1 Site-Visit Interview Paper: Francis Lopez LMHC Nicolle Baraque School of Education, Leadership, and Human Development, Barry University CSL 501:

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Site-Visit Interview Paper: Francis Lopez LMHC

Nicolle Baraque

School of Education, Leadership, and Human Development, Barry University

CSL 501: Orientation to Counseling Profession

Dr. Yahyahan Aras

February 1st, 2024

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After weeks of calling and researching counseling centers near me, I could not reach

anyone available to me for a site visit or interview in the weeks leading up to this assignment.

Finally, I found Ms. Francis Lopez through LinkedIn and she was more than happy to help with

this assignment. Ms. Lopez is located in Davenport, FL, is a licensed mental health counselor as

well as a certified behavior analyst, and works for the online telehealth company, BetterHelp (F.

Lopez, personal communication, February 9, 2024). The purpose of her work at Betterhelp is to

provide clients with trauma resolution, traumatic incident reduction, and to lessen symptoms of

anxiety and depression in adults. Francis provides individual therapy sessions, but some other

services offered at BetterHelp include family therapy, cognitive behavioral therapy, interpersonal

psychotherapy, talk therapy, couples therapy, eating disorder therapy, and so much more

(BetterHelp, n.d.).

Betterhelp was started in Delaware on October 24th, 2012 by two gentlemen by the

names of Alon Matas and Danny Bragonier and was originally known by the name of Compile

Inc (Loeb, 2020). Matas had the idea of online therapy while he was trying to operate a separate

startup and became so overwhelmed by it that he decided to seek help but could not find

therapists available to fit his busy schedule. During his search for a counselor who would meet

his needs, he stumbled upon statistics that stated that 25% of people in the United States need

mental health counseling but are unable to receive it due to the price, the stigma, the

inconvenience of actually going, and the stress and overwhelming factors involved in showing up

to a session; parking, what to wear, awkwardness in meeting someone new, being in a waiting

room full of other strangers, etc (Loeb, 2020). After Matas sold the startup that originally pushed

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him into searching for mental health support, he knew exactly the next step of entrepreneurship

he wanted to take (Loeb, 2020).

Matas decided to introduce his concept of BetterHelp at the Silicone Valley Health

meetup where he came across a tech center called Plug and Play (Loeb, 2020). Plug and Play

provides venture capital investment services and connects large corporations to the world’s best

startups. By 2014, BetterHelp presented at another Silicone Valley Health event sponsored by

Plug and Play. By this point, BetterHelp was offering e-counseling through email which users

voted to be a preferred method of contact, and had more than 80 counselors providing therapy

online and more than 500 weekly users receiving online therapy (Loeb, 2020). One year later, in

2015, BetterHelp was bought out by a telehealth service called Teledoc for $3.5 million cash and

a $1 million promissory note. By 2016, BetterHelp had over one million user sign-ups. As of

2018, BetterHelp has had over $60 million in annual revenue, and app downloads have increased

60% from January 2020 only to April 2020 (Loeb, 2020).

After speaking to Francis on the phone for some time, she told me that her intended

clients are adults and those who are dealing with trauma, anxiety, and depression and they’re not

exactly referred to the program by anyone but clients sign up on their own, rather (F. Lopez,

personal communication, February 9, 2024). After asking Francis about her caseloads, she said

that she doesn’t like to take on a large number of clients at once because it takes away from the

quality of care she can provide for each one. According to Francis, she handles about five clients

per week which is considered part-time. In contrast, her colleagues handle about three to four

clients daily.

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As far as staffing of the program, Francis tells me that anyone can sign up to be a

counselor on BetterHelp’s online therapy website (F. Lopez, personal communication, February

9, 2024). All the company founders check for are credentials such as Ph.D., PsyD, LMFT,

LCSW, LMSW, or LPC, as well as formal education and training as upheld by CACREP

standards (BetterHelp, n.d.). After this is all verified, a quick interview between BetterHelp and

the prospective counselor is held and then the counselor is all set to start taking clients (F. Lopez,

personal communication, February 9, 2024).

Next, I asked Francis for a background on her training and experience as an LMHC. She

told me that she received her Master of Science in Counselor Education from Florida

International University and completed her post-grad internship at the Trauma Resolution Center

in Miami, FL (F. Lopez, personal communication, February 9, 2024). During this internship,

Francis learned about and also had hands-on experiences with traumatic incident reduction,

trauma bonding, domestic violence cases, the effects of trauma, and cycles of violence. Before

BetterHelp, Francis told me she used to expedite bio-psychosocial assessments and treatments

through methods of cognitive behavioral therapy and motivational interviewing. She is also a

board-certified behavior analyst and has experience supervising potential board-certified behavior

analysts as well (F. Lopez, personal communication, February 9, 2024).

Some programmatic and administrative measures BetterHelp has include enforcing

HIPAA compliance, notes taking sections within the BetterHelp system, strict security and

spyware website measures, and mindful assignments assigned to clients that can be completed

right within the website (F. Lopez, personal communication, February 9, 2024). Another

programmatic and administrative feature Francis mentioned about BetterHelp is that the system

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is adamant about replying to clients’ messages. If a counselor goes more than 24 hours without

replying to a client on the system, their account is automatically suspended and the therapist

must reach out to BetterHelp’s tech support to regain access to their account. This system feature

also falls under accountability. The website holds you accountable for making sure your clients

hear from you when they need you the most. Another accountability feature the program has for

their therapists is liability insurance. Since, sessions cannot be recorded or monitored due to

HIPAA, liability insurance is set in place should anything illegal or tragic happen. According to

Francis, BetterHelp therapists do not have any supervision whatsoever but instead, rely on the

feedback and surveys they send out and receive from clients on their progress and about their

specific counselor (F. Lopez, personal communication, February 9, 2024).

BetterHelp’s mission statement is “To make professional therapy accessible, affordable,

and convenient- so anyone who struggles with life’s challenges can get help, anytime, and

anywhere (Social Impact n.d.).” BetterHelp supports its mission by making efforts to make

therapy equitable and accessible to underfunded communities and persons in need. BetterHelp

aims to reduce the stigma and provide support during crisis’(Social impact n.d.). According to

their website, BetterHelp has given $65,697,925 in financial aid for counseling costs to

low-income persons, 95,647 months of free counseling to communities in need, and free therapy

to Ukranians impacted by the crisis, individuals impacted by Hurricane Ian in Florida, the

LGBTQ+ community impacted by the Club Q shooting in Colorado Springs, and numerous other

communities and individuals in need of low-cost therapy (Social impact n.d.). These are all ways

that BetterHelp supports their mission and vision.

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According to Francis, BetterHelp does not follow any treatment plan or model in

particular (F. Lopez, personal communication, February 9, 2024). Each therapist is allowed to

and given the freedom to set their treatment plan. According to Francis, she likes this because she

believes no two individuals are alike and setting everyone up on the same treatment would be

ineffective. She believes custom attention and treatment to each individual is the best way to

assist them in their needs and she likes that BetterHelp gives her the freedom to do so (F. Lopez,

personal communication, February 9, 2024).

BetterHelp receives operating revenues through insurance, clients that pay out of pocket

per therapy session, and clients that pay a monthly rate to use the website (F. Lopez, personal

communication, February 9, 2024). The funding sources are reasonably stable because

BetterHelp has over 2.5 million customers as of January 29th, 2024 (Erban, 2024). According to

BetterHelp’s website, online therapy could be less expensive than in-person therapy because the

therapist does not need to rent out office space, hire employees, neither the therapist nor clients

need to pay for gas or a vehicle to attend their sessions, etc (Erban, 2024). Traditional therapy

sessions go for about $100-$200 a session, while on BetterHelp, the weekly cost of a

subscription is $65 per week but the website takes your credit card info and bills you for the

entire month. If one cannot afford this price, BetterHelp does have a section for those struggling

with affording therapy to fill out and see if they qualify for financial aid (Erban, 2024).

When I asked Francis if there was anything about the program she would like to change

she mentioned that she was very happy with BetterHelp and the only thing she wanted to change

was the pay. Although I did not ask how much she earns as a counselor on BetterHelp, after

some research, I learned that a counselor working full-time for BetterHelp can earn up to

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$100,000 a year, while someone working part-time will only earn up to $40,000 a year (Jelinek,

2024).

Although BetterHelp does not directly associate with any other sites or programs within

the community, they do their part in public relations through advertising and marketing (Jelinek,

2024). BetterHelp advertises on podcasts, commercials, radio stations, and billboards (Jelinek,

2024). Therapists are also permitted to host group sessions in cases where various clients are

experiencing the same traumas (F. Lopez, personal communication, February 9, 2024).

Therapists might put them all together so that they can relate to each other and feel less alone in

their situations.

According to the peer-reviewed article regarding the relationship between therapeutic

alliance and the quality of care in patients with advanced cancer in Spain, one can conclude that

those who felt they had a good therapeutic alliance had more successful treatment outcomes and

better overall satisfaction of the care they received (Velasco-Durántez et al., 2023). This goes

hand in hand with what was learned in module two regarding the outcomes of the therapeutic

alliance. The material in module two states that there is research to support that the relationship

between counselor and client is vital to the outcome and success of a client’s treatment. This

information does not only go for those being treated for mental illnesses but for those with

physical ailments such as cancer, as the article research demonstrates (Velasco-Durántez et al.,

2023).

According to the peer-reviewed article regarding the use of Child-Centered Play Therapy,

CCPT allows children to explore problems relating to culture, human development, experiential

issues, and traumas through a familiar outlet for children such as play (Davis & Pereira, 2014).

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Some examples of this include using safe toys, scary toys, aggressive toys, expressive toys, and

imaginary toys to express themselves more comfortably and familiarly (Davis & Pereira, 2014).

This is very similar to what was learned in module 3 about creative approaches to counseling.

While the methods mentioned (music, journaling, visual arts, bibliotherapy) were more geared

towards adults of all ages, it makes sense that children experiencing trauma or mental issues

can’t follow these same methods that are centered around the adult brain, but the concepts are

similar and work to achieve the same goal; help the client work through their traumas or mental

issues through fun, safe, and familiar environments and tasks.

The peer-reviewed article by Tannous Haddad & Shechtman aims to display how movie

therapy in school-based group counseling has more favorable results than those who did not

attend any kind of counseling at all. Research shows that group counseling is effective but

convincing adolescents to attend such counseling is not easy, which is why movie therapy was

implemented (Tannous Haddad & Shechtman, 2019). This allows young adults to enter the

setting of group counseling and experience the intended effects that they are not alone in the way

they feel by being with other adolescents of their similar age group with similar traumas or

feelings (Tannous Haddad & Shechtman, 2019). When the results of the therapy were compared

to the control group (no treatment at all), those who attended movie-based group counseling and

those who attended just regular group counseling without movie therapy, had more favorable

results (Tannous Haddad & Shechtman, 2019). These concepts are similar to what we learned in

module 3 about group counseling. While attending individual counseling might be intimidating,

group counseling is a way to slowly enter the field of potentially being able to work through

one’s problems through therapy and counseling.

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References

BetterHelp. (n.d.-a). Best affordable online therapy. effective counseling services.

Davis, E. S., & Pereira, J. K. (2014). Child-centered play therapy: A creative approach to

culturally competent counseling. Journal of Creativity in Mental Health, 9(2), 262–274.

Erban, E. (2024, January 30). How much does BetterHelp online therapy cost? BetterHelp.

Jelinek, J. (2024, January 29). 2024 better help review: Our experience and more. Medical News

Today.

Loeb, S. (2020, November 11). When Betterhelp was young: The early years. VatorNews.

Social impact. BetterHelp. (n.d.-b).

Tannous Haddad, L., & Shechtman, Z. (2019). Movies as a therapeutic technique in

school‐based counseling groups to reduce parent–adolescent conflict. Journal of

Counseling & Development, 97(3), 306–316.

Velasco-Durántez, V., Mihic-Góngora, L., Coca-Membribes, S., Galán-Moral, R.,

Fernández-Montes, A., Castillo-Trujillo, O. A., Sorribes, E., Quilez, A., Puntí-Brun, L.,

Jiménez-Fonseca, P., & Calderon, C. (2023). The relationship between Therapeutic

Alliance and quality of care in patients with advanced cancer in Spain. Current Oncology,

30(4), 3580–3589.

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