“Uberized” online therapy platforms—like BetterHelp, or subscription based ones like Talkspace—have surged in popularity over the past decade, partly due to their promise of affordable, on-demand mental health care. But these services often trade away client confidentiality, compromise clinical quality, and treat therapy as a commodity rather than a relational process. Below, I explore how Uber-style mental health platforms betray core ethical principles and suggest more trustworthy alternatives.
Breaches of Confidentiality: Data as the New Currency
Confidentiality isn’t just professional jargon; it’s the foundation of any therapeutic alliance. When a client discloses suicidal ideation, trauma history, or severe anxiety, they need to believe that information won’t be repurposed for targeted ads. In March 2023, the U.S. Federal Trade Commission (FTC) fined BetterHelp $7.8 million for sharing consumers’ email addresses, IP addresses, and even health-questionnaire responses with Facebook, Snapchat, Criteo, and Pinterest in order to drive advertising revenue (FTC, 2023). In other words, private mental health struggles became fodder for Meta’s algorithm.
Consider a teenager wrestling with anorexia nervosa: they sign up for BetterHelp in hopes of receiving confidential care, detail their disordered eating behaviors, and then suddenly find themselves bombarded with “quick weight-loss” ads on social media which can exacerbate shame cycles and derail treatment (Masi et al., 2021). When platforms monetize vulnerability, they erode the very trust that clients need to talk openly.
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The Therapist-as-Gig-Worker Model: Quality vs. Quantity
On virtual platforms, therapists are frequently compensated at a flat rate per session—often keeping only 20–40 percent of the fee—while the platform retains the remainder (BetterHelp, 2023). Lower pay can translate into higher caseloads, abbreviated session times, and reduced investment in ongoing training (Espinet et al., 2022). In effect, providers become gig-workers racing to meet billing targets instead of dedicated clinicians fostering therapeutic relationships.
Empirical research on telehealth shows that, although virtual care can match in-person outcomes for mild to moderate depression or anxiety, it is less effective for complex cases (e.g., major trauma, comorbid personality disorders, or acute crisis) (Brown, 2022). In these scenarios, nuanced clinical judgment and longer session durations are paramount—luxuries that uberized therapists rarely afford. When therapists are underpaid and overextended, clients with deeper wounds may slip through the cracks.
Commercialization of Mental Health: Selling Data, Eroding Ethics
Why do platforms like BetterHelp harvest sensitive client data? Because in the digital advertising economy, knowing someone’s mental health status is marketing gold. Reports indicate that BetterHelp used “lookalike audiences” on Facebook—leveraging users’ therapy-related data to find new customers whose online behavior mirrored existing clients (FTC, 2023). The result: a continuous pipeline of vulnerable individuals funneled into an ad machine.
This approach runs counter to professional ethical codes. For example, the Canadian Counselling and Psychotherapy Association (CCPA, 2018) mandates that practitioners safeguard client information to “protect clients from potential harm.” When a platform treats therapy like a ride-share gig, it normalizes data exploitation and undermines public trust in mental health care. Over time, people may avoid seeking help altogether for fear their private struggles will be sold to advertisers.
Downstream Harms: When Convenience Backfires
I’ve spoken with clients who—after signing up for an app-based service—felt violated when they saw ads directly related to their disclosed issues. One young adult described planning a suicide attempt in session, only to later encounter targeted advertisements for “anti-depressant supplements” and “self-harm recovery programs” while scrolling Instagram. For someone already in crisis, such digital reminders can be destabilizing, even dangerous (Arbeau, 2017; Brown, 2017).
Moreover, when a client believes their therapist’s first loyalty is to an algorithm rather than to their well-being, the therapeutic alliance collapses. And without a strong alliance—consistently identified as the single best predictor of positive outcomes (Wiredu & McLean, 2020)—therapy becomes little more than a transactional exchange. In short, what appears “convenient” can ultimately cause more harm than help.
Alternatives and Best Practices: Reclaiming Ethical Care
- Seek Credentialed Counsellors Responsible to an Approved Organization: Ensure they’re accountable to external standards and subject to a complaints process. Since counselling isn’t yet provincially regulated in BC, your safest bet is to choose practitioners affiliated with a FACT BC member association (FACT BC, 2024) or BCACC. These counsellors commit to adhere to a code of ethics, complete ongoing supervision, and participate in mandatory continuing education.
- Explore Nonprofit or Community-Based Telehealth: Organizations like Foundry (2024) and COAST (2024) operate on government or charitable funding, not ad revenue. Their priorities center on client welfare rather than data monetization. While wait-lists may exist, these services uphold stricter privacy protections and usually offer sliding-scale fees or no-cost options for youth and vulnerable adults.
- Hybrid Care Models: Combining periodic in-person sessions with secure, encrypted video check-ins maintains both flexibility and confidentiality. Research shows that blended models often yield higher engagement and better outcomes than purely app-based care (Espinet et al., 2022). For example, you might meet your counsellor monthly face-to-face and use a secure telehealth platform for brief check-ins.
- Scrutinize Privacy Policies Under PIPA or PIPEDA: In BC, the Personal Information Protection Act (PIPA, 2003) governs how organizations collect, use, and disclose personal data. Federally, it’s the Personal Information Protection and Electronic Documents Act (PIPEDA). Before subscribing to any online therapy service, spend a few minutes reading its privacy policy with information protection in mind. If the policy remains ambiguous—especially around advertising partnerships—keep scrolling. When in doubt, reach out directly and ask how they meet BC’s PIPA requirements. Your mental health data deserve at least that much diligence.
Conclusion: Prioritize Trust Over Hype
Uberized therapy platforms like BetterHelp may tout “affordable, on-demand care,” but the empirical record shows that convenience often comes at the expense of confidentiality and clinical integrity. FTC sanctions, variable provider qualifications, and data-driven marketing practices expose how these services prioritize profit over people. If you—or someone you know—are considering online therapy, remember this: meaningful healing requires a trustworthy relationship, not an algorithm.
Ask yourself: Do I really want my private struggles sold to Meta? If the answer is no—as it should be—opt instead for counsellors who answer to an approved association, nonprofit telehealth services, or hybrid models that place your well-being above targeted advertising. Real therapy isn’t a commodity; it’s a collaborative journey guided by ethical commitment and genuine expertise.
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References
Brown, L. (2017). ADHD and adverse childhood experiences: Exploring the link. Child Psychiatry Review, 12(2), 89–102.
Brown, S. (2022). Teletherapy outcomes in complex clinical presentations. Canadian Journal of Counselling, 56(1), 33–51.
Federation of Associations of Counselling Therapists of British Columbia (FACT BC). (2024). Member associations and standards. Retrieved from https://factbc.ca
Federal Trade Commission. (2023). FTC fines BetterHelp $7.8 million for deceptive privacy practices. Retrieved from https://ftc.gov/news-events
Foundry. (2024). Virtual mental health services for youth. Retrieved from https://foundrybc.ca
Masi, G., Mucci, M., & Milone, A. (2021). Video gaming, screen time, and ADHD symptoms. Journal of Child Development, 92(5), 1453–1465.
PIPA, S.B.C. 2003, c. 63 (Personal Information Protection Act).
Wiredu, N., & McLean, S. (2020). The therapeutic alliance: A meta-analysis of empirical studies. Psychotherapy Research, 30(8), 986–1003.