You’ve shifted your work meetings and Pilates class to a virtual setting, but what about your mental health care?
“The pandemic has accelerated our movement to telehealth, changing the face of mental health services,” says Marlene Maheu, PhD, a clinical psychologist and the executive director of the Telebehavioral Health Institute, an organization that trains mental health practitioners to provide safe and effective teletherapy. “Prior to the pandemic, most therapy was delivered in person, but telemedicine is becoming a more important component.”
Here’s a rundown of what you should know about online therapy before trying it.
What Is Online Therapy?
In a nutshell, online therapy — also known as e-therapy, e-counseling, teletherapy, or cyber-counseling — shifts mental health services out of a traditional office setting and into the virtual world.
Online therapy can include:
- Phone sessions
- Online chats and voice messaging
- Email and text sessions
Many apps can be used to track mood and symptoms, and to try therapy-inspired exercises, like monitoring thinking patterns.
Does Online Therapy Work?
Yes, online therapy, specifically connecting to a therapist via videoconferencing or even phone, can be appropriate and effective in many cases.
“Therapy is all about the relationship you have with your psychologist,” says Lynn Bufka, PhD, a licensed clinical psychologist and an associate chief of practice transformation at the American Psychological Association (APA), where she works on healthcare policy issues and improving mental health care delivery.
Many clinicians consider this one-on-one relationship to be essential for good therapy, and something that develops over time as a client continues to work with a provider, she says. “Typically that’s going to happen in real time, whether in an office [in person] or via telehealth.”
The lead author, Ashley Batastini, PhD, an assistant professor of counseling, educational psychology, and research at the University of Memphis in Tennessee, notes that her group analyzed research dating back to the late 1990s. The studies included patients being treated for a wide range of mental health conditions, such as depression, psychotic disorders, trauma, and eating disorders, among other issues. Studies included patients treated (virtually and in-person) in a variety of settings, such as private care, university clinics, outpatient centers, prisons, and hospitals.
There’s less evidence that therapy delivered via asynchronous communication (such as text messages or email) is as effective as talk therapy delivered in real-time between a patient and provider, one-on-one, Dr. Maheu says. Studies have not yet compared the effectiveness of therapy apps with one-on-one counseling in a way that proves they work just as well.
But the further away you get from traditional talk therapy delivered in a one-on-one setting in real-time with a therapist (either in an office or virtually), the more you should tread carefully, says Maheu.
Apps with chat- and text-based therapy, for example, should not replace traditional one-on-one talk therapy, she says. Mental health providers pick up on your facial expressions, tone of voice, hesitations, and pauses in conversation when they’re talking with you one-on-one (more so in person when you don’t have to worry about videoconferencing delays and other limitations). They can’t do that via chat or email.
“In-person is the gold standard. Second best is on camera. Third best is hearing your voice. Those are the mainstays,” Maheu says.
Bufka says there is room for apps in bettering your mental health, but they shouldn’t be used as a stand-alone.
“These tools can be a great supplement to integrate into your care and move therapy along faster,” she says.
How Can I Determine if the Option I’m Choosing Is Legit?
If you're ready to look at your online therapy options, here are a few tips that will help you determine ahead of time if a provider or platform is safe and qualified to meet your mental health needs.
If you’re going to do video counseling with a provider:
- Look for the clinician’s state license. If you’re shopping for a therapist who provides online therapy, make sure they’re appropriately credentialed. Therapists will list their license, designation (such as MD, PhD, LCSW, or MSW), training and areas of specialization prominently on their websites. You can check the licensing status of any mental health professional in your state through its licensing board. Start by visiting the Association of State and Provincial Psychology Boards.
- Consider a referral from your insurance provider. Your insurance company may have a list of online therapy providers included in your coverage. This will help ensure the providers are available to you and your coverage will apply, Maheu says.
- Be aware of who might be listening in. If you’re connecting to a therapy session via videoconferencing or telephone, pay attention to who else in your home, office, or wherever you’re connecting from may be able to listen in. This includes who might be able to listen in virtually. Aside from having stable, reliable internet, check that you’re on a secure network, meaning your network is encrypted and your Wi-Fi connection is password protected, Liz Morrison, LCSW, a New York City–based psychotherapist. If you’re working with a provider one-on-one, he or she may send you a link to join a session via Zoom or Microsoft Teams. If you’re connecting with a provider on a platform, you’ll typically convene on the platform, Maheu says.
If you want to use an online therapy app:
- Take stock of who was involved in the app’s development. Bufka says consumers should do their research and look up who was involved in the creation of a therapy app. IntelliCare, which provides a string of apps to treat symptoms of depression and anxiety, for example, was developed by researchers at Northwestern University in partnership with the NIH. Check that the app is backed by research, allows access to a licensed therapist if you need more support, and lists the credentials of the experts who helped developed it, Batastini says. Companies' claims that they’re supported by research can be misleading. When Harvard Medical School looked at mental health apps, for example, they found that while 64 percent of apps made claims about evidence that supported and inspired their app, only 1.4 percent applied that evidence in the development of the app.
- Use apps recommended by official authorities. Batastini says consumers can turn to trusted sources, such as the U.S. Department of Veterans Affairs, that provide their list of approved tools. She points to VA Mobile, which keeps a list of therapy-based apps the agency has signed off on. The?Depression Alliance also has a list of therapy apps, including Better Help, which provides therapy via chat-room messaging, live chat, phone, and videoconferencing.
How Much Does Online Therapy Cost?
The cost of online therapy varies. It may be cheaper than in-person therapy because providers may not have overhead costs (such as office space and maintenance), but this isn’t always the case. Online therapy apps range in price, too.
Morrison says her team has switched exclusively to phone therapy and videoconferencing since the pandemic, but her fees have stayed the same, at about $225 per session.
Bear in mind that the cost of therapy will depend on a number of factors, such as:
- Location Expect to pay higher fees if your therapist is practicing in cities with living costs like those in New York City or Los Angeles, compared with smaller towns in the same state, Morrison says. Keep in mind that some therapists offer sliding scales – fees based on clients' income, with lower fees for those who can’t afford the full rate.
- Experience Veteran therapists with extensive training or niche areas of specialization may charge more for counseling than their counterparts who just completed their licensing and are in the beginning stages of establishing their private practice.
- Platform If you’re working one-on-one with a therapist in private practice, you may encounter higher prices than with subscription services like BetterHelp or Talkspace.
How Do I Decide if Online Therapy Is Best for Me?
Choosing online therapy over in-person counseling is a matter of personal preference. Online therapy may better suit your lifestyle because of these factors:
- Accessibility If you’re in a rural or remote part of the state you live in, online therapy may widen the scope of therapists available to you, Bufka says. Even though you’re not meeting face-to-face, a virtual session can replicate the experience.
- Convenience Time saved commuting to a therapist’s office is a major perk for people leaning toward online counseling, Batastini says. For many people, online therapy may better fit into their schedules while they juggle professional and caregiver responsibilities, she says.
- Internet speed and familiarity with technology Because online therapy relies on a stable internet connection and use of technology to access services, you’ll want to make sure you feel comfortable using apps, videoconferencing, and other resources, Batastini says. “Think about your level of competency with technology and if you have family members who can help you if you have tech problems.”
- What type of environment makes you comfortable Morrison’s company specializes in providing CBT to children as young as 7 years old. She’s found that videoconferencing helps kids and their therapists connect — kids can show their therapist their bedroom, school projects, or other aspects of their home life and personality. But it’s up to you to decide if you prefer to talk to your therapist face-to-face instead of on a screen for an hour or more each week.
Editorial Sources and Fact-Checking
- A Growing Wave of Online Therapy. American Psychological Association. February 2017.
- Worsening Mental Health Crisis Pressures Psychologist Workforce. American Psychological Association. October 19, 2021.
- App Advisor — an American Psychiatric Association Initiative. American Psychiatric Association. 2022.
- Clay RA. Telehealth Proves Its Worth. American Psychological Association. January 1, 2022.
- Batastini A, Paprzycki P, Jones A, MacLean N. Are Videoconferenced Mental and Behavioral Health Services Just as Good as In-Person? A Meta-Analysis of a Fast-Growing Practice. Clinical Psychology Review. November 17, 2020.
- Varker T, Brand R, et al. Efficacy of Synchronous Telepsychology Interventions for People With Anxiety, Depression, PTSD, and Adjustment Disorder: A Rapid Evidence Assessment. Psychological Services. 2019.
- Turgoose D, Ashwick R, Murphy D. Systematic Review of Lessons Learned From Delivering Teletherapy to Veterans With PTSD. Journal of Telemedicine and Telecare. September 29, 2017.
- Reynolds DJ, Stiles WB, Bailer AJ, et al. Impact of Exchanges and Client-Therapist Alliance in Online-Text Psychotherapy. Cyberpsychology, Behavior and Social Networking. May 16, 2013.
- Wagner B, Horn AB, Maercker A. Internet-Based Versus Face-to-Face Cognitive Behavioral Intervention for Depression: A Randomized Controlled Non-Inferiority Trial. Journal of Effective Disorders. January 2014.
- Digital Therapy Apps: Good or Bad? National Alliance on Mental Illness. April 5, 2019.
- Larsen ME, Huckvale K, et al. Using Science to Sell Apps: Evaluation of Mental Health App Store Quality Claims. Nature. March 22, 2019.
- How Much Does Better Help Cost? Price of Better Help Therapy. BetterHelp. March 30, 2022.
- How Much Does Talkspace Cost? Talkspace. March 26, 2020.
- How Does Online Counseling Work? Chicago School of Professional Psychology. February 29, 2020.