Does uber style therapy work?

Dr. Sanjay Rao

11 April 2019

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Does uber style therapy work?

If the question was could Uber therapy work then the answer would be ‘yes’. 

With the rise of  ‘shared rides/space’ economy like  Uber and Airbnb, it is tantalizing to speculate if uberising therapy could work. A number of start-ups and established companies have started offering this in different forms. They match clients to therapists online and are always available.  

As much as we care about easy access to therapy we also care about evidence base and outcomes.  

Here are some important considerations 

1. The spare space/capacity argument does not apply well to therapy 

Uber and Airbnb use the spare capacity with resources (transport, housing) which many people have. This does not translate well to therapy. It is a specialized skill and not everyone will have it. Just as you would not want to get surgery by finding a surgeon through an app which locates people who claim to do surgery in their spare-time! 

The companies who offer uberised therapy may claim to have a clutch of licensed therapists offering their services via this platform available online which brings us to the next point. 

2. Who monitors the competence of the uber therapists? 

First therapy is not ‘one thing’ as much as the term ‘building’ could mean a house or a supermarket and more. So, for each therapy, there would need to be standards which are evaluated by national or international organizations. Some examples for Cognitive Behavioural Therapy (CBT) are Beck’s Institute, Canadian Association of Cognitive and Behavioral Therapies (CACBT-ACTCC), British Association of Behavioral and Cognitive therapies (BABCP), etc. These organizations provide additional scrutiny for CBT over and above being a licensed profession (e.g. psychologist, physician, nurses, social works). Most uber therapy matching companies have claims but no proof that their matching procedures meet accepted accreditation standards of the specific therapies they offer.  

3. Who should get what therapy? 

This is a thorny issue. Therapy could mean anything from counselling for a relationship to managing stress to therapy for PTSD or Obsessive-Compulsive Disorder. Typically, the Uber Therapy App or webpage would have a ‘assessment tool’ which would have drop-down menus for the client to select the problems and text boxes to type in some problem descriptions. Based on this a therapist match would be found. BY NO MEANS IS THIS A VALID ASSESSMENT ESPECIALLY WHEN TREATING CLINICAL CONDITIONS. 

Do the apps know what therapies are evidence-based? Well not really, for example, the following therapies have clinical trial level evidence for PTSD: prolonged exposure therapy, cognitive behavior therapy, EMDR, cognitive processing therapy, and narrative exposure therapy. Most apps will not tell us this nor evaluate the competence in these areas.  

4. Who monitors the quality of uber therapists? 

When you buy a regulated medicine, it comes with quality standards of manufacturing. This level of quality is hard to implement but has been done (see improving access to psychological therapy, UK or Strongest Family in Canada) for both face-to-face and telephone therapy. No such standards have been applied to Uber therapies.  

The question remains, how can we make Uber therapies work? 

That would be an entire article and today I have reached the end of my blog quota. So another time maybe….. 

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