by Monique Hill

Digital Advocacy: Creating space for access and regulation

If you take a look at BetterHelp’s website, you’ll see that they have over 4.1 million customers (Betterhelp, 2023). That means over 4 million people who are looking for help online, on only one of the many available online therapy websites. BetterHelp has also recently settled a lengthy lawsuit, returning $7.8 million to customers after the Federal Trade Commission in the USA accused the tech giant of sharing confidential information (including information about client mental health issues) with companies including Snapchat and Facebook (Bajak, 2023). Although BetterHelp is adamant that they did nothing wrong, and that the settlement does not mean that they shared user information inappropriately, it is a lot of money to pay for doing nothing wrong. It would certainly make a lot of sense for social media companies to buy information about how we are feeling, if for nothing else but to sell us wellness products, exercise programs, and the newest fad supplement that promises to cure all our ills.

“…over 4 million people who are looking for help online, on only one of the many available online therapy websites. “

If it sounds like I am angry, I am. As many of you know, I am a huge advocate for online therapy, and I see it as an incredible avenue to create access for clients who are underserved or far from home. Mass online therapy companies, in my opinion, lure therapists with the promises of making private practice easier, and lure clients with low prices, and end up taking advantage of both by dismissing ethical best practice guidelines. This is one of the reasons why I consider digital arts therapies to be such an important frontier. As arts therapists, especially in South Africa, we are accustomed to facing ethical dilemmas with no clear answers, and grappling with issues of power and privilege in our daily practice. For this reason, I would argue that we take up a seat at the table wherever online therapies practice, research, or training be discussed.

“Arts therapists also understand what it means to be client-led and person-centred: there is no one-size-fits-all way to approach therapy, and every therapist and client is different.”

Arts therapists also understand what it means to be client-led and person-centred: there is no one-size-fits-all way to approach therapy, and every therapist and client is different. It is important to approach working online with this in mind, as online therapy is not for every person, every problem, or every therapist. When massive companies take over the conversation, they have the money to sponsor podcasts and youtubers, and to be the first search result on any Google search remotely linked to online therapy. Advocacy, for me, also means helping our clients to understand how to check if therapists are legitimate, and how to access appropriate means of support that is effective in treating the issues they bring to therapy. To do this, we must be findable for our potential clients, a huge battle when we have limited advertising budgets and high ethical standards that mean we do not claim to be able to help everyone all the time.

So what are our options in the face of such difficulties?

I believe that the online world that so often disconnects us, can also provide us with a way to take part in global conversations to which we may not otherwise have access. An example is the Mental Health Virtual Reality Coalition (MHVR): a collection of mental health professionals, researchers and app developers who come together to create a safer, more ethical world for the integration of Virtual Reality (VR) in healthcare. Just this week we are finishing up a white paper on ethical mental health research involving VR which we hope will connect potential researchers with the gaps in the VR research so far, as well as guidelines to help researchers make sure their work is of the highest ethical standards. If you are interested in this international, voluntary group, let me know, we would love to have you! I am the only arts therapist involved at the moment, and it would be a joy to have more of us on board.

When we can find communities with similar values and ideals to us, such as the MHVR, we add our unique voices to conversations that can start to shape legislature, and make an impact on the future of our digital spaces. I know that not everyone is as excited about online therapy as I am, and actually, I believe that is a great thing! If you are not sure about online work, if you have reservations and concerns, your voice is so desperately needed in this conversation. If the only people involved in digital therapy advocacy are those of us who love working online, then we risk creating an echo chamber, missing out on important questions of safety, efficacy, and education, among others.

So, SANATA, this is my advocacy for today:

come join the conversation, no matter if you love, hate, or are indifferent to online work.

Your voice is vital to ensuring that we create an equitable, ethical, accessible digital therapy world in the future.

If you are reading this and would like to access online therapy more safely, here are some tips:

1. Use online databases to search for online therapists that are licenced to work in your area. Some good places to start include Therapy Route and Psychology Today.

2. When you find a potential therapist, check their qualifications. In South Africa, you can search for a mental health professional on the HPCSA database HERE.

3. Ask if your potential therapist is open to a consultation call before you commit to a full session. Not every therapist offers this service, but it can be a good way of meeting a therapist and getting a sense of whether they will be a good fit for you. During this meeting you might want to ask them about their experience with working online and how they approach confidentiality online.

You can join us at the Mental Health Virtual Reality Coalition on Facebook HERE.


Bajak, F. (2023) Counseling service BetterHelp to return $7.8M to customers in FTC settlement, Fortune. Available at: (Accessed: 3 September 2023).

Betterhelp (2023) BetterHelp – Get Started & Sign-Up Today. Available at: (Accessed: 3 September 2023).

Monique Hill


Monique is a Drama Therapist with a special interest in working online through video chat, email, and text. She is currently a PhD candidate at Wits University, where her research focuses on play, story, and embodiment in text-based drama therapy. She is also a consultant in the therapeutic gaming and Virtual Reality spaces, both of which she incorporates into her practice.