Report

Executive Summary

This report presents the outcomes of a UX research project that aimed at improving trust in psychotherapy. Psychotherapy, which is also called “talk therapy” is a mental health treatment that helps people identify and change unhealthy thought patterns, emotions, and behaviors.

From the research in HCID 695, multiple therapists mentioned that trust plays a critical role in helping clients to open up, which makes it easier for therapists to understand, interfere, and suggest changes. Crits-Christoph et al., (2019) concluded that trust helps to foster a good relationship between therapists and clients, which is important in patient improvement. However, it takes time to build trust, given many options of therapists, clients might have a hard time choosing one that fits with them. Whether the way therapists present themselves contributes to trust remains unknown. On the other hand, if therapists show that they care about clients by listening and understanding them, trust can be built and strengthened. Although it takes time to build trust, according to therapists, clients can evaluate whether they trust a therapist by interacting more with them. This can apply similarly to therapists as well when they want to see if they can help certain clients or have to turn them away.

Relying on the insight that clients are more likely to find a trustworthy therapist through more initial consultation and interaction before commitment, a mobile application was designed to serve this purpose of enabling the interaction of therapists and clients at the initial stage. Through ideation, I came up with an idea of developing a mobile application to help connect clients with therapists through matching and getting to know therapists. Any user or therapist can sign up for this application. After more cognitive prototype testing was done, the design is being revised and updated to reflect human centered aspects.

Research Insights

Psychotherapy practice highlights the importance of having a strong relationship between therapist and clients, otherwise, it would not work. From the point a client thinks of therapy, they are hoping to make changes in their lives. However, they want to feel heard and be understood for what they have been through to take any action. A therapist reported that when she asked one of her clients why the client chose to work with her, the client said that “because you are like my black nanny”. In reality, to find someone you can trust just by reading through profiles and one or two interactions like what Growtherapy and PsychologyToday.com provide is challenging. Not to mention, this barrier can deepen the hesitation of clients to begin therapy. Another therapist provided an insight that clients sometimes come to her and try to make a decision immediately of whether they want to do therapy with her, nevertheless, that might not be the best practice. She recommended her clients to talk to other therapists and even think through who is a good fit for the clients. Once therapy is initiated, it requires a commitment from clients regarding how many sessions they need and how that will work out for them to meet up with the therapist. If this commitment is interfered with by the fact that clients do not see a good fit in the therapist, it can affect clients in a negative way. Therefore, as much as clients would like to feel comfortable with the therapist, they need to invest time and effort in getting to know the therapist beforehand. Moreover, the initial consultations are also opportunities for therapists to evaluate a client’s situation and see whether they are capable of helping clients. One therapist shared that “my client came to me and asked me to create a document to approve their divorce, which is completely out of my expertise”. How might we empower therapists and clients to interact with each other more before clients make a decision of which therapist to work with?

Ideation

There are many ways to motivate clients and therapists to interact with each other more before therapy.

One idea was to let clients freely describe how they want a therapist to be. It could be under chat format and Artificial Intelligence (AI) supported to ensure that the AI can verify the client’s need before suggesting a therapist. The outstanding benefit of these ideas is that clients can talk to the AI like a trusted friend to get recommendations. However, without a solid training model, this AI might not be capable of analyzing the input and giving qualified therapists. How therapy works is left unknown and mysterious, therefore, this idea does not seem feasible. Moreover, due to the concern of the training model, this idea, if being implemented , might leave some doubts to clients.

Conceptually what if we create a space for clients to experience more initial consultation. The point is to empower them to talk to therapists without having to worry about payment or commitment. On Psychotherapytoday.com, some therapists display on their profiles that they offer 15 minute to 1 hour free consultation. Therefore, it is not something novel but something that should be welcome and encouraged. A therapist shared that when she offers clients over 1 hour of consultation, they appreciate her generosity and are more likely to go with her service.

Last but not least, for guided decision making, perhaps, we can break down the steps for clients to follow through. For instance, clients need to talk to therapists before deciding. Not only that, clients are suggested to talk to many therapists until they find a good fit. What is defined as a good fit can be reflected through how they feel after talking to therapists, whether they find it comfortable to continue talking to this person.

To narrow down, it would make sense to have a mobile application that connects therapists and clients together, and through that platform, enabling them to interact more before starting therapy.

The application focuses on matching the right therapist based on clients’ preferences which include therapist’s culture, gender, religion experience, relationship experience, sexual orientation experience, mental disorder experience, location, and cost per session. It also gives clients the opportunities to talk to therapists immediately or to schedule sessions based on their availability. Most importantly, with the acceptance of therapists, these sessions can be free until clients decide to start therapy.

After ideation and prototyping, there were three rounds of testing being done to collect users feedback on the prototype. In general, users support the idea of the application as well as the color scheme of the prototype. There were several concerns regarding legal compliance and user data privacy. The user experience was designed with clients being the central. All functionalities are targeted to bring in ease of use, clear workflow, and to attract users to provide information for their own benefits.

Persona

This application is aimed to serve both clients and therapists. Clients can use it for the purpose of looking for a therapist while therapists should register their profiles to promote their service. Specifically, these following are potential client and therapist who might use this product:

“Anni is 28 years old, working as a teacher at a local high school in the Bay area, California. Working with teenagers who do not follow her lectures can be dreadful sometimes. She also has some issues with family and personal relationships. She is desperate to have someone to listen and provide her insights of overcoming challenges in her busy life. Her friends suggested she try therapy while she is quite reluctant to do it. She has perceived that therapy is expensive and can be a waste of money, she was not sure whether it is worth it. Plus, no one would probably understand her that quickly in a short amount of time.”

“Michael is 42 years old, having obtained a therapy license for 2 years. He specializes in family and relationships. He is working for a therapy group in San Jose. Although the job fits with his qualities, he is eager to gain more experience and to make his name known in the field. Having an online platform where he can advertise himself and help clients would be ideal for him.”

Testing Methodology

Due to time constraints, only a cognitive walkthrough method was used to test the prototype. Participants were invited to join a Zoom call or in person session where they were shown the design on figma and in presenting mode. I played a role as a moderator who explained how each functionality is meant to use and observe their reaction as well as answer their questions. These participants include 2 therapists and 5 clients. Some of them already participated in 659 HCID research so they were familiar with the project.

Feedback

Feedback from low-fi design

The first prototype was done with three main functionalities: the ability for clients to create profiles, swiping to find therapists, and the ability to join a virtual room to talk to therapists or schedule an initial consultation.

Client’s flow

For creating a profile, clients are asked to input some personal information such as their name, location, insurance, and why they need therapy. Besides, they are expected to fill in their email, phone number, ethnicity, education level, and introduction. This information will be used to fetch a matching algorithm. However, a potential user pointed out that by doing this, I am making an assumption about the client’s expectation of a therapist, which can be misleading if the application does not inform users how the data is being used. In the meantime, clients might hesitate to provide personal information without a clear purpose. There was also feedback regarding how it is not clear which input field is required and which one is optional.

Regarding the question about the need for therapy, one therapist gave feedback that the language written in the input label and description should be more conversation based to generate a feeling of welcoming to clients.

• “Some people don’t even know what their symptoms are about, instead we should ask ‘what makes you want to talk to a therapist today?’”
• “To create trust, the questions should be open ended, conversation based, and qualitative instead of checkboxes”
• “Can I go back and change the need for therapy after creating profile?”
• “Should ask clients their preferred method of contact?”
• “I would not assume that people know that these information are for matching purposes. I would ask which information is important for them when it comes to seeking for a therapist”
• “I want to know what the app uses these information for?”
• “No need to say ‘Your ..’, it’s redundant”
• “I might not want to share my phone number, some fields should be optional”
• “Ethnicity: determined by power, not culture => instead, should ask “with what cultural group do you like to identify them about?” => conversation (where is your great grandfather from)
• “Which is optional question?”
• “there should be an option to to share privately, “this information is only for matching purpose”, phone number and email are not revealed to the public”
• “Religion or marital status can be what people care about at a therapist as well”

As for how users find their partners on dating apps, that feature is adopted for this application to allow users to select therapists. Swiping left on a profile means users want to pass while swiping right implies that they are interested and would like to proceed. This functionality not only empowers users to choose but also creates excitement throughout the process. However, when being applied in the context of therapy, it did not receive good responses. Some participants commented that “swiping is too cheesy” or “what is the point of swiping?”. There is also a need to see many therapists at the same time for comparison, therefore, when users experience the feature, they have a concern of “what happens to the profiles that I swipe left? Could I visit them again in case I want to reach out to them”.

• “I want the ability to choose which therapist to work with”
• “too cheesy, I want to see all the profiles and glance through and read all of them, could be just picture and description and cost (how do I go back if I already swiped). Swiping is hard
• “do I have an option to revisit the therapist (like I want to talk to her again if she is available, what if she is not available right now)”

The virtual room functionality is introduced so that clients can reach out directly to therapists in a secure and monitored way. Instead of providing clients the therapist’s contact and of letting them contact the therapists by themselves, the application can detect when the therapist is available to provide the functionality and can help clients dial in with the therapist through phone. On the other hand, clients can also find a time on the therapist’s calendar to talk to them later. Both of these capabilities were well received by testing participants, except their concern about language and how much time they might need to wait to talk to therapists. The term “virtual room” might not be very user-friendly and participants suggested replacing it with “talk now” or something similar.

• “Only use language that your grandma can understand”
• “Virtual room term might be hard to understand, how do I know what it is?”
• “The pain point is that there might be 1000 people calling one therapist at the same time, how does the app handle this?”
• “There needs to be an indication that the therapist is available”
• “Are therapists available for virtual rooms? Is there a chat option? Either to interact or send messages?”
• “Being able to talk to the therapist is good. It gives you an idea whether you want to work with this person”

Therapist’s flow

Similar to clients, therapists are also asked to create their own profiles and populate information. Some inputs such as name, expertise, insurance, and whether they provide free initial consultation are required. Besides, for security and credibility, they are asked to upload their license and provide their phone number and email for verification.

• “It would be great to ask therapists: are there any patients that you love working with? Or any that you’d rather not working with? (Teenagers from 14–17). This can bring joy to screening process”
• “Not just insurance, should include HSA (health saving account)”
• “Just need license number, no need for license photo”
• “Check with therapist: Do you reduce your fee under any circumstances?”
• “Two initial consultation might be too much, should ask for one initial consultation and let therapists decide for how long. This will affect whether the clients choose them”

Furthermore, to inform clients about therapist’s availability, the application is designed to capture calendar and available times of the therapist. Therapists have options to import calendars from Outlook, Google, and Teams. The system should be intelligent enough to integrate with these platforms to synchronize user’s data. Overall, therapists are content with the flow, they pay more attention to the client’s flow than their own user experience. This indicates that clients seem to be the main persona of this application.

Last but not least, once a client decides to talk to a therapist, the therapist will receive a notification on their phone that directs them to the application and to accept or reject the request. This gives therapists control of whether they are available to work and whom they are working with.

In summary, most participants like the idea of the application and they do find the color theme as well as the user experience nice, trustworthy, and pleasant.

Feedback from mid-fi design

By listening to user feedback on the first iteration, some changes have been made to the design.

Client’s flow

Since therapists suggested using more user-friendly language, some questions such as “what makes you want to talk to a therapist today?” are turned from selection of available options into open-ended questions. Regarding client’s expectation on the therapist, the design now includes input fields to inquire culture, origin country, personality, marital status, and religion. Therefore, clients can understand the intention of questions and there will be more transparency of how data is being used.

• “There needs to be some matching based on location as well”
• “When I am down or depressed, my mind is blank and I don’t know what to type in”
• “Is this app only for individuals? Therapy is not only for individuals, also for kids or couple. Something to keep in mind”
• “Payment option should be part of the match (required only in setup): insurance, max amount they are okay to pay
• “Culture — is it not just ethnic background? Should this just be racial category like white culture? What does this mean? I don’t know what to type in”
• “Are they in a committed relationship? Is religion important to them? Are you gay/straight/tell you later?”
• “Therapists do not share religion, marital status => the question should be: what age group you have experience with, what marital group they have worked with, LGBT?”

Regarding matching, instead of having a swiping feature, a list of therapists is provided for users to scan through many therapists. If they are interested in any therapist, they can click on ‘View Profile’ to see the therapist’s introduction, experience, and cost per session. Users are also introduced to the ‘save’ functionality, in which they will get to store therapist’s profiles and revisit later. Additionally, the term “virtual room” is transformed to “Talk now”.

• “The second therapist looks white, perhaps even in the prototype, it should include other races as well so that it is diverse.”
• “Is there any indication that the therapist is available? The green dot is not obvious.”
• “Regarding the information about the therapist, it should be more personal such as where they locate, where they grew up, their interest, does she speak any other language?”
• “I like that i am not automatically matched like on BetterHelp, I want to know more information to make decision, before I share a deepest part of myself.”
• “Clarify that Talk now is free initial consult.”
• “Consult means therapists just answer, not giving advice. Consent, fee, risk and benefit, confidentiality, training need to be discussed before starting therapy”

There were no changes in the ‘talk now’ and booking functionalities. The overall structure is slightly adjusted because users only need to verify their profile before they can be connected to a therapist to talk to him or her for the first time. This makes it easy for users so that they do not have to invest too much into the initial setup.

Therapist’s flow

In the profile setup for therapists, license photo upload has been replaced by license number. There was also an additional question regarding what clients might be expecting to hear when they dial in to talk to a therapist but they are not available to pick up. This is designed to accommodate the situation of therapy in which some clients are in severe cases of emergencies that they need to know a response immediately. An option for Apple calendar is also added to accommodate users who use Apple products. For the purpose of matching, any information that therapists provide will be useful for the matching algorithm. A therapist suggested aggregating data from other sources such as Youtube and Quora where therapists usually exploit to practice their expertise and help the community. These data can give hints into therapists’ expertise and preference. After getting the data, we can apply supervised learning to train the model and generate insights. That seems to be an idea worth exploring.

• “Some therapists use their own software, maybe just ask for calendar link (not part of Google/Apple)”
• “Use AI and unstructured data for matching (data from their website and posts) => picture to clients Quora, youtube, => permission to use data”
• “Office: as long as they are in the same state (is it just virtual therapy). Therapists like to talk to anyone from anywhere as long as they are in the same state (more than a small area) => make it more appealing to therapists when it’s widely used”
• “Insurance should be a multi select/dropdown. Therapists are not willing to offer phone number (need to specify the purpose: will not be made for public, just for connecting with client)”

Feedback from hi-fi design

In the high fidelity design, there were only adjustments in client’s flow. The question regarding need for therapy was changed from open ended into prompted answers for users to select. After letting users fill in basic information, they will be asked directly what matters to them in looking for a therapist. Inputs for that section include many areas such as culture, gender, relationship experience, sexual orientation, religion understanding, mental disorder experience, family dynamics, and ideal image of a therapist. The rest of the flow remains the same as the mid fidelity design.

Future Considerations

There was feedback regarding having a chat feature and the concern of data privacy as well as legal compliance that need to be continued addressed. The chat functionality will allow users to have a different means of communicating with therapists other than talking. Not to mention, about compliance, it might be needed to collect the user’s consent before asking them to fill in information. Last but not least, this application is built mainly for users to look for a therapist, however, what if they want to continue therapy on this platform? How can the application support both client and therapist to schedule sessions and report progress there? These are good questions to continue thinking about.

In summary, the application has received positive responses from both therapists and clients. It is promising to proceed with implementation and continuous iteration through feedback. I personally want to send gratitude to Professor Richard Wirth for his discipline to guide me through the iteration process and I am deeply thankful for all Professors in HCID and at Harrisburg for providing me knowledge and helping me to complete the major.