Does Cannibalizing Therapy Make Good Business Sense?

Cannibalization denotes a business practice that sounds ominous. It involves harvesting or salvaging part of a product to build another one. This may lead to a valuable new product, but an essential component from the original is missing in the new creation. Moreover, the original might ultimately be destroyed in the process of cannibalizing its parts for other purposes.

Psychotherapy is going through this process today. Businesses are now valued in the billions of dollars based on digitizing the technical elements of therapy. Similarly, coaches are adopting elements of therapy in their goal-focused work in both primary care and executive training programs. Coaches have no professional degrees but get paid to perform therapy-like interventions in various settings.

The digital therapeutics (DTx) industry promotes its value as being like therapy itself. Coaches deny providing therapy, but describe their work in precisely the same terms as the practice of therapy. If you believe the marketing, you are getting a perfect imitation.

However, the therapist is missing. Decades of psychotherapy research have solidified the simple notion that the person doing therapy matters far more to the outcome than the techniques being used. This inconvenient truth is buried in the enthusiasm for DTx products. Coaching gets a similar makeover. The advantages provided by a clinical education are obscured with lofty claims of coaching success.

Therapists are in a bind if they want to argue that the genuine article—psychotherapy—is the only product people should consider for help. The bind is created by the very research methods that have validated their worth. Live by the sword, die by the sword? Research studies on DTx products over the past several years show a level of clinical improvement that is comparable to psychotherapy.

This is reminiscent of the emergence of novel therapies like EMDR. It was initially decried as bogus, and it is now listed alongside other empirically supported treatments by professional organizations. While coaches may not measure their clinical outcomes, in all likelihood, some will achieve fine results. It gets back to the person. Some people have therapeutic qualities regardless of their education.

Should therapists surrender to cannibalization and acknowledge that products based on aspects of what they do may be just as valuable? Never. It is too early to clarify differences in therapy and DTx outcomes, but who believes digital therapeutic exercises are equivalent to talking with a smart, caring person? Are self-taught coaches really on par with people devoting years to study and training?

The success of products splintered off from therapy should not discourage people from pursuing a career in psychotherapy. However, these derivative products highlight the critical need for therapists to act like businesspeople. Therapy needs good marketing and strong leaders who preserve its unique qualities. Cannibalization happens in business, but it need not ruin the template for new products.

This does not imply preservation of the original product is always right or necessary. Consider another business case. Insurance products have varying degrees of profitability. Insurers often develop cheaper variants of highly profitable products, risking that people will no longer buy the more expensive or profitable products. In the end, such product changes produce winners and losers on all sides.

DTx and coaching are successful instances of cannibalization. Should behavioral healthcare companies use these offshoots? Many outpatient behavioral providers clearly see digital products as valuable treatment extenders. They see a role during waitlist periods, between sessions, and post-treatment. Is there a role for a product that replaces therapy? Who gains by replacing therapy?

Companies at financial risk for behavioral healthcare (e.g., health plans, health systems) are motivated to meet behavioral needs at lower cost since they often have tight budget goals to meet. While finances might justify driving access to digital tools or placing coaches in primary care, at some point one must question if this impacts healthcare results. Are we providing inferior care with these products?

Do you want a loved one who is suffering to only have access to digital tools? Do you want coaches thriving without training in the signs of depression or substance misuse? We need a precise measure of quality for lower cost products. While doing that, we might also require outcomes data for high-cost options. The day rapidly approaches when measurement-based care is no longer elective in our field.

Cost and quality are both important, and each should be transparent for every product sold. The ideal is having a cost-benefit calculation for every clinical option. How much quality can we expect for our fixed budget? What clinical results are likely for the amount we are prepared to invest? Most businesses answer such product questions today. Behavioral healthcare needs to function like them soon.

Ed Jones, PhD is currently with ERJ Consulting, LLC and previously served as president at ValueOptions and chief clinical officer at PacifiCare Behavioral Health.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.