mental health

The Expanding Shrink Landscape

A guide to the newest players in virtual therapy, both earnest and cynical.

Illustration: Shira Inbar
Illustration: Shira Inbar

You are looking for traditional therapy but don’t want to leave your house.

Try one of these national telehealth companies that offer mental-health care alongside virtual medical treatments. The psychologists, psychiatrists, social workers, and counselors in their databases practice cognitive and dialectical behavioral therapy with specialties including anxiety, trauma, and addiction issues.

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Doctor on Demand

Fill out two short questionnaires about the frequency and intensity of your issue and your irritability levels, mood, and any recent changes in sleep and diet. Then choose a therapist (40 percent of whom identify as people of color) by selecting the time that works on their calendar. Most reviewers describe their therapy sessions positively, calling the app, which was co-founded by Dr. Phil in 2012, a “godsend” and a “gold mine.” One sums it up this way: “The process is so easy, you have a lot of people to choose from, and it’s really reliable.” For urgent situations, the app guarantees visits within two hours.

Price: $129 for a 25-minute video session or $179 for 50 minutes. Psychiatry appointments are $299 for the initial visit and $129 per 15-minute follow-up.
Insurance: Yes.

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Amwell

Launched as American Well in 2006 by two Israeli doctors and brothers, Amwell feels a lot like using the Yellow Pages, with a simple categorized listing of providers and no hand-holding. Therapists are given star ratings, but only about half actually have ratings, and of those who do, almost all of them are exactly five stars. And while it’s easy to see someone’s first appointment, you’re stuck clicking through, day by day, for later appointments. Aside from a couple of people who lost their internet connection and had trouble reconnecting, most reviewers find the service “fabulous” or, once again, a “godsend.” And quite a few like the ability to hide their face onscreen, a unique feature that makes focusing on the conversation much easier.

Price: $99 to $110 for a 45-minute video session. Psychiatry appointments are $269 for the initial visit and $99 per 15-minute follow-up.
Insurance: Yes.

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MDLIVE

After you report any past diagnoses and enter your insurance info and local pharmacy, the app presents you with a list of available therapists and their earliest appointment time, with long personal bios that feel almost like classified ads. (A sample: “If you are experiencing Depression, Frustration in your marriage, are facing a divorce, workplace issues, spiritual conflict … or you feel like you’re just existing day to day but not LIVING, contact me NOW!”) The biggest complaint among users is bugginess, which can make changing an appointment time or entering insurance info difficult.

Price: $108 for a 45-minute video session. Psychiatry appointments are $284 for the initial visit and $108 per follow-up.
Insurance: Yes.

You prefer texting to talking (unless you really need to talk).

These subscription-based models offer unlimited text messages with a licensed therapist, psychologist, social worker, professional counselor, or marriage and family therapist. Although many do more, therapists are supposed to regularly respond to your messages. There is also the option to schedule video sessions, often for a higher fee.

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Talkspace

Founded in 2012, the company received two grants from the NIH in January and went public in a $1.4 billion SPAC. After you sign up, a consulting therapist chats with you to hear your needs before suggesting three possible treatment therapists. That’s followed by a ten-minute video session with your therapist to ensure that you click. You can send your therapist as many texts and audio and video notes as you like, though therapists will provide a response at least once daily on days they are active. Redditors complain that this puts the onus on the patient to initiate every conversation, which can stunt progress. On Twitter, some users say their therapists straight-up ghosted them.

Price: $260 per month for text-based therapy, plus $56 for one 30-minute video session or $136 for four. Psychiatry is offered separately and costs $199 for an initial consultation, with follow-ups at $125 each.
Insurance: Yes.

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BetterHelp

A brief controversy spurred by YouTube creators in 2018 has many people still believing that BetterHelp uses unlicensed counselors, even though the founder swiftly debunked that claim. That’s probably why there’s now an enormous counselor directory on the site (available even to nonmembers) showing degrees, license numbers, specialties, and customer reviews for every provider. After taking a brief multiple-choice quiz to collect background information, you’re matched with an available therapist. Many reviewers who say they had trouble connecting with a therapist in the past say their BH counselor “understands me” or is “a perfect fit.” Quite a few mention the group webinars, which cover topics such as “The Power of Saying No” and “Building Blocks of Happiness.”

Price: $240 to $320 per month, depending on commitment. The price includes unlimited text-based therapy and a weekly 45-minute live session.
Insurance: No.

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Ginger

Offered only through employers or insurance companies, Ginger provides unlimited, nearly immediate responses via text. The catch is that those responses aren’t from your therapist but from a “coach,” whom Ginger defines as someone with “a graduate degree in psychology or a related field and/or a coaching certification.” And it’s not always the same coach: If yours isn’t available, another will fill in. If your coach determines it’s necessary, you can be referred for video sessions with a goal-oriented, evidenced-based clinician. Some users point out the inefficiency of texting, which would apply to any of the other text-based apps as well. As @Lkzstw puts it, “60 min spent with a coach texting is the equivalent of a 15 minute phone conversation.” Also, multiple reviews mention chats being interrupted by a coach’s “scheduled break” during an appointment. The app includes soothing meditation sessions and brief tutorials. (For example, a ten-minute guide to multitasking proves that effective multitasking is a myth, then shows you how to get things done more effectively. Pro tip: Choose the text version instead of audio to cut the time in half.)

Price: Since Ginger is provided by your employer or insurance company, it can often have only a small co-pay or be completely free.
Insurance: Yes.

You are a confident self-helper.

These apps are less expensive and offer a holistic lifestyle approach with virtual events, group-therapy sessions, guided meditations, and peer-to-peer support.

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Real

Ariela Safira left a master’s program in clinical psychology at Columbia in 2019 to launch Real, enlisting a Stanford psychiatrist as chief medical officer. The app encourages you to self-assess, requesting your energy level and mood on a scale of one to ten once a month. You can choose a psychological topic or “pathway” you’re struggling with (anxiety, say, or body image), then explore audio and video programming around that topic. Users have access to live virtual events and group-therapy sessions that focus on things like impostor syndrome and maintaining one’s identity as a new parent. Owing to the newness of the app and its SEO-unfriendly name, it’s tough to locate much chatter about the business, though moves like getting a company exec onto Gwyneth Paltrow’s Goop podcast in January are sure to help with that.

Price: Starting at $28 per month.
Insurance: No.

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Sesh

This app offers one-hour, millennial-friendly, therapist-led group sessions (capped at 14 people) such as “Oh Sh*t I’m 29, 30, 31” and “Art-Making for Racial Stress & Anxiety,” in which board-certified art therapist Deanna Barton shows work by a BIPOC artist (a recent class started by watching a violin performance) before having participants draw whatever comes to mind and then discuss it with the group. Since comments on the App Store and Reddit seem clearly placed by marketers, the site’s success so far is perhaps best measured by the $3 million seed round it closed in December.

Price: $60 per month for unlimited group sessions.
Insurance: No.

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Sanvello

Launched in 2015, Sanvello is the visual equivalent of spa music, with soothing colors and soft shifts from screen to screen as you explore an ecosystem of behavioral-health tools including lessons, meditations, and message boards. The self-guided programming, though, feels revelatory. One lesson asks you to write out a concern, then helps you recognize when you’re catastrophizing, personalizing, or setting other traps for yourself. You can also sign up for video therapy with psychologists and psychiatrists and — even cheaper — “coaches.” Reviewers praise the content (one says that “you can tell [it] is written by well-educated professionals who really want to help … not just to make money”), but some report that the many tools and options can be too much for someone suffering from depression or anxiety. One person says, “The app can feel daunting and overwhelming so you just end up closing it.”

Price: $9 for access to the full library of mental-health tools. An initial live therapy session costs up to $140 with follow-ups from $65 to $105.
Insurance: Yes.

You are on a budget and open to the suggestions of well-programmed robots.

These AI counselors sound a little dystopian until you consider how botlike some responses from a human therapist can be. (“That sounds hard. How did that make you feel?”) One important thing to realize is that they’re not actually trying to replace in-person therapy; they guide you as you help yourself respond to your feelings.

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Youper

Co-founded by a Bay Area psychiatrist, this bot, which is obviously available whenever you want it, mostly asks questions (“How are you feeling about that?”) and prompts reflection or action (“What could you do to deal with the situation?”). Reddit users note that the tech can observe your history in a way no human therapist ever could. “It tracks how my mental health curve is doing,” writes one. “Everything I text is being saved in my profile. It’s really covering all corners plus a little more.”

Price: $7.50 per month.
Insurance: No.

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Woebot

Designed for older adolescents and young adults — more peer than authority figure — Woebot, launched in 2018 by a psychologist and Stanford lecturer, has a process similar to Youper’s. In response to a problem, the bot might say, “I’ve got two great tools that can help you with this,” then direct you to guided lessons on breaking habits and challenging negativity. One Twitter user says the bot “helps me reframe my thoughts, work on gratitude, and it has a whole tool kit of emotional regulation tips!”

Price: Free.
Insurance: No.

Plus: The Collective That’s Trying to Make Therapy Affordable for Everyone

When you do find the perfect therapist, paying for the service is often (massively) expensive. Even with in-network insurance coverage, you can face high deductibles and co-pays that quickly add up. Open Path Psychotherapy Collective, founded by psychotherapist Paul Fugelsang in 2012, is trying to change that by organizing private-practice clinicians nationally to offer discounted therapy sessions. After a (onetime) $59 sign-up fee, you can click through the Open Path directory, which lists the available master’s- and Ph.D.-level therapists based on specialty (over 150 topics, from identity issues to fertility) and treatment style. According to patients, navigation is simple: After filtering through therapists based on your preferences, you can read the profiles of the ones who meet your needs, then contact them through the website. One Twitter user with diabetes, @aut0immuneallie, says being able to specifically search for “chronic illness and disability” prevented her from “chaotically Googling ‘diabetes therapist’ and getting unrelated results.” Sessions for individuals, couples, and families range from $30 to $80. —Kayla Levy

The New York Social Clubs Bringing Mental-Health Care to People of Color

According to the American Psychological Association, in 2019, 84 percent of psychologists in the U.S. were white. For people of color, that can make finding a clinician who looks like you and understands your experience a challenge. While some national groups — like BEAM and Black Mental Health Alliance — serve the BIPOC community with databases of therapists of color and POC-led online workshops, there is also a growing network of BIPOC organizations in New York connecting people of color with therapists of color and other culturally trained professionals. Here are two.

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HealHaus

Members of this inclusive wellness space and café in Clinton Hill have access to sliding-scale private counseling, including teletherapy from any of 17 clinicians HealHaus has partnered with. (All of them take out-of-network insurance.) Plus there are issue-based one-on-one sessions, like support from an art therapist for mourning the loss of a pregnancy. HealHaus frequently hosts donation-based astrology overviews and other fund-raisers for the HealHaus Therapy Fund, which offers people in the BIPOC community eight free therapy sessions.

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Ethel’s Club

Group-therapy sessions at the East Williamsburg–based private club are free to members, led by licensed therapists, and more interactive than most. (One required pen and paper so members could visualize, journal, and then draw out their life path.) In February, Ethel’s Club partnered with Onyx Therapy Group, a D.C.-based Black women-owned business, to offer members one-on-one consults with Onyx’s clinical team of primarily licensed graduate professional counselors and licensed graduate social workers.

K.L.

The Expanding Therapy-App Landscape