In 2016, Ricardo Lori was an avid user of Talkspace — an app that lets people text and chat with a licensed therapist throughout the day. A part-time actor in New York City, Mr. Lori struggled with depression and anxiety, and he credited the app with helping him get out of an abusive relationship. He was a believer in Talkspace’s stated mission to make “therapy available and affordable for all,” and when the start-up offered him a job in its customer support department, Mr. Lori was ecstatic.
Talkspace, which has raised more than $100 million from investors, had an office in the old Studio 54 building in midtown Manhattan, with all the usual perks — a Ping-Pong table in the conference room and beer and wine in the company fridge, plus all the therapy employees wanted. “I felt like I was at the best place in the world,” Mr. Lori said.
After he wrote a general account of his therapy sessions on the company blog, an executive named Linda Sacco came to Mr. Lori with an intimate request. She wanted to give employees a sense of a typical user’s experience. Could she and one of the company’s co-founders, Roni Frank, read through two weeks of his therapy chat logs and then share excerpts with the staff?
Mr. Lori thought about his sessions, which included deeply personal information about his sex life and insecurities. Ms. Sacco assured Mr. Lori that they would keep him anonymous. “If I wasn’t such a true believer, I probably would have said, ‘Are you nuts?’ But I was so enamored of the place,” said Mr. Lori. He agreed.
At an all-hands meeting on a Friday afternoon in December 2016, employees gathered in a 13th-floor conference room. The Ping-Pong table was folded up so that Ms. Sacco and Ms. Frank could sit on the floor, cross-legged and back-to-back, for a dramatic reading. Ms. Sacco played the role of the therapist; Ms. Frank played a female version of Mr. Lori.
As Mr. Lori drank a tall glass of red wine and watched, he noticed that a few employees kept glancing his way. Afterward, a member of the marketing department approached and asked if he was OK. Later, Oren Frank, Ms. Frank’s husband and the chief executive officer, thanked him in the elevator. Somehow, word had gotten around that Mr. Lori was the client in the re-enactment.
Mr. Lori began to reconsider whether Talkspace was the dream employer he’d imagined — and whether it could be trusted to protect the privacy of its users.
“Everything was done with employee-informed consent,” said Ms. Sacco, who no longer works at Talkspace. John Reilly, a lawyer for Talkspace, said, “At the time, the employee expressed great pride over their Talkspace treatment with their therapist, and willingly told multiple co-workers that the transcript was theirs.” Mr. Lori said he did so only after it became clear that his identity was widely known.
Despite the embarrassing episode, Mr. Lori stayed with the company for two more years, until he was let go in 2018. He sued Talkspace for discrimination and wrongful termination, claiming he was told that his anxiety and depression were interfering with his work. The lawsuit settled at the beginning of 2020. Mr. Lori asked the company to take down his blog post; the company didn’t, which is part of why Mr. Lori decided to share his story with a reporter.
Mr. Lori and other former Talkspace employees, who asked not to be named for fear of being sued, describe a company with an admirable ambition to destigmatize therapy — but that they say has questionable marketing practices and regards treatment transcripts as another data resource to be mined. Their accounts suggest that the needs of a venture capital-backed start-up to grow quickly can sometimes be in conflict with the core values of professional therapy, including strict confidentiality and patient welfare.
This year, with a pandemic, a recession and an election shredding Americans’ nerves, those concerns are relevant to more people than ever before: In May, Talkspace told The Washington Post that its client base had jumped 65 percent since mid-February.
“The app-ification of mental health care has real problems,” said Hannah Zeavin, a lecturer in the English department at the University of California, Berkeley whose book about teletherapy is scheduled to be published next year by MIT Press. “These are corporate platforms first. And they offer therapy second.”
“Talkspace has democratized access to therapy and psychiatry by meeting patients where they are in their lives and making treatment more affordable,” said Neil Leibowitz, Talkspace’s chief medical officer. “The need is profound, especially now in this time of unease, and we are so proud of what our team of therapists is achieving.”
Signing up with Talkspace is quick. Users create an account, fill out a questionnaire, and get a choice of therapists, who work for the platform as independent contractors. Those who sign up for the “Unlimited Messaging Therapy Plus” plan, at $260 a month, can send a therapist messages at any time and are promised daily responses. Higher-priced subscription tiers offer “live sessions” of 30 minutes. While users can send messages by text, audio and video, Talkspace is known popularly as a platform for texting.
The company was founded in 2011 by Oren and Roni Frank, an Israeli couple who felt inspired after their relationship was “saved” by marriage counseling. Mr. Frank had a background in marketing, and Ms. Frank was a software developer.
Ms. Frank is the company’s head of clinical services; as of Aug. 6, her LinkedIn page said she had a master’s degree in psychoanalysis and psychotherapy from the New York Graduate School of Psychoanalysis, but she never completed the program. The degree claim was deleted after an inquiry from The Times. Mr. Reilly said Ms. Frank “studied for an M.A. but left her program before completion to launch Talkspace. Her LinkedIn profile was created while she was studying, the inadvertent error was corrected as soon as the NYT brought this to our attention.”
The app launched in 2014 to positive press but lukewarm customer reviews, with ratings of about three stars out of five on both the Google and Apple app stores, according to a Times analysis. Users complained about glitchy software and unresponsive therapists.
In 2015 and 2016, according to four former employees, the company sought to improve its ratings: It asked workers to write positive reviews. One employee said that Talkspace’s head of marketing at the time asked him to compile 100 fake reviews in a Google spreadsheet, so that employees could submit them to app stores.
Mr. Lori said that Talkspace gave employees “burner” phones to help evade the app stores’ techniques for detecting false reviews. “They said, ‘Don’t do it here. Do it at home. Give us five-star ratings because we have too many bad reviews,’” Mr. Lori said.
Mr. Reilly, the Talkspace lawyer, disputed this account, saying that employees were free to write reviews any way they liked. “We alerted employees if they were to leave a review, to do it from their personal phones — not from the Talkspace office network, as that would cause issues with the app store,” Mr. Reilly said in an emailed statement. “To be clear: We have never used fake identities or encouraged anybody to do so; there is no event involving ‘burner’ phones, and the idea in and of itself is nonsensical relative to the large number of reviews outstanding.”
Mr. Lori still has the iPhone 4 that Talkspace gave him. On the back, there is a white sticker on which someone has written “#7 App Store login,” along with a Yahoo email address and password. Two other former employees said burner phones were made available to workers.
“Fake reviews are deceptive to consumers,” said Eric Goldman, co-director of the High Tech Law Institute at Santa Clara University. If the Talkspace employees didn’t disclose their role when leaving reviews, “then the company-encouraged reviews are problematic on multiple legal fronts,” Mr. Goldman said.
Posting fake online reviews is considered a deceptive business practice and can violate laws against false advertising. The New York attorney general and the Federal Trade Commission have fined companies for posting such reviews, though consequences can also be less severe. After the F.T.C. accused the cosmetics brand Sunday Riley of posting fake reviews, it simply made the company agree not to do so again.
Irreverence unusual to health care
Talkspace has also seized on moments of national anxiety as opportunities for promotion. On Nov. 9, 2016, the morning after the election of Donald Trump, Mr. Frank wrote on Twitter: “Long night in NYC. Woke up this morning to record sales.” The company told reporters that users were flocking to the app to help process the news. CNBC and The Washington Post published stories about Talkspace’s “7-fold spike in traffic,” and Mr. Frank shared a Fast Company link claiming a “7x spike in sales.”
According to data from two app analytics firms, App Annie and Sensor Tower, the number of Talkspace downloads declined in the months after the election. The Times analyzed more than 3,600 reviews of the Talkspace app. There was no significant increase in the number of reviews, positive or negative, following the 2016 election.
Dr. Leibowitz, Talkspace’s chief medical officer, who joined the company in 2018, said in an email: “We saw an uptick in use after the election, including, as the piece mentions, an uptick in traffic from existing clients concerned about election results. App analytics fail to capture a few elements: Much of our traffic is on the web.”
The Trump election tweets are examples of the sometimes unfiltered social media presence of Mr. Frank and Talkspace — an irreverence familiar among start-ups but unusual among organizations devoted to mental health care.
In 2016, a man named Ross complained on Twitter that the company’s subway ads “were designed to trigger you into needing their services.” Talkspace’s official Twitter account responded, “Ads for food make people hungry, right?” and added, “I get what you’re saying, Ross, but medical professionals need people to buy things.” The company later deleted the messages and blocked the man. (Ross wrote about the exchange in a Medium post; when The Times asked for comment recently, he deleted it and asked that his full name be withheld, citing personal reasons.)
From his own Twitter account, Mr. Frank called the man a “sweet bored troll” and mocked him for spending $20,000 a year on therapy, saying Talkspace could offer “a more affordable alternative.” The company declined to comment about the episode.
‘We need data. All of our data.’
Therapy sessions are incredibly sensitive by their nature — they are intended to be a sacrosanct space for people to confess their secrets and share their deepest vulnerabilities.
Talkspace’s website promises users that their conversations will be “safe and confidential,” but people may not have as much control as they might think over what happens to their data. Users can’t delete their transcripts, for example, because they are considered medical records.
Karissa Brennan, a New York-based therapist, provided services via Talkspace from 2015 to 2017, including to Mr. Lori. She said that after she provided a client with links to therapy resources outside of Talkspace, a company representative contacted her, saying she should seek to keep her clients inside the app.
“I was like, ‘How do you know I did that?’” Ms. Brennan said. “They said it was private, but it wasn’t.”
The company says this would only happen if an algorithmic review flagged the interaction for some reason — for example, if the therapist recommended medical marijuana to a client. Ms. Brennan says that to the best of her recollection, she had sent a link to an anxiety worksheet.
Talkspace also has been analyzing transcripts in order to develop bots that monitor and augment therapists’ work. During a presentation in 2019, a Talkspace engineer specializing in machine learning said the research was important because certain cues that a client is in distress that could be caught during in-person sessions might be missed when a therapist is only communicating by text. Software might better catch those cues.
Last year, Mr. Frank wrote an opinion article for The Times encouraging people to make their health data available to researchers. “We need data. All of our data. Mine and yours,” he wrote, arguing that analysis of anonymous data sets could improve treatment.
The anonymous data Talkspace collects is not used just for medical advancements; it’s used to better sell Talkspace’s product. Two former employees said the company’s data scientists shared common phrases from clients’ transcripts with the marketing team so that it could better target potential customers.
The company disputes this. “We are a data-focused company, and data science and clinical leadership will from time to time share insights with their colleagues,” Mr. Reilly said. “This can include evaluating critical information that can help us improve best practices.”
He added: “It never has and never will be used for marketing purposes.”
Many licensed therapists sign up with Talkspace for reasons similar to why drivers work for Uber. The company provides a steady stream of clients, takes care of administrative tasks and deals with some insurance issues.
“The beauty of text-based therapy is we are meeting clients where they are, and giving them access to something different,” said Dr. Reshawna Chapple, a Talkspace therapist whom the company made available for an interview. “It’s about convenience for me.”
“The thing that Talkspace allows me to do is to put my hands in a lot of different pots,” said Dr. Chapple, who communicates with 30 clients via Talkspace, treats 15 in person, and works as a full-time professor at the University of Florida. She also has a contract with Talkspace to advise other therapists.
The approximately 3,000 therapists who work on the platform are paid by “engagement,” according to the company, based on the number of words they write to users or how often they talk by video or audio, with bonuses for client retention.
According to multiple therapists, Talkspace paid special attention to their interactions with clients who worked at places like Google, Kroger and JetBlue — “enterprise partners” that provide Talkspace to employees as a perk. (The New York Times offers Talkspace to its workers as a benefit.)
A college professor who provided therapy via Talkspace for two years said the company reached out to her when it thought two clients from Google had been waiting too long for a response.
“Like all businesses, we focus on clients based on size and scope,” said Dr. Leibowitz, the chief medical officer.
Last year, Talkspace introduced a new feature: a button that users could press after sending a message that required the therapist to respond within a certain time frame. If the therapists don’t respond in time, their pay can be docked.
Some therapists on the platform were alarmed, in part because the function required them to work on demand, rather than on their own schedule. More significantly, they asked: Is it harmful to give clients with anxiety and boundary issues a button to press for immediate gratification?
“That’s a corporate model: You need to respond to the customer no matter what,” said Shara Sand, a psychologist with her own practice in New York. “Limit-setting and boundary-setting is part of the therapy. If you can’t manage not to talk to your therapist for four hours, you are very ill and need a higher level of care than a texting app.”
Pushback on clinical benefits
Talkspace is advertised to users as unlimited, “24/7” messaging therapy. “Your therapist will see your messages and respond to you throughout the day,” the company says. Therapists get a different pitch: “Set your business hours, and check in on your clients daily, five days per week.”
The company says the two messages are not in conflict. “I don’t think it’s a discrepancy in expectations,” said Rachel O’Neill, a licensed therapist at Talkspace whose title is director of clinical effectiveness. “It’s not 24/7 therapy, it’s 24/7 ability to communicate.”
Some traditional mental health professionals question the free-flowing format, saying that the benefits of therapy stem from regular, scheduled check-ins — sessions with clear beginnings and endings that help mark progress.
“It’s called the ‘frame’ in psychoanalysis. It’s the room. It’s how long the session will last. How much it will cost,” said Berkeley’s Ms. Zeavin. “Boundaries are really important to the history of therapy. If texting is equated with no boundaries, that’s a real problem.”
“Talkspace’s No. 1 priority is quality of care for patients and driving the clinical outcomes desired by patients,” said Dr. Leibowitz. “Talkspace has conducted research in partnership with many of the top academic universities,” he said, adding that the work has yielded “10 vetted papers in peer-reviewed journals.”
Lynn Bufka, the senior director for practice transformation and quality at the American Psychological Association, or A.P.A., said the research on text-based therapy has been based on surveys of whether people find it satisfactory.
“There’s been much less research into whether there’s a clinical benefit,” Dr. Bufka said. “We would offer cautions around relying on text therapy, particularly when there is greater severity in terms of symptoms. We would urge people to seek direct care, which at this time would be by phone or video.”
In 2018, a therapists advocacy group called the Psychotherapy Action Network wrote a letter to the A.P.A. and to the Olympian Michael Phelps, who has appeared in ads for Talkspace, calling the company a “problematic treatment provider who aggressively sells an untested, risky treatment.” After receiving the letter, the A.P.A. changed its policy on therapy-tech ads and stopped letting Talkspace exhibit at conferences.
In 2019, after Talkspace signed a deal with Optum, a unit of the health care giant UnitedHealth, to provide teletherapy to its two million customers, the advocacy group wrote another letter of “alarm” to the A.P.A. Talkspace sued the group for defamation, claiming damages of $40 million. The lawsuit was dismissed for jurisdictional reasons.
“Maybe their products and services are helpful to certain people,” said Linda Michaels, a founder of the Psychotherapy Action Network. “But it’s just not therapy.”
Until 2018, the Talkspace user agreement said the same thing: “This Site Does Not Provide Therapy. It provides Therapeutic conversation with a licensed therapist.” The company has since removed the clause.
“That is very old,” said Dr. Leibowitz. “The company has evolved quite a bit.”
Mr. Lori no longer uses the Talkspace app. But he is still seeing the therapist, Ms. Brennan, whom he originally met via the platform.
“Even through this toxic company, wonderful things can happen,” he said. “It’s such a sad story in totality, of what the company could have been versus what it is.”
Susan Beachy contributed research.