JMIR Publications

ABSTRACT

Background:

Teletherapy apps have emerged as a promising alternative to traditional in-person therapy, especially after the COVID-19 pandemic, as they help overcome a range of geographical and emotional barriers to accessing care. However, the rapid proliferation of teletherapy apps has occurred in an environment where the development has outpaced the various regulatory and ethical considerations of this space. Thus, researchers have raised concerns about the ethical implications and potential risks of teletherapy apps given the lack of regulation and oversight. Teletherapy apps have distinct aims to more directly replicate practices of traditional care as opposed to mental health apps which primarily provide supplemental support, which suggests a need to examine the ethical considerations of teletherapy apps from the lens of existing ethical guidelines for providing therapy.

Objective:

In this study, we examined user reviews of commercial teletherapy apps to understand user perceptions around whether and how ethical principles are followed and incorporated.

Methods:

We identified eight mobile apps that 1) provide teletherapy on two dominant mobile platform app stores (Google Play and Apple App Store) and 2) had received more than 5,000 app reviews on both app stores. We wrote Python scripts to scrape user reviews from the eight apps, collecting 3,262 user reviews combined across two app stores. We used thematic analysis to qualitatively analyze user reviews, developing the codebook drawing from the ethical codes of conduct for psychologists, psychiatrists, and social workers.

Results:

The qualitative analysis of user reviews surfaced the ethical concerns and opportunities of teletherapy app users. Users frequently perceived unprofessionalism in their teletherapists, mentioning their therapists not listening to them, being distracted during therapy sessions, and not keeping their appointments. Users also noted technical glitches and therapist unavailability on teletherapy apps that might impact their ability to provide continuity of care. Users held varied opinions on the affordability of those apps, with some perceiving them as affordable and others not. Users further brought up that the subscription model resulted in unfair pricing and expressed concerns about the lack of the cost transparency. Users perceived that these apps could help promote access to care by overcoming geographical and social constraints.

Conclusions:

Our study suggests that users perceive commercial teletherapy apps as adhering to many ethical principles pertaining to therapy but falling short in key areas around professionalism, continuity of care, cost fairness, and cost transparency. Our findings suggest that in order to provide high-quality care, teletherapy apps should prioritize fair compensation for therapists, develop more flexible and transparent payment models, and invest in measures to ensure app stability and therapist availability. Future work is needed to develop standards for teletherapy and improve the quality and accessibility of those services.