Talkspace, a site for online therapy and counseling, was apparently in a panic. When its commitment to client confidentiality was challenged, its response was hasty, ill-advised and hurtful to clients. And in the process they revealed organizational priorities that undervalue both clinical confidentiality and the client-therapist relationship. The significant promise of tele(mental)health deserves better. Here’s what happened.
On August 2, 2016 a now former Talkspace therapist filed a complaint with the Office of Civil Rights of the U.S. Dept. of Health and Human Services alleging a breach of clinical confidentiality. This is known as a HIPAA violation. She then told her clients. She cited what appeared to be a routine Talkspace procedure she saw as a threat to their privacy. Then she resigned from Talkspace, giving the requested two weeks notice, hoping to use that time to prepare her clients for a transition in their care, either to a new platform or a new therapist.
Two days later a Talkspace VP sent an email directly to the 18 clients involved. Reassuring in tone, the email also vigorously defended Talkspace's actions and stated “(a)s of today, your Therapist will no longer be granted access to provide services using the Talkspace platform.” In other words, Talkspace banned her from her clients because of the administrative conflict.
From a clinical perspective, this move should be considered totally unacceptable, unthinkable even. Whatever administrative/business problems the Talkspace administration were having with a therapist because she alleged a breach of clinical confidentiality should never have risen to the level at which those conflicts were more important than the relationship that therapist had with her clients. The therapist should have been given ample room to say goodbye. Patients/clients must come first, whether online or offline. What would you say about a clinic that put patients at risk by interrupting a procedure because the provider was having a spat with administration?
As bad as that is, the story gets much worse than just depriving clients a two week transition. The Talkspace VP sent her email as a mass email with all 18 email addresses clearly and fully exposed to all. That’s right, in their apparent panic to clean up after what might or might not be more systemic violations of clinical confidentiality, Talkspace broadcast everyone’s email. They exposed personally identifying information, exactly the kind of information their expansive marketing campaign promises to protect.
And this violation of trust has done damage. It is not a “whatev.” I have been in contact with several of the clients who were hurt by the email disclosure, people who should have been protected.
One person from New Jersey who was very wary of mental health professionals had worked online with the now banned therapist for several months “which was enough time to build up enough of a trust that I could discuss things.” That trust was violated when the emails were disclosed: “I was furious.” This person also stated “mental health is a stigmatized category, only one person in my life aside from my doctor knew that I was talking to a therapist, and now several people connect an email address that I use publicly to a person who uses therapy.”
Another person, from Pennsylvania, was more troubled by the loss than the disclosure. In some very moving and painful emails they wrote that Talkspace “caused me mental anguish by making me try to find a new therapist and start all over again telling the same heartaches to a new therapist.”
We have to ask why this mistake took place. For clues we can look to what happened after the Talkspace VP disclosed the client emails. The next day, August 5, Roni Frank, cofounder of Talkpsace sent another—but this time properly addressed—email to the clients involved. She acknowledged the panic: “In our rush to resolve the miscommunication, one of my team members made a mistake that copied your email address to the group.” To make it up to them she offered a month’s refund and three months of free access. She also minimized the significance of the breach. I should note some clients were less than pleased with this communication. One aggrieved client wrote me “I did not take comfort from Roni Frank's email trying to play the situation off.”
In any event, the important clue is when Roni Frank went on to write that “I am interested in trying to help you be a past, or future, satisfied customer.” Take note of the use of “customer.” Note she did not write client. She did not write patient. This is significant.
Users of Talkspace are customers of a business. They are neither clients nor patients of a mental health professional. It is a business relationship, not a professional relationship. In fact, Talkspace explicitly defines itself as a “Platform.” It is a business with customers and not a healthcare provider with clients or patients. And it is as a business they promise both anonymity and confidentiality. They use the language of a clinical relationship. But that is not what Talkspace is. When Talkspace promises confidentiality it is done with all the limitations in trust inherent in any company’s marketplace promises. Talkspace defines itself and is only accountable as a business, not as a healthcare provider.
So, how then does treatment take place? For treatment they hire therapists as independent contractors. Talkspace’s customers are clients or patients of the therapists. These therapists, not Talkspace, are the professionals who must maintain standards of clinical confidentiality. A professional relationship exists between therapist and client, not between Talkspace and its customers. It is specifically a business relationship, not a clinical one, between the therapists’ clients and Talkspace. When Talkspace markets a promise of confidentiality it does not have the same value as the promise of confidentiality made by a healthcare provider.
I know, it’s confusing. But it gets even worse, much worse. Talkspace not only promises confidentiality. It also promises anonymity. You can be a Talkspace customer without your therapist having any access to personally identifying information. But the business side can access it, like the VP who revealed all the emails, even when therapists can not, even in an emergency. Despite the fact that, for example, the National Association of Social Workers best practices guidelines suggest location and contact information be available before each contact, Talkspace does not make that information available to therapists, even in an emergency. The very same VP who was able to access supposedly confidential identifying email addresses when asked by a Talkspace therapist about those NASW’s guidelines for contact information in case of emergencies cryptically replied as follows: “In an emergency we contact 911 and provide their IP address and the police will have their location.” First, calling the police should never be the first and only response to an emergency. Second, geolocation is no where near precise enough for this purpose. In fact, someone who actually understands geolocation said “(t)heir contention that police will be able to locate people by IP address is completely entirely and absurdly wrong.”
In other words, if you’re a Talkspace customer and you have an emergency you are on your own. Your therapist will not be able to do what therapists are supposed to do which is contact you immediately like with a phone call.
Overall, what this unfortunate episode reveals is that the Talkspace model is backwards. I’m all for business and profit. I’m also committed to the promise of tele(mental)health to improve the lives of many who are not helped by the current mental health delivery system. Both are worth fighting for. But client/patient care must come first, not second. That is apparently not how Talkspace has been set up. Talkspace is apparently set up so that the licensed professionals required by license and the canons of professional ethics to maintain confidentiality are denied access to personally identifiable information while, simultaneously, those who view users as customers can access privileged information. This is backwards.
Unfortunately, we do not have Talkspace’s response. I tried. But they do not talk to me or respond in any way to my requests for comment. In fact, in an email Roni Frank sent to their entire Clinical Team on June 10, 2016 about presenting a “united front” to the public, she wrote “(a)s an additional precaution, if you're contacted by Todd Essig, do not respond or engage with him.” But please know, if you are a therapist who works at Talkspace there are already several of you talking with me. Please join them. All it takes is a commitment both to the significant promise of tele(mental)health to improve care while extending care to the under-served and to the highest standards of existing clinical practice. Both. The incredible promise of tele(mental)health will only be achieved if we build on what we already clinically know, do and value. Promises of re-invention and disruption in the mental health space cannot ignore current expertise and science. Caring for another in distress is just not the same as a taxi service or hotel. I hope to hear from more of you.
