health issues.3
Larger questions about the ethical nature of Betterhelp have also been raised,2 especially since the platform wavers on whether or not it is a “treatment” for mental health and substance use disorders. The site seems to target people with these conditions, even posting a study on its homepage which suggests their service is just as effective in treating depression as traditional counseling is.4
At the same time, the site’s terms explicitly discourage those with serious mental health issues from using the platform and therapists are not allowed to provide an official diagnosis.
The trickle down effect of this could mean that people sign up for Betterhelp expecting the same services they would receive in a counselor’s office, only to be told they cannot be diagnosed or even treated for any disorder. In a more concerning scenario, people with severe mental health issues might sign up for the site instead of receiving treatment they need. If they chose to remain anonymous, the Betterhelp clinician might not be able to follow the appropriate protocols of getting help in the event of a crisis or emergency situation.
Betterhelp is not the only provider of online counseling. Another major player in this industry is Talkspace. Talkspace offers very similar options to Betterhelp, with the ability to message or have live phone or video sessions with a counselor.
According to a professional review,5 the key differences between the two services are:
While at first glance the subscription price tags look identical, Talkspace has some add-on fees for those who want live sessions with their therapist, while Betterhelp’s price is all-inclusive. In the top tier plan for Talkspace, members are only allowed four 30 minute live sessions per month with unlimited messaging (5 days a week) at $396 per month.
Betterhelp offers unlimited sessions in their package at $260 per month. Betterhelp also claims to have discounted rates for those unable to afford their service, while Talkspace does not advertise a financial assistance program.
Types of Counseling Offered
While it is possible to get live sessions on Talkspace, it is not included on their “standard plan.” The standard plan only includes messaging services (similar to text) which have not been proven to be an effective method of counseling, unlike teletherapy sessions. Talkspace allows for a range of messaging options including sending audio files, video files, pictures, or text in a private chat room with the therapist. Betterhelp also offers messaging and chat services, but includes phone and video sessions as well.
Insurance Coverage or Reimbursement
One advantage that Talkspace has over Betterhelp is that they have begun the process of partnering with insurance companies, EAPs, and large corporations. This means that some people are able to use their insurance to reduce the cost of their online therapy subscription, and others are able to receive the service for free through their employee benefits program. Health Savings Accounts (or HSAs) may also be used for Talkspace, even if it is not covered by the insurance plan.
Both Betterhelp and Talkspace offer online counseling, but Talkspace also offers psychiatric services. Psychiatric services include appointments with doctors, psychiatrists, and other prescribing professionals who specialize in treating mental health conditions and addictive disorders using medication.
Psychiatric services can be difficult to access due to a national shortage of trained providers, so having this service available is a major benefit that Betterhelp does not have. Appointments can be made online, but are billed separately from the subscription. Current pricing is $199 for the initial appointment and $125 for subsequent appointments.
On Betterhelp, being matched with a therapist happens through an algorithm based on your responses to a questionnaire. It is possible to choose your own therapist, but is discouraged. Talkspace has a slightly more interactive process that involves talking with a real person and selecting from three options, instead of being automatically “matched.”
If you are unhappy with the options provided, you can choose to “get matched again,” providing another 3 options. Both Betterhelp and Takspace make it easy to switch to a new therapist at any time, for any reason.
Cancelations and Refunds
Unlike Betterhelp, Talkspace offers an option to “pause” a subscription at any time for a 30 day period. Neither site offers refunds for unused time but on the FAQ page for Talkspace, it states that refunds are sometimes granted on a case-by-case basis, while the refund policy is not discussed at all on Betterhelp’s FAQ page. Both companies have complaints about their refund policy and billing errors filed on the BBB website.
Online therapy is becoming more common, and this growth has accelerated due to the COVID-19 pandemic. Still, it is a relatively new practice, continuing to form it’s identity and secure its place in the treatment of mental health conditions. Preliminary research from the past ten years suggests that online therapy can be just as effective as in-person therapy,1 but much more research is still needed.
Specifically, a better understanding of what issues can be effectively treated online is necessary, as well as what factors make online therapy more likely to be successful. Until then, people need to make decisions about what type of therapy is right for them based on an understanding of their needs and options.
Betterhelp might make counseling possible in cases where there are barriers to other counseling options. These might include situations where a person is uninsured or has a high deductible plan and cannot afford the cost of traditional counseling, or in small or rural communities with limited treatment options. Online therapy might also be necessary for those who are homebound or without reliable transportation. Still, Betterhelp is not the only option for online therapy.
Because of the recent pandemic, almost all insurance companies have extended coverage of telehealth sessions for counselors. This means that fewer barriers exist in accessing online therapy that is covered by health insurance. Before signing up for a site like Betterhelp, make sure to look into the details of your insurance plan to find out the coverage and cost of in-person or online therapy. It could be more affordable to find a therapist within your insurance network, and also provide assurance that you will get a formal diagnosis and treatment deemed appropriate for that issue.
This is especially important if you are seeking counseling for a more serious issue or if you have an existing diagnosis that you need treatment for. While the counselors on Betterhelp are qualified to diagnose and treat mental health or substance use disorders, they are prevented from doing so on the platform.
This means people who are struggling with mental health or addiction issues might not get the help they need on Betterhelp. Keep in mind that counseling is a service that you are paying for, and like all paid services, you should shop around until you find one that is effective, affordable, and proves over time to be a valuable investment.