Since the start of 2020, online therapy has become the “new normal,” with most therapists offering video or phone sessions, and even options to connect via chat and messaging. Early research shows that online therapy can be just as effective as in-person sessions, while also offering people the ability to receive therapy from the comfort of their own homes.1,2,3
What Is Online Therapy?
Online therapy, also referred to as teletherapy or e-therapy, allows people to connect with a therapist online who is licensed to practice in their state. Live video sessions are the most common form of online therapy, and the most similar to in-person sessions. Video sessions also have the most research to support their effectiveness. Live chats, emails and messages may also be a part of online therapy, although there is not enough evidence to prove they are effective as standalone treatments.2,4,5
How Does Online Therapy Work?
Online therapy offers people different ways to connect with a licensed therapist virtually through their computer, laptop, tablet, or other mobile device. In online therapy, clients can do live video sessions with their therapist, and may also have the option of connecting with their therapist through messaging, live chats, or phone calls.
Online therapy has allowed clients to broaden their options when finding a therapist, as most therapists are allowed to provide online therapy to anyone in their state. While most therapists offer online therapy through their individual or group practices, sites like Betterhelp and Talkspace provide weekly or monthly subscription options for online therapy.
What Are the Goals in Online Therapy?
The goals you have for therapy are up to you to determine. Most people come to counseling to get help with a specific problem, learn better ways to cope, or make a lifestyle change. It’s a good idea to prepare for your first session by having some goals in mind. In your first session, you and your therapist can work together to set goals for therapy and outline a plan for reaching these in future sessions.
Online Therapy vs. In-Person Therapy: Pros & Cons
Research is still “catching up” to the growing trend of online counseling. There is more research to support the benefits of specific types of online therapy, especially live video sessions, but less to support the effectiveness of live chats and messaging.2,4 Some research has shown messaging options can be effective additions to people who also receive other therapy via individual or group sessions, text message support, or phone calls with a therapist. 6,7
Still, even video sessions can have some pitfalls. Technological issues, lack of internet connection, and discomfort or inexperience with the technology can all reduce the effectiveness of online therapy.1,2,5,8 Also, online therapy may not meet the needs of all clients, especially those with more severe symptoms or who are in need of intensive support.5
Here are some of the pros and cons of online therapy:8,910
| Pros of online therapy | Cons of online therapy |
| More convenient and accessible option for some people | Technological issues or slow internet can disrupt sessions |
| Some clients feel more comfortable opening up in online sessions | Freezing or delays can lead to therapist talking over the client |
| Multiple ways to connect with a therapist (video, chat, etc.) | Some people feel like online sessions are less personal |
| Broader options to include any licensed therapist in the state | May not meet the needs of people with more severe issues |
| Most insurers have expanded coverage for online therapy | Necessary to have a quiet, private, space for sessions |
| Flexible scheduling for people with busy schedules | Sessions can be interrupted by children, pets, doorbells, etc. |
| May be more affordable than in-person sessions | Online sessions can be distracting for some people |
| Clients with social anxiety/phobias are less likely to no-show/cancel | Less tech savvy clients and therapists may have more issues |
| No risk of transmission of COVID-19 or other viruses | No/fewer options to transfer from online to in-person during the pandemic, should a client wish to do so |
| Lessens time wasted in commute and transitions | Adds to daily screen time at a point where many want to reduce it |
| Comfort factor of being able to do sessions from home | May be harder to pick up on nonverbal cues |
| Removes any transportation barriers | Can be difficult to engage younger children in online sessions |
| Can connect using any smartphone, tablet or online device | May be difficult to conduct family or couples sessions online |
| Files & videos can be shared and viewed together during session | Therapists who aren’t tech savvy may offer better in-person sessions |
How Do I Know Which Is Better for Me?
Ideally, people would be able to choose between doing sessions online or in-person, or even a combination of both, but options have become more limited during the pandemic. Most outpatient therapists are doing sessions online, but people who need higher levels of care (inpatient or residential) can still have access to in-person options.
How Do I Decide Between the Two?
People who need to choose between doing sessions online or in-person should consider the following factors:5,8,9
- Preference: Do you have a strong preference for either in-person or online sessions? If so, it may be important to narrow your search for therapists offering this option.
- Needs: Do you feel like your mental health issues are severe or that you need urgent or intensive support? If so, online therapy may not be able to meet all of your needs.
- Age & attention span: Are you looking for therapy for a younger child or teen? If so, it may be hard for them to engage in online therapy. The same is true for adults who struggle with short attention spans.
- Access: Do you know what your options are for local in-person therapy? If you live in a more rural or remote location, your options for in-person therapy may be limited, meaning you would have an easier time finding a therapist online.
- Risk of COVID-19: Are you or people you live with at high-risk for complications related to COVID-19? If so, it may be important to take certain precautions (vaccine, social distancing, masks, etc.) and confirming that a therapist who has also taken these precautions.
- Comfort with technology: Have you used Zoom, Webex, Google Meet or other video platforms before? If so, you are probably familiar with the technology, and may have an easier time adapting to online therapy.
- Internet speed: Is your internet fast enough to support online video sessions? You can run a speed test to find out. Most sources recommend a minimum speed of 10 Mbps of download and 1 Mbps of upload speed for each person working remotely in a house.
- Privacy: Do you have a private and quiet place in your home or office to do therapy sessions? If not, privacy issues could be a problem with online therapy.
- Costs: Does your insurance cover online sessions? Most insurance companies have expanded their coverage for online counseling, but it is still important to verify costs by checking the details of your insurance plan.
According to the research, freezing, delays, and other technological issues are one of the major pitfalls of online sessions.8 Poor connections can keep clients from being able to clearly communicate, build rapport, and get the help they need from their therapist. In order for online therapy to be effective, both the client and therapist need to feel comfortable with the technology and need a strong and reliable internet connection.1,2,5
What Can Online Therapy Help With?
According to research, online therapy has proven to help people with:1,2,6,7,10
- Depression and mood disorders
- Anxiety disorders
- Panic disorder
- Posttraumatic Stress Disorder
- Substance Use Disorders
- Smoking cessation
- Eating disorders
- Chronic pain
- Autism Spectrum Disorder
According to most research, people who receive online video sessions were just as satisfied as those who received in-person therapy, and made the same amount of progress.1,2,10 People who received text and message support benefitted when these were combined with other forms of support like individual or group sessions or skills training.4,6,7
Early studies on online therapy have shown promising results, but there are still a lot of gaps in the research. For instance, there is less research to support the effectiveness of online therapy for couples or family therapy sessions.10
Some types of mental health issues have less research to support the premise that online therapy is as effective as sessions that occur in-person.
Common Types of Online Therapy
There are a growing number of options for people who are interested in online therapy, allowing clients to connect with their therapist in a variety of ways.
Some of the options for online therapy include:8
Video sessions
Video sessions are the most common type of online therapy, and offer an experience most similar to in-person sessions. Using a secure video platform, therapists can conduct scheduled sessions with their clients and interact with them in real time. While many insurance companies have extended coverage for telehealth, it is still important to verify that the counselor or doctor is in-network, and that online sessions are covered by your plan.
Phone Sessions
A phone session is just a therapy session that occurs over the telephone instead of in an office or on a video call. Sites like Betterhelp offer this service, but so do many private therapists you can find on an online directory. People who feel uncomfortable with video calls may prefer phone sessions. Phone sessions can also be a good back-up option for times when there are technological issues or poor connections that interrupt a video session. Not all phone sessions are covered by insurance, so it is important to verify this ahead of time with your insurance company.
Messaging
This form of therapy allows clients to interact with a therapist similar to text-messaging or emailing, where people need to wait for a reply. This form of therapy is not usually covered by insurance, and has less evidence to support its effectiveness as a standalone treatment for mental health issues.2,4 Asynchronous messaging has some clear disadvantages when compared to phone, video, or in-person sessions.
Miscommunications are more likely to occur via text and email because a lack of nonverbal cues make it hard to interpret emotions and meaning.11 Also, the delay in response time might mean that some clients are not getting the support they need when they need it.
Live Chats
Live chats between a therapist and client are also an option offered by certain therapists, especially on subscription sites. There is some evidence that live chat therapy can help people struggling with depression, although most of these studies included other interventions as well. For instance, two studies found chat therapy was a helpful addition for depressed clients who also received other kinds of support, including phone sessions, activities sent to their mobile phone, and access to group therapy chats.6,7
Online Group Therapy
Group therapy is a good option for people looking to connect with a community of people who have a similar issue. Online group therapy may include live video sessions, phone sessions, or access to group chats or support forums. Group therapy is usually led by a licensed therapist who can act as a moderator for group members, leading discussions and topics and enforcing rules.
Group therapy is sometimes covered by insurance, but tends to be less expensive than individual sessions for people paying out-of-pocket.
Online Support Groups
Many support groups have been meeting virtually since the start of the pandemic. Most virtual groups use video calls, but some may also be held on live Youtube channels or through peer-to-peer chats. Support groups aren’t technically considered “therapy” because there is not usually a licensed therapist leading the group. Instead, people with similar problems (i.e. grief, divorce, addiction, pain) come together to share their experiences and provide support to each other.
Support groups are often free or operate off of voluntary donations.
Online Therapy Examples
Because there are so many different options for online therapy, your experience will vary depending on the type of therapy you receive, the style of your therapist, and the issue you are working on.
Here are some examples of what online therapy may be like:
Video Session
If you opt for video sessions, your therapist may send you a link via email or text to connect for the session at the time of your appointment. For your first session, you may need to install software or test your system to make sure everything is working. Once you connect, your therapy session would be similar to what you would expect in-person. Your therapist may use the time to talk about your symptoms, better understand your experiences, or teach you new coping skills.
Phone Session
If you do a session over the phone, your therapist will call you at the time of your scheduled appointment. Once connected, you could use the time to talk about your issues, discuss stressful situations, or learn new ways to cope. The downside to phone sessions is that you and your therapist can’t read each other’s non-verbal cues. Because this is a big part of how we communicate with clients to make sure their needs are being met, many therapists prefer video sessions.
Messaging
If your online therapy includes emails or messaging, you might send your therapist a message when something stressful happens or when you are experiencing symptoms. In your message, you might describe what’s going on and ask for tips on how to cope. Depending on the terms of your online therapy, it may take a day or so for your therapist to get back to you.
Online Couples Therapy
If you and your partner are seeing a therapist together, you will both show up for an online video session. If you are in the same place, you can sit in the room together for the session. If one of you is somewhere else, you can individually connect to the session. Sometimes, the therapist may want to meet briefly with you or your partner alone to discuss specific issues, so you may be asked to leave the session for a few minutes.
How Much Does Online Therapy Cost?
The cost of online therapy varies depending on where you live, which insurance you have, and the specific fees set by your therapist. Most therapists charge between $100-$200 for a 50-60 minute session. In an expensive city like Los Angeles or New York City, costs for in-person therapy can be as high as $250 or more per session.
One of the advantages of online therapy is that there is often a reduced rate for sessions.9 Many therapists have been able to bring their practices 100% virtual, reducing overhead and passing on these savings to clients. Many therapists will offer “sliding scales” or reduced fee options for people who can’t afford to pay their full rate. Even if a therapist doesn’t advertise sliding scale options, people who cannot afford to pay the full rate can still ask about reduced rate options.
At $60-90 per week, subscription sites used to be a more affordable option for online therapy, but most insurance companies have started to cover online therapy. People with insurance can often find an in-network therapist in a group or private practice, rather than paying for a subscription out of pocket.
How to Find an Online Therapist
When you are choosing a therapist, it is important to spend some time shopping around. Many people begin their search online by using a therapist directory, where you can search for a therapist who specializes in your concerns or your demographic. While it might seem strange to “interview” a therapist before scheduling an appointment, a quick phone call or meeting can be the best way to find someone who is a good match.
Most therapists will offer phone or video consults to new patients at no cost. During this 10-15 minute call, you can find out more about the therapist, their areas of specialty, and what style of therapy they use. Because you are more likely to benefit from therapy when you like and feel comfortable with your therapist, these consults can be very helpful.
What to Expect at Your First Appointment
If you decide to book an appointment, this is what you can expect:
- You will get an email with a link or attachment to allow you to fill out forms (most practices have electronic forms) including forms asking for personal information, signed consents, and insurance information.
- You may be asked to provide a credit or debit card number to hold your appointment, and may be charged a fee if you don’t cancel with appropriate notice (usually 24 or 48 hours).
- You will be sent instructions about how to connect for the scheduled appointment (i.e. a zoom link, phone number to call, login information for live chat, etc.).
- Your therapist will usually use the first session to ask you questions and get a lot of background information from you, including personal questions about your mental health, substance use, and childhood. You may receive a diagnosis at the end of the first appointment, which would be discussed with you.
- Your therapist may want to know your goals for therapy and will work with you in the first or second session to form a treatment plan. This plan will include how often you will meet, what you will work on, and some ideas about how to help you reach your goals.
- Depending on what you agreed on, you will either be charged by the therapist after the session for a self-pay rate, a copay, or subscription cost. If your session is covered by your insurance, you may not need to pay anything. Many therapists do their own billing, and will let you know if they need additional information or action from you.
Is Online Therapy Effective?
While the research is still catching up to our new digital age, early studies indicate that online therapy can be just as effective as in-person therapy. Video sessions are the gold standard for online therapy, and provide an experience most similar to live sessions, but phone sessions can also be helpful for some people. Messaging and chats have less research to back their effectiveness, and most institutions see these as helpful additions to treatment, instead of as a substitution for therapy sessions.1,2,4,5,6,7
Risks of Online Therapy
As with most online activities, there is always a risk of privacy breaches with online therapy. People who opt into online therapy should ask questions about what kind of platform their therapist uses and what measures they have in place to protect their personal information. While most video platforms have added additional security and encryption to their sites to avoid hacking and privacy breaches, there is never a 100% guarantee of privacy online.5
In addition to these risks, there are some ways in which online therapy may fall short of meeting the needs of certain clients, especially those with more severe symptoms. Some clients find it hard to navigate technology or feel less comfortable in online sessions, making it harder for them to open up. Also, technological issues like a poor or interrupted internet connection can provide disruptions, delays and lags that detract from the therapy session.8
Final Thoughts on Online Therapy
There is a lot we are still learning about the differences between online and in-person therapy. Still, the research that does exist suggests that in most cases, people who receive online video sessions are just as satisfied and engaged, and make just as much progress as those who choose in-person therapy.1,2,10 People who have a strong internet connection, are comfortable with technology, and have a private place for sessions often report benefits from online therapy.8
