Several of the apps evaluated are subscription or freemium products that depend on users returning. This creates a structural conflict of interest: The business succeeds when users stay engaged, but good mental health care succeeds when users get better and need less support.
This structural conflict is the most fundamental critique of the entire category — not a product flaw but a business model flaw. Successful mental health treatment produces clients who no longer need the product. Gamification mechanics (streaks, coins, follow-up questions) are retention tools that optimize for the opposite outcome. As long as revenue depends on engagement, these apps face an inherent incentive to keep users symptomatic enough to return.