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Mental Health

Why therapists are sounding the alarm on big box therapy companies

Why therapists are sounding the alarm on big box therapy companies
Photo by Nik Shuliahin on Unsplash

A greater demand for therapy is putting strain on therapists and creating avenues that might not be all they seem.

Given the state of the world we have all been living in for the last two-plus years, it’s no surprise that therapists are in high demand right now, and have been throughout the pandemic. Many therapists have long waiting lists and are taking on more clients than they normally would just to meet the need. New private practices are opening frequently to provide quality mental health care that people so desperately need in these (still) unprecedented times. But something else is happening simultaneously. Large tech companies have cropped up promising mental health care, and even promising to get patients in with a same-day appointments. On the surface, this seems like it should be a good thing. After all, these companies are helping to meet the growing and overwhelming demand for mental health care, so we should make room for them, right? At least that’s what most would think.

I’ve been in the mental health field since 2006, and have been in and around mental health from a professional standpoint, and therapists have been raising concerns about these large platforms for quite a while. In fact, one therapist made it his mission to show his followers on TikTok what the fine print of one mental health platform’s terms and conditions said. Viewers were shocked to hear, and read, as the therapist pulled the information from the company's actual website in real time, that clients' information was being sold to third parties for advertising purposes. This wasn’t hidden in microscopic print, it was there within the terms and conditions in plain print. But some companies bank on consumers not reading the terms of their agreement. Many people will quickly scroll through to get to the bottom of the long legal information and click the button to simply move to the next part of the process.


This therapist did the reading for you in an effort to honor his professional ethical code and protect clients. The company fought back against the claims and changed the language, all very publicly on TikTok, but it was only the language that changed, not the terms. When the therapist pointed this out, the company continued to publicly feud with the therapist on the social platform.

Now, at this point you may be wondering why I’m not using this therapist’s name, telling you where to find him and calling out this platform. It’s because when the company continued to mislead its consumers and continued to have its feet held to the fire by this ridiculously brave therapist, the mega large platform sent a cease and desist with the threat to sue this small private practice owner. It forced the therapist to remove any trace of anything unappealing he had said about this company, and he is no longer permitted to discuss the disturbing things he uncovered.

As a therapist, I feel a duty to protect this other therapist from any further threat that may come from this mega company, and to do so, allow him to remain as anonymous as possible. Nevertheless, it feels important to reveal the lengths to which one of these companies is willing to go to keep consumers in the dark about its fine print items. Therapists have an ethical obligation to protect their clients from exploitation, and it would absolutely violate ethical codes to sell client data.

When you meet with a licensed therapist your information is protected by the Health Insurance Portability and Accountability Act (HIPAA), which means we could get into trouble with our licensing boards and in some cases, depending on the level of breach, it could be criminal. Big box therapy companies seem to have found a loophole around this as the companies may not be billed as “therapy” but as lay counseling services, which is something anyone with life experience can do. A therapist who runs the YouTube account Private Practice Skills discusses this and why she was not comfortable putting her license on the line for a company that may not be bound by HIPAA. Privacy is a huge deal in the therapeutic relationship and you won’t find too many therapists willing to risk the privacy of their clients for any amount of money.

Money brings me to my next point. Many of these big box therapy companies such as Talkspace, BetterHelp, Happier Living, and so on, pay their therapists poorly. They seem to prey on therapists who have just recently earned their licenses and want to work for themselves, but may not know how to. Companies like these use the 1099 model to give therapists a sense of autonomy over their schedules, but in the case of at least one of these companies, therapists have had their pay affected by not responding to client’s texts in the middle of the night due to an arbitrary timeline the company has enforced. Let me be clear, the expectation to be readily available to your clients at all times is unrealistic and damaging to the client and the therapeutic relationship.

Bonus ranges for client retention.

TalkSpace therapist FAQ section

Therapists teach their clients skills that they are supposed to learn to utilize in between sessions with the hope that eventually they will not need a therapist to continually reinforce these skills as they will become a reflex. When a client is given access to a therapist whenever they would like between sessions it creates a reliance on the therapist to be an emotional barometer and regulator, which is not what a therapist is for. Most therapists’ ultimate goal is to work themselves out of a job. They want their clients to get to a point where they no longer need them. That’s a good thing. We welcome you back should something change, or we offer maintenance sessions on a spread-out basis like once a month or every six weeks until the client is feeling confident enough to be without a therapist.

Some of these platforms build dependency and often their policies go up against a therapist's professional ethics. One of these companies offers a bonus for client retention. Meaning if the client stays longer than what may be therapeutically necessary, then the therapist gets a monetary bonus. Does this mean all clients that stay long-term with this company don’t need the therapy? No. It means that some therapists may feel pressured to retain clients who are ready to discharge in order to receive a bonus.

The pay is so low for a licensed therapist in this situation that unless you see 30 to 40 clients a week, you're not making enough to make ends meet and pay off student loans. Seeing this many clients a week doesn’t leave room for administrative tasks that are required, and in a setup like these companies it is likely to be unpaid time. For every client, you have to have a treatment plan completed at the start of therapy and progress notes after every session. If they’re only being paid for the client contact, when are therapists supposed to do these tasks? There’s also finding resources to use in sessions, looking for assessments or referral sources, and other behind-the-scenes tasks that clients know very little about.

Photo by Priscilla Du Preez on Unsplash

I interviewed with one of these companies and declined the offer after explaining the ethical dilemma it would put me in, and the inevitable burnout I would experience. This particular company wanted its therapists to see 12 clients a day with a 30-minute lunch break. The average therapist in private practice sees between five and six clients per day. Some therapists choose to see up to 8 or 9 a day, but they are few and far between. The therapists that do choose that greater load, usually do so in order to take a day or two off during the work week. Twelve clients a day averages out to 60 clients a week, which is even more than some of the other platforms require to be considered full time.

When I made the company aware of ethical concerns due to the sheer volume of clients they were expecting therapists to see, I was contacted by the VP of the company. I again explained the concern, and while at first they sounded empathetic, the tone changed to indifferent and the call ended with no resolution. I’m still listed on the site as a therapist, which I discovered recently, though I’ve never been employed by them.

There is really so much more to dive into, and I could write a book about the concerns raised by licensed therapists about these big-box therapy companies, but the key takeaway is if you need mental health care it’s best to find a therapist in private practice. When money is an issue, many therapists offer sliding scale fees to make it affordable and some even offer pro bono spots. You can find therapists offering reduced rate fees on Open Path Psychotherapy Collective.

If virtual therapy is preferable to you due to time constraints, many therapists are now offering virtual therapy as an option. If you still can’t find a therapist, there is no shame in using one of these platforms because most employ licensed therapists and your mental health is our number one priority. One can understand the appeal and affordability of these large platforms and it's important to do whatever you can to look after your well-being. Just be sure to read the fine print.

Pop Culture

Here’s a paycheck for a McDonald’s worker. And here's my jaw dropping to the floor.

So we've all heard the numbers, but what does that mean in reality? Here's one year's wages — yes, *full-time* wages. Woo.

Making a little over 10,000 for a yearly salary.


I've written tons of things about minimum wage, backed up by fact-checkers and economists and scholarly studies. All of them point to raising the minimum wage as a solution to lifting people out of poverty and getting folks off of public assistance. It's slowly happening, and there's much more to be done.

But when it comes right down to it, where the rubber meets the road is what it means for everyday workers who have to live with those wages. I honestly don't know how they do it.


Ask yourself: Could I live on this small of a full-time paycheck? I know what my answer is.

(And note that the minimum wage in many parts of the county is STILL $7.25, so it would be even less than this).

paychecks, McDonalds, corporate power, broken system

One year of work at McDonalds grossed this worker $13,811.18.

assets.rebelmouse.io

This story was written by Brandon Weber and was originally appeared on 02.26.15

Family

Husband is certain wife’s baby name will cause too much pain for their child. Is he wrong?

"It's going to cause him major problems with passports and ID as well as job and college applications."

A father can't handle the name his wife chose for the baby.

It’s one thing to debate with your spouse over giving your child a name that is so unique it could cause them trouble. It’s another to fight with your spouse over giving your child a name that is so incredibly common it’s used as a placeholder when an unidentified man has passed away.

This was the problem a Reddit user (The_Doeberman), whose last name is Doe, faced when his wife wanted to name their baby boy after her grandfather, John.

“My wife is six months pregnant and wants to name our future son after her grandfather, who died of cancer in September. His name was John,” the husband wrote on the AITA forum

“I liked her grandfather, and I know he and my wife were very close, but I won't even consider it, not even for our son's middle name,” he continued. “I feel that's just setting him up for a world of problems, especially when he grows up and has to apply for jobs. Nobody's going to believe ‘John Doe’ is his real name.”


The wife thought that the husband was being difficult for vetoing the name and claimed he was “exaggerating” the issues the child would face.

But he has a pretty strong argument. The name John Doe is synonymous with the unclaimed dead body that someone finds in a roadside motel in the middle of nowhere or an anonymous victim of trauma that can’t be named in court documents. It’s also often used as a placeholder, which could cause the child problems when applying for college or a job.



There is no exact answer to why John Doe was chosen to represent the “everyman,” but it has been used in the UK for hundreds of years. It’s believed because John Doe was a popular name at the time. Later, in the US, unidentified females would come to be known as Jane Doe.

The husband used Reddit’s AITA page to ask whether he was in the wrong and the commenters were overwhelmingly supportive of him.

One commenter thought that "John Doe" was a bad idea but gave a solution that could work for the wife. “People will think it's a fake name. It's going to cause him major problems with passports and ID as well as job and college applications. He may have issues with medical stuff etc.,” they wrote. Instead, they suggested using an alternative version of “John” from another language.

“As an example only: Look for other languages' version of John. For example Eoin is the Irish way of spelling Owen. Eoin in itself is the Irish version of John…” they wrote.


Another commenter was blunt about their objection.

“I'm not superstitious, but I'd feel uncomfortable having a kid whose name basically stands for ‘found dead in the park, stab wound to the chest, no ID,’” they added.

One commenter noted all of the legal troubles that could come with having the name John Doe.

“I imagine a lifetime of getting stopped by the TSA for enhanced screening, of job applications being tossed for being fake and just everything being harder than it should be because you have a fake name,” they wrote. “If giving him the grandfather's name is so important, why not give him the grandpa's middle name?”

In the end, it's touching for a mother to name their newborn son after her grandfather, but according to the father and a legion of people online, “John Doe” simply carries too much baggage and would be more of a hindrance than a tribute. The good news is that there are many ways that the wife can pay homage to her grandfather that won’t make her son’s life more difficult.

Pop Culture

Middle class families share how much money they have in savings and it's eye-opening

"I transfer money each paycheck but always end up needing to transfer it back."

Many middle class families are sharing that they have nothing in savings right now.

According to an April 2024 Gallup poll, 54% of Americans identify as part of the middle class, with 39% identifying as "middle class" and 15% identifying as "upper-middle class." That percentage has held fairly steady for years, but for many, what it feels like to be a middle class American has shifted.

Notably, inflation caused by the pandemic has hit middle class families hard, with incomes not keeping up with cost-of-living increases. Housing costs have skyrocketed in many areas of the country, mortgage interest rates have risen to levels not seen since the pre-Obama era and grocery bills have increased significantly. One government study found that cost of living has increased between around $800 and $1,300 a month depending on the state since 2021, putting a squeeze on everyone, including the middle class.

One woman shared that her family is just getting by and asked other people who identify as middle class to "chime in" with what they have in their savings account.

"I swear, every paycheck I am putting money into my savings, but needing to transfer it back within a few days," shared @abbyy..rosee on TikTok. "My registration is due. My husband's registration is due. He needed two new tires, even though they had a warranty. That's $300. My oldest needs braces, he needs a palate expander, that's $120 a month. Not to mention groceries are $200 more a week. Forget about feeding your family great ingredients because who has $500 a week to spend on perfect ingredients to feed your family?"


@abbyy..rosee

somethings gotta give #savings #middleclass #relatable

She explained that her husband makes enough money that they should be able to live comfortably, and that she quit her job because the cost of daycare was more than she was making.

"At some point, something has to give," she said. "What is going on? How do I save money?"

People in the comments chimed in with their savings account totals and it was quite eye-opening. Many people shared that they have $0 saved.

"We make the most money we ever have and have zero savings. We live paycheck to paycheck and every month I don’t know how we get by."

"I think the middle class is 1 personal disaster away from bankruptcy."

"Y’all got savings accounts?!?! 😂"

"I used to freak out if I had under $10k in savings, now I’m happy when I have over $150. 😫"

"We make almost 100,000 a year with no savings!!!! It's always something!!"

"I'm lucky if we have $500-$1K for an emergency. every single time we start saving something happens. the vet, the cars, the kids... something."

"Savings account? I transfer money each paycheck but always end up needing to transfer it back. My husband makes great money too but we are scraping by."

"$803 but we have to pay a $750 deductible this week b/c my Husband hit a deer soooo… back at it 😭 It’s exhausting. Constantly draining it, refilling it, transferring."

Some people shared that they do have some savings, but several said it was because they'd had an inheritance or other chunk of money come their way. Many people shared that their savings has dwindled as increased costs have taken their toll. Some people gave lifestyle advice to save money, but most agreed that just the basics have gotten so expensive it's harder to make ends meet much less put extra into savings.

Thankfully, the inflation issue appears to be waning, but even just plateauing at their current financial reality isn't ideal for many American families. Middle class is supposed to be a comfortable place to be—not rich, but well enough off to feel secure. That's not how many middle class folks feel, though. Most Americans don't have anything close to the amount of money saved that is recommended across the age spectrum, but at least hearing that others are in the same boat is somewhat comforting.

It can be vulnerable to put your financial reality out there, but it's helpful to hear what other people are doing and dealing with so we all feel less alone when we're struggling. Perhaps if people were more open about money, we'd all be able to help one another find ways to improve our financial situations rather than lamenting our empty savings accounts and wondering how to change it.

A kind nurse offers a flower.

As the old saying goes, “You don’t know what you’ve got ‘til it’s gone.” Sadly, this hard truth becomes increasingly evident as we reach our final days. The things we take for granted today, such as our health, relationships, and time itself, become much more precious when we know they are about to end.

How much happier would we be every day if we lived with the perspective of those who are experiencing their final days?

Julie McFadden, known to her hundreds of thousands of followers on social media, as Hospice Nurse Julie, helps people appreciate their lives by regularly sharing her experiences with those who are living their final days.

Recently, she stopped by Rob Moore’s “The Disruptors” podcast, where she shared some of the big lessons she’s learned from the dying. Moore is a public speaker, entrepreneur and bestselling author of “Life Leverage.”


Given his background as an entrepreneur, Moore assumed that when people reach their final days, they regret the amount of time they spend working. "People definitely say that. 'I wish I didn't work my life away. I wish I didn't wait until retirement to do the things I wanted to do,'" McFadden said. However, there is another big regret that many share. “The main thing people say, that I don't hear a lot of people mention, is ‘I wish I would have appreciated my health,’” she added.

“I think the biggest thing I hear from people [who are] dying is that they wish they would have appreciated how well they how well they felt before,” she continued.

It seems that when people’s health begins to decline, they miss the vitality they never fully appreciated.

"I think most people take for granted things that have always been,” she told Moore. “You know, it's really easy to forget. We're so lucky to be alive in this moment. We're taking a breath right now. We're here on a rock that's like soaring through space. I mean, that alone can blow your mind."

McFadden believes that her profession reminds her to be grateful because dying is just as natural as living.

“I think because of my job, it's easier for me to see how once-in-a-lifetime this is. The fact that everything works together in our bodies to make us live and grow and I see that in-depth, too. I see how our bodies are biologically built to die,” she said. “That, right there, is so fascinating. We literally have built-in mechanisms to help us die. Our body can naturally do it. That's wild."

To get the most out of the miracle of life, McFadden writes a gratitude list every night so she’s sure to appreciate everything she has. Because, in the blink of an eye, it can be gone. “I like the fact that I can breathe, I'm walking around, I can feel the sunshine – little things like that,” she shared.

Our lives are filled with incredible gifts, whether it’s the people we love, the amazing things our bodies can do, or the places we get to see. But without gratitude, these beautiful gifts can easily go unnoticed and unappreciated. Practicing gratitude allows us to cherish these moments, so we’re fulfilled by what we have, instead of disillusioned by what we don’t.

Pop Culture

What is 'Generation Jones'? The unique qualities of the not-quite-Gen-X-baby-boomers.

This "microgeneration" had a different upbringing than their fellow boomers.

Generation Jones includes Michelle Obama, George Clooney, Kamala Harris, Keanu Reeves and more.

We hear a lot about the major generation categories—boomers, Gen X, millennials, Gen Z and the up-and-coming Gen Alpha. But there are folks who don't quite fit into those boxes. These in-betweeners, sometimes called "cuspers," are members of microgenerations that straddle two of the biggies.

"Xennial" is the nickname for those who fall on the cusp of Gen X and millennial, but there's also a lesser-known microgeneration that straddles Gen X and baby boomers. The folks born from 1954 to 1965 are known as Generation Jones, and they've been thrust into the spotlight as people try to figure out what generation to consider 59-year-old Vice President Kamala Harris.

Like President Obama before her, Harris is a Gen Jonesernot exactly a classic baby boomer but not quite Gen X. Born in October 1964, Harris falls just a few months shy of official Gen X territory. But what exactly differentiates Gen Jones from the boomers and Gen Xers that flank it?


"Generation Jones" was coined by writer, television producer and social commentator Jonathan Pontell to describe the decade of Americans who grew up in the '60s and '70s. As Pontell wrote of Gen Jonesers in Politico:

"We fill the space between Woodstock and Lollapalooza, between the Paris student riots and the anti-globalisation protests, and between Dylan going electric and Nirvana going unplugged. Jonesers have a unique identity separate from Boomers and GenXers. An avalanche of attitudinal and behavioural data corroborates this distinction."

Pontell describes Jonesers as "practical idealists" who were "forged in the fires of social upheaval while too young to play a part." They are the younger siblings of the boomer civil rights and anti-war activists who grew up witnessing and being moved by the passion of those movements but being met with a fatigued culture by the time they themselves came of age. Sometimes, they're described as the cool older siblings of Gen X. Unlike their older boomer counterparts, most Jonesers were not raised by WWII veteran fathers and were too young to be drafted into Vietnam, leaving them in between on military experience.

Gen Jones gets its name from the competitive "keeping up with the Joneses" spirit that spawned during their populous birth years, but also from the term "jonesin'," meaning an intense craving, that they coined—a drug reference but also a reflection of the yearning to make a difference that their "unrequited idealism" left them with. According to Pontell, their competitiveness and identity as a "generation aching to act" may make Jonesers particularly effective leaders:

"What makes us Jonesers also makes us uniquely positioned to bring about a new era in international affairs. Our practical idealism was created by witnessing the often unrealistic idealism of the 1960s. And we weren’t engaged in that era’s ideological battles; we were children playing with toys while boomers argued over issues. Our non-ideological pragmatism allows us to resolve intra-boomer skirmishes and to bridge that volatile Boomer-GenXer divide. We can lead."

Time will tell whether the United States will end up with another Generation Jones leader, but with President Biden withdrawing his candidacy, it has now become a distinct possibility.

Of note in discussions over Kamala Harris's generational status is the fact that generations aren't just calculated by birth year but by a person's cultural reality. Some have made the argument that Harris is culturally more Gen X than boomer, though there doesn't seem to be any record of her claiming any particular generation as her own. However, a swath of Gen Z has staked their own claim on her as "brat"—a term singer Charli XCX thrust into the political arena with a post on X that read "kamala IS brat." That may be nonsensical to most older folks, but for Gen Z, it's a glowing endorsement from one of the top Gen Z musicians of the moment.