# ‘It’s not 1800-phone-a-friend’: the failed promise of therapy apps

An episode of [7am](https://invisiblenetwork.ai/podcast/1461999702), 3 Oct 2026, 17 min.

Audio: https://p.podderapp.com/2544644999/traffic.omny.fm/d/clips/2fb3740d-3436-44af-8cc0-a91900716aa5/62723a1f-3e96-4fc4-882c-b25e0181da4d/afb2fea1-495d-49ff-8e8c-b4d7007a147e/audio.mp3?utm_source=Podcast&in_playlist=70f29d90-2a63-48aa-bf8f-b25e0181da70

If you listen to podcasts, and let’s be honest, there’s a fair chance that you do, it’s likely that you’ve heard ads for a thing called Better Help. It’s an app offering flexible, affordable therapy whenever you need it. Kind of an “Uber for therapy”. Since we first brought you this story two years ago, app-based therapy has continued to grow – and now AI chatbots are increasingly being used for mental health support too. So are we actually better off with BetterHelp and apps like it? Today, we’re returning to our conversation with clinical and forensic psychologist Dr Ahona Guha, on the Uberfication of mental health care – and why a gig economy for psychologists isn’t the answer to our struggling mental health system. This episode first aired in August, 2024 If you enjoy 7am, the best way you can support us is by making a contribution at 7ampodcast.com.au/support. Socials: Stay in touch with us on Instagram Guest: Clinical and forensic psychologist Dr Ahona Guha Photo: betterhelp.com See omnystudio.com/listener for privacy information.

## Transcript

[0:01] Speaker 1: I'm Daniel James, and you're listening to 7am. If you
[0:09] Speaker 1: listen to podcasts, and let's be honest, there's a fair
[0:11] Speaker 1: chance that you do, it's likely that you've heard ads
[0:14] Speaker 1: for a thing called BetterHelp. It's an app offering flexible,
[0:18] Speaker 1: affordable therapy whenever you need it. Kind of an Uber
[0:21] Speaker 1: for therapy. Since we first brought you this story two
[0:24] Speaker 1: years ago, app-based therapy has continued to grow and And
[0:28] Speaker 1: now AI chatbots are increasingly becoming used for mental health
[0:32] Speaker 1: support too. So are we actually better off with better
[0:35] Speaker 1: help and apps like it? Today we're returning to our
[0:38] Speaker 1: conversation with clinical and forensic psychologist Dr Ahuna Gua on
[0:42] Speaker 1: the uberfication of mental health care and why a gig
[0:45] Speaker 1: economy for psychologists isn't the answer to our struggling mental
[0:49] Speaker 1: health system. It's Sunday, October 4. This episode first aired
[0:57] Speaker 1: in August 2024.
[0:57] Speaker 2: Dr.
[0:58] Speaker 1: Ahona, when did you first start hearing about BetterHelp?
[1:04] Speaker 3: I think I'd say I first heard about BetterHelp about
[1:07] Speaker 3: 10 years ago, and that was just when I was
[1:09] Speaker 3: listening to a range of podcasts back in my pre-psychology
[1:13] Speaker 3: days when I had more time.
[1:17] Speaker 2: This show is sponsored by BetterHelp.
[1:18] Speaker 4: You know, Mitch, I have some self-care non-negotiables.
[1:21] Speaker 2: I never skip leg day, and I never skip therapy day.
[1:24] Speaker 1: Wow, Wags, good for you.
[1:26] Speaker 2: BetterHelp is an online counseling service. It offers licensed professional
[1:30] Speaker 2: counselors who specialize.
[1:31] Speaker 1: In issues like depression, stress, anxiety, relationships, sleeping, anger, family conflict, self-esteem,
[1:36] Speaker 1: and more. And I didn't have a boyfriend to text anymore,
[1:39] Speaker 1: so I was like, might as well text a therapist.
[1:41] Speaker 3: And it was really, really a great experience.
[1:44] Speaker 2: So We have an awesome offer for people who listen
[1:48] Speaker 2: to the Daily Detectives.
[1:50] Speaker 3: So kind of vaguely been aware of them for a
[1:52] Speaker 3: while and certainly known that they've been a very, very
[1:55] Speaker 3: big digital mental health provider in the States because they
[1:58] Speaker 3: don't have the same health care system as we do here.
[2:04] Speaker 3: But in terms of when I realized or started to
[2:07] Speaker 3: see them more in the Australian market, look, I'd say
[2:09] Speaker 3: that was probably about two to three months ago. I
[2:12] Speaker 3: started to just see ads coming up both on LinkedIn
[2:16] Speaker 3: because they were trying to advertise for clinicians and then
[2:19] Speaker 3: also on my social media where it looked like they
[2:23] Speaker 3: were trying to target clients. So I was quite alarmed, honestly,
[2:26] Speaker 3: to see it start to creep into the Australian market.
[2:30] Speaker 3: I was starting to wonder whether this would be attractive
[2:33] Speaker 3: to clients who wouldn't really be stopping to maybe think
[2:37] Speaker 3: through the implications of signing up for a tech entrepreneur
[2:42] Speaker 3: based app like this.
[2:44] Speaker 1: So from a patient's perspective, what's the difference between logging
[2:50] Speaker 1: onto this app and seeking treatment through that app as
[2:53] Speaker 1: compared to going and seeing someone like yourself?
[2:57] Speaker 3: So I'm a clinical psychologist, and I work in both
[3:00] Speaker 3: the public and the private mental health spaces. And obviously,
[3:04] Speaker 3: I can't speak for the entire public mental health system.
[3:08] Speaker 3: But effectively, when you come into either of these services,
[3:12] Speaker 3: you're typically referred by someone else, usually a GP, sometimes
[3:17] Speaker 3: another healthcare provider, you come in, you'll do a range
[3:21] Speaker 3: of assessments, maybe get a really good history as well.
[3:24] Speaker 3: So it's quite detailed. It's quite intensive. It's usually assessment
[3:29] Speaker 3: based initially, because it's not that I'm trying to diagnose
[3:32] Speaker 3: and slap labels onto people, but it's more that that
[3:35] Speaker 3: helps me provide better treatment once I've identified what a
[3:39] Speaker 3: person's issues are. So my understanding of BetterHelp, what you
[3:43] Speaker 3: do is you sign up, you fill out a questionnaire,
[3:47] Speaker 3: just like, you know, I've done for my dog's pet
[3:50] Speaker 3: food delivery, but slightly, slightly different.
[3:54] Speaker 5: Starting your therapy journey has never been easier with BetterHelp.
[3:57] Speaker 5: When you first come to the site, we'll ask you
[3:59] Speaker 5: some questions about yourself and what you're looking for in therapy.
[4:03] Speaker 5: We use this information to match you to one of
[4:05] Speaker 5: our licensed therapists.
[4:07] Speaker 3: I don't really know how they actually match and triage,
[4:10] Speaker 3: but I can say that both in the public and
[4:12] Speaker 3: the private mental health systems, you're thinking through things like
[4:16] Speaker 3: the complexity for clients' needs, the seniority of a clinician,
[4:20] Speaker 3: the type of intervention and whether you're well matched and
[4:23] Speaker 3: well suited to each other.
[4:25] Speaker 5: You'll get an email once you've been matched. This usually
[4:28] Speaker 5: takes less than 48 hours.
[4:29] Speaker 3: So you're matched and then you have a shorter session
[4:33] Speaker 3: a week, 30 to 45 minutes, based on how much
[4:36] Speaker 3: you're paying. Their charges at this point in time are
[4:38] Speaker 3: Australian $ 90 or $ 120. And if you pay the higher rate,
[4:43] Speaker 3: you get the capacity to basically text your psychologist In
[4:48] Speaker 3: quite an unlimited capacity, and you're told that they'll log
[4:50] Speaker 3: in twice a day to respond.
[4:52] Speaker 5: As soon as you're matched, your therapist will introduce themselves
[4:55] Speaker 5: and ask you some questions to get to know you better.
[4:58] Speaker 5: This is your chance to get acquainted with your therapist.
[5:00] Speaker 3: So it's really subscription-based. Kind of like Netflix for mental health.
[5:05] Speaker 1: Netflix is good for mental health, isn't it?
[5:07] Speaker 3: Well, I suppose it depends on what you're watching, but
[5:10] Speaker 3: from the... perspective of a clinician. It's more like Uber
[5:14] Speaker 3: or Psych. It's really starting to bring the gig economy
[5:18] Speaker 3: into what is traditionally not a gig economy space at all.
[5:23] Speaker 1: Yeah, right. It's pretty easy to see why a gig
[5:26] Speaker 1: economy around mental health has opened up. Affordable and timely
[5:30] Speaker 1: access to mental health professionals is a pretty appealing proposition,
[5:34] Speaker 1: isn't it?
[5:34] Speaker 3: Look, I do agree. I think we have a very,
[5:37] Speaker 3: very tricky mental health landscape across the world. You're in
[5:40] Speaker 3: a reasonably... unique situation here because we do have access
[5:44] Speaker 3: to Medicare. Look, we certainly know that waitlists are spiralling
[5:48] Speaker 3: and especially for more specialty services, but I do note
[5:51] Speaker 3: that Absolute Better Help can't actually provide services to people
[5:55] Speaker 3: who are seeking assessments and things like that. In the
[5:59] Speaker 3: fine printers bury the caveat that they can't write letters
[6:03] Speaker 3: for court, they can't do medical legal reports and they
[6:06] Speaker 3: obviously can't prescribe medication. Now, when you see a psychologist here,
[6:11] Speaker 3: we also can't prescribe medication. But what often happens is
[6:14] Speaker 3: we work as a care team, especially for more complex
[6:18] Speaker 3: mental health issues. You know, if you're thinking something like PTSD,
[6:22] Speaker 3: serious major depressive disorder, psychosis, bipolar, we all work together
[6:27] Speaker 3: to effectively coordinate some of our interventions. And my understanding
[6:32] Speaker 3: is that app-based platforms like BetterHelp just don't allow access
[6:37] Speaker 3: for that because there's no contact outside of session with
[6:40] Speaker 3: a person's treating team. And indeed, I believe that users
[6:43] Speaker 3: can remain anonymous, which I think is very ethically problematic
[6:48] Speaker 3: because if there's a crisis, you know, therapist is left
[6:51] Speaker 3: holding that and doesn't know who to contact.
[6:53] Speaker 1: So there's a series of alarm bells related to these
[6:57] Speaker 1: type of apps, but the mental health system that we
[6:59] Speaker 1: have isn't perfect either and people are continually falling through
[7:03] Speaker 1: the cracks. Shouldn't we embrace the disruption of it all?
[7:07] Speaker 3: So I'm not saying that app-based services don't have their place.
[7:11] Speaker 3: There's been very little research into the actual effectiveness of
[7:15] Speaker 3: most app-based services and most that have been assessed for
[7:19] Speaker 3: effectiveness in terms of reducing symptoms with things like text
[7:22] Speaker 3: messages have been shown that they don't actually work. So
[7:25] Speaker 3: there is hope to try new approaches and absolutely acknowledging
[7:30] Speaker 3: that the mental health state in Australia is terrible and
[7:34] Speaker 3: I don't feel like there's a lot of federal political
[7:37] Speaker 3: will at this point in time to improve that. But
[7:41] Speaker 3: therapy is not one in a hundred phone a friend.
[7:45] Speaker 3: You know, it's really about helping you talk through your
[7:48] Speaker 3: symptoms when you're there in session and building ways to
[7:51] Speaker 3: cope outside of therapy. And I really do worry that
[7:54] Speaker 3: that kind of constant possible contact leads to a level
[7:58] Speaker 3: of dependence and people just never exploring or actually using
[8:03] Speaker 3: the skills. You know, we have to be cautious. We
[8:06] Speaker 3: have to test. We have to work based on the
[8:07] Speaker 3: data and not on what sounds like a good idea
[8:10] Speaker 3: or on what's going to help this app make money.
[8:15] Speaker 1: Should you be worried about your data when using one
[8:17] Speaker 1: of these apps? That's coming up. Dr Ahona, patient data
[8:30] Speaker 1: and its privacy is paramount in any sort of healthcare setting.
[8:34] Speaker 3: Absolutely.
[8:35] Speaker 1: When it comes to mental health particularly, there's differently an
[8:38] Speaker 1: expectation that what you say is private between you and
[8:41] Speaker 1: your practitioner, what does the app actually do with the
[8:45] Speaker 1: information that you give it?
[8:47] Speaker 3: I don't know. So I know that there's been a very,
[8:50] Speaker 3: very big case brought against BetterHelp.
[8:52] Speaker 2: All right, we're keeping an eye on your wallet tonight.
[8:57] Speaker 2: You may be entitled to a refund if you used
[8:59] Speaker 2: online therapy through BetterHelp because they're accused of selling information
[9:04] Speaker 2: about your mental health.
[9:05] Speaker 4: The company agreed to a $ 7. 8 million settlement. This is
[9:09] Speaker 4: what the FTC, the agency says BetterHelp, promised to keep users'
[9:13] Speaker 4: information private, but the FTC says your information was given
[9:17] Speaker 4: to Facebook, Snapchat, Pinterest for advertising purposes.
[9:21] Speaker 3: They sold consumers' private data, so we're talking things like
[9:25] Speaker 3: email addresses and responses to the mental health questions that
[9:28] Speaker 3: people receive. complete as part of the intake. So they
[9:32] Speaker 3: sold that to third party advertisers so that they could
[9:35] Speaker 3: better target ads.
[9:37] Speaker 4: BetterHelp says the settlement with the Federal Trade Commission is
[9:40] Speaker 4: not an admission of wrongdoing and adds that what they
[9:44] Speaker 4: did is a standard for the industry.
[9:49] Speaker 3: Data privacy is absolutely paramount in health care. Who owns
[9:54] Speaker 3: the data? Things like case notes. Who has access to it?
[9:58] Speaker 3: These are all things that when you attend a psychology-led
[10:01] Speaker 3: service are thought through very, very carefully. If you are
[10:05] Speaker 3: a registered health practitioner here, you're bound by an entire
[10:10] Speaker 3: host of laws, effectively meaning that you can only share
[10:13] Speaker 3: information either with consent for the purposes of providing healthcare
[10:17] Speaker 3: or or in certain key situations where you're mandated to,
[10:22] Speaker 3: like if a court asks for access to information. So
[10:25] Speaker 3: there's so many protections. And when you're giving your data
[10:28] Speaker 3: to a third party, non-clinically led company that operates overseas,
[10:35] Speaker 3: you have very, very few data privacy provisions.
[10:39] Speaker 1: You mentioned earlier that they're recruiting psychologists in Australia. I'm
[10:42] Speaker 1: just looking at one of these ads now. They're saying
[10:46] Speaker 1: that you can be, quote, An independent contractor and earn
[10:51] Speaker 1: between $ 111, 000 and $ 135, 000 a year, offering flexibility with no overheads.
[10:57] Speaker 1: What do you make of that as someone who knows
[11:00] Speaker 1: the inside of the industry? Is it tempting for someone
[11:03] Speaker 1: like you? Yeah.
[11:04] Speaker 3: Look, there's absolutely nothing about that that is tempting for
[11:08] Speaker 3: me in the current Australian landscape. I suppose my view,
[11:11] Speaker 3: just looking at the pay that they offer, they have
[11:14] Speaker 3: a bit of a tiered model. So it looks like
[11:16] Speaker 3: it's 30 USD if you do under 30 hours a week.
[11:20] Speaker 3: And that's not 30 hours of overall work. That is
[11:23] Speaker 3: 30 hours of clinical work. So clinical engagement with a client.
[11:29] Speaker 3: And if you're over that, then you make the higher
[11:31] Speaker 3: rate of 45 USD, which is similar to what clinicians
[11:35] Speaker 3: and public mental health get. But we also have access
[11:39] Speaker 3: to and will leave sick leave, professional development, and quite
[11:43] Speaker 3: a host of other entitlements. And all of our time
[11:46] Speaker 3: is not clinical time. So if you're working 30 to
[11:49] Speaker 3: 45 hours a week and just seeing clients back to
[11:52] Speaker 3: back for that, as appears to be the model, you
[11:54] Speaker 3: will burn out very, very quickly. It might be attractive
[11:58] Speaker 3: to clinicians who might just be starting out, who might
[12:01] Speaker 3: be trying to build up a bit of a referral base.
[12:04] Speaker 3: But honestly, if I was going to have to work
[12:06] Speaker 3: for that amount of time, I'd probably be finding work
[12:09] Speaker 3: in a different industry.
[12:10] Speaker 1: Podcast host.
[12:11] Speaker 3: Podcast host, except that also sounds like very hard work
[12:15] Speaker 3: where you're talking to people all of the time.
[12:18] Speaker 1: So can I ask about your work then? Because you
[12:21] Speaker 1: work in both the private and public sectors, you would
[12:24] Speaker 1: never work for a platform like BetterHelp. But do you
[12:27] Speaker 1: worry about the impact this sort of tech disruption could
[12:30] Speaker 1: have on clinicians less experienced than yourself and the industry overall?
[12:35] Speaker 3: Look, so I work in quite the pointy end across
[12:38] Speaker 3: both of my roles. So within my public mental health role,
[12:41] Speaker 3: we assess and we treat people who have been identified
[12:45] Speaker 3: as possibly being at high risk of re-offending. You know,
[12:49] Speaker 3: the types of behaviours that they might be engaging in
[12:51] Speaker 3: are things like arson, stalking, intimate partner violence, sex offending,
[12:57] Speaker 3: general violence and making threats. And then in my private work,
[13:01] Speaker 3: I see a lot of trauma and complex trauma, as
[13:05] Speaker 3: well as mood and anxiety disorders. I usually see, you know,
[13:10] Speaker 3: anywhere between five to seven clients a day. And outside
[13:15] Speaker 3: of that, I do things like obviously making session notes,
[13:18] Speaker 3: spending some time reflecting on session, tracking how we are going.
[13:22] Speaker 3: So all of this is outside of session work that
[13:25] Speaker 3: you know, usually happens after hours. So the mental health
[13:29] Speaker 3: profession is in flux. I think I'm certainly post-COVID noticing
[13:34] Speaker 3: a lot of almost a moral injury, a lot of burnout,
[13:38] Speaker 3: a lot more people trying to find passive income and
[13:41] Speaker 3: ways of trying to move into other spaces. And I
[13:44] Speaker 3: think I am concerned about things that I'm seeing, even
[13:47] Speaker 3: outside BetterHelp, things like using AI, where we are starting
[13:50] Speaker 3: to rely more on machines and There's a couple of
[13:54] Speaker 3: patient note-taking software things that would actually listen in to
[13:59] Speaker 3: your sessions and then just transcribe a note for you.
[14:02] Speaker 3: And I know a fair few people in private practice
[14:04] Speaker 3: starting to use that, but just all kinds of implications
[14:07] Speaker 3: from a privacy perspective. But I also think fundamentally as psychologists,
[14:12] Speaker 3: we have to have a good grasp of why a
[14:15] Speaker 3: person behaves the way that they do. And if we
[14:17] Speaker 3: are relying on machines to give us those answers, we're
[14:21] Speaker 3: going to lose some really essential case conceptualization skills.
[14:25] Speaker 1: So finally, given what we do know and what we
[14:27] Speaker 1: don't know, what advice would you be giving anyone that's
[14:31] Speaker 1: considering signing up for one of these apps?
[14:34] Speaker 3: I would say buyer beware. Know what you're signing up for.
[14:38] Speaker 3: I would ascertain whether your mental health are mild to moderate.
[14:44] Speaker 3: So if you're not hugely distressed, if there's maybe the
[14:47] Speaker 3: one issue that you want to talk through and it
[14:51] Speaker 3: isn't overly severe, then that might be okay. But I'd
[14:54] Speaker 3: be looking through carefully the fine print and I'd also
[14:58] Speaker 3: be asking questions about the person you're seeing and what
[15:02] Speaker 3: their qualifications are like. So approaching with a lot of caution,
[15:07] Speaker 3: if you do choose to approach, would probably be my suggestion.
[15:11] Speaker 3: And then if you do have maybe slightly more severe
[15:15] Speaker 3: difficulties or if there's a lot of distress or more
[15:18] Speaker 3: complex issues, say you have PTSD, understanding that what better
[15:23] Speaker 3: help offer are only 30 or 45 minute sessions, you know,
[15:27] Speaker 3: the capacity to do things like cognitive processing therapy for
[15:31] Speaker 3: PTSD or maybe EMDR. You can't do any of that
[15:34] Speaker 3: in a 30 or 45-minute session. So you're better off,
[15:40] Speaker 3: I would say, trying to establish whether you can see
[15:44] Speaker 3: a practitioner, even if it's via telehealth within a more
[15:48] Speaker 3: traditional therapeutic setting where you are offered, I guess, the
[15:51] Speaker 3: longer sessions, which are usually 50 to 60 minutes, and
[15:55] Speaker 3: also continuity of care and maybe more wraparound care.
[16:00] Speaker 1: Dr. Ahona, thank you very much for your time.
[16:02] Speaker 3: Pleasure. Thanks for having me.
[16:15] Speaker 1: 7am, we'll be back tomorrow with a very special episode.
[16:18] Speaker 1: I like Al Bowen.
[16:20] Speaker 6: I think he gets a pretty hard rap a lot
[16:22] Speaker 6: of the time. I think Pauline Hanson's in a slightly
[16:24] Speaker 6: different position to Nigel Farage because Nigel Farage is slightly
[16:27] Speaker 6: on the skits. The feeling is there that he's slightly
[16:29] Speaker 6: on the skits. Trump would imagine he was laughing at
[16:32] Speaker 6: Joe Biden. I don't think he was. I think he
[16:34] Speaker 6: was looking at that thinking, this is really wacky.
[16:37] Speaker 1: My conversation with former Tony Blair advisor and co-host of
[16:40] Speaker 1: The Rest Is Politics, Alastair Campbell. On the future of
[16:43] Speaker 1: the centre-left... the challenge of populist politics and a global
[16:47] Speaker 1: order being reshaped by Donald Trump and China.
[16:50] Speaker 6: So I think you need these smart leaders who can
[16:52] Speaker 6: mobilise people to feel that they're going somewhere with them.
[16:56] Speaker 6: And much as I despise Trump, you know, he has
[16:59] Speaker 6: shown that he has the ability to do that, just
[17:01] Speaker 6: in a way that I think does massive damage to
[17:04] Speaker 6: the world.
[17:05] Speaker 1: I'm Daniel James. Thanks for listening.
[17:10] Speaker 3: Thank you.

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