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Disrupting psychology: Text a shrink for $25/week. Does it work?

Therapy is known as the talking cure. But if the New York-based tech startup Talkspace has its way, therapy will also become known as the texting cure. The company scored a round of $9.5 million in funding earlier this month from investors who have backed companies like Twitter (TWTR) and Tumblr (YHOO).

“Our mission is to make therapy affordable and accessible for all,” co-founder and head of clinical services Roni Frank tells us in the video above.

Frank describes Talkspace as a platform that connects people with licensed therapists, giving them unlimited access for $25 a week (with the most popular pricing plan).

That’s the pitch. This isn’t traditional therapy though. Sessions are conducted entirely through online messaging-- a technique other psychologists we spoke to had some concerns about.

For the married co-founders, the idea all began when couples therapy helped them through a difficult time as husband and wife. Empowered from the experience, Roni decided to leave her career as a software developer to study psychology. She came to feel the mental health system in America was "completely broken" with "millions not receiving care they need," and she and Oren set out to help bridge the gap. 

“Both Roni and I love traditional face-to-face therapy,” co-founder and CEO Oren Frank tells us. “We’re not fighting it, not trying to replace it. We just think since the average cost is around $150 an hour, it’s completely inaccessible for most people in need.”

How does it work and who is text therapy meant to help?

Oren and Roni Frank say they’ve used technology to cut down overhead costs and create efficiencies. That’s allowed them to lower the price of treatment.

Meanwhile, they appeal to therapists like Nicole Amesbury who told us she enjoys the flexibility of practicing online.

“We call it therapy for all, so it’s really for anyone who is interested to know more about therapy,” Amesbury, who is also the company’s head of clinical development, tells us. She says that while some people may need a higher level of care -- from a psychiatrist, for example -- she thinks Talkspace therapists are able to assess that. People are always trying to show you who they are.”

Amesbury says the rationale for text therapy versus talk therapy is found in the number of people who aren’t getting help or can’t find help.

About one in five adults in the US has a mental illness in a given year, while only about four out of 10 of them receive treatment, according to Substance Abuse aand Mental Health Services Administration.

Talkspace thinks its platform could reduce barriers to getting help, such as stigma and inconvenience. Right now they say the site has a few thousand active users each month, with 100,000 since they started the business three years ago.

The company said it couldn’t connect us with a patient because of privacy concerns, so we created an account and logged on to the site to see how the process works. A user has a free consultation with a therapist, and all communication with Talkspace is anonymous for customers.

The consultation therapist led us through three different pricing options and also asked a number of questions such as age, gender, occupation and background with therapy, to connect us with a professional. From there, we would sign up and start therapy in a private online chat room on a computer or smartphone.

Does the research back it up?

Some have concerns about this technique.

“I think texting can be effective if it is a supplement to face-to-face therapy,” says New York psychotherapist Robi Ludwig. Ludwig worries that without seeing a patient in person, communication could be misinterpreted and emergencies would be hard to monitor.

“What if someone becomes suicidal over time, or there is a drug issue that you can’t see or address?” she asks. “There’s a lot to be said about seeing a person face-to-face and getting a lot of information a therapist can interpret and analyze.”

In addressing the cost issue, she also points out that therapy is often covered by health insurance. Though she does see the appeal of texting, she thinks the “problem is we don’t have any good research yet.”

Talkspace points to studies from the University of Zurich and others showing the benefits of online and text therapy.

Psychologists at the American Psychological Association reviewed the abstracts for the research Talkspace provided us, and Dr. Lynn Bufka, associate executive director of practice research and policy, told us in a statement:

What is concerning is that this research is not on text therapy as the specific or sole intervention; rather this research is on various uses of technology in providing mental health services. It would be inaccurate to say that this research demonstrates the efficacy of text therapy.”

Bufka adds that they have little if any data about how therapy via text alone compares to other techniques. And in the absence, they cite concerns similar to those expressed by Ludwig. She does note that the lack of data about texting alone as therapy does not mean that the use of technology is always bad.

In response to the APA, Talkspace in a statement said:

"We appreciate the input from the APA, and we are excited to finally start this dialogue. The current delivery of therapy is antiquated and does not address the needs of people who need treatment the most. We are not trying to replace [face-to-face] therapy; we created a new approach that effectively and quickly eliminates the existing barriers to entry associated with traditional therapy."

Oren does concede that pushback has been tough.

“We’re inventing something that did not happen before -- there’s a lot of resistance,” he says. But he welcomes this as “the sound of disruption.” Frank told us the company is happy to share findings with the APA so it can be used to help more people get care.

For the Franks, making therapy a widely accepted part of normal healthcare is part of the mission.

“If I broke my foot I would go to the ER, and you know, if Roni breaks my heart I will go to therapy,” quips Oren.