How does online therapy work?

There are many reasons why someone might be hesitant to go see a therapist in person. One possible solution is online therapy, also called teletherapy. Online therapy can be a great option, especially if:

• It’s hard for you to find time to go into a therapist’s office physically.
• You live in a small town, where there aren’t enough therapists or the closest one lives far away.
• You’re on your parents’ health insurance, and you’re covered for therapists back home but not where you currently live.
• You’re more comfortable using an app than going into an office to talk to a stranger in-person.
• You need more flexible hours than most therapy offices can provide.

Online therapy is still relatively new. Some insurance providers are hesitant to pay for it, saying that it isn’t as well-established as traditional, in-person therapy. But research is showing that online therapy can often be just as effective as traditional therapy [1], and more and more providers are starting to cover it.

Right now is a great time to start taking advantage of online therapy. The COVID-19 pandemic caused a huge shift in the online therapy world, pushing more therapists and insurance providers to support online options for therapy. Online therapy has become just as natural as in-person therapy, and for many people it feels more comfortable and convenient.

Things to be aware of

Online therapy can be a lot more convenient than traditional therapy, but it’s not perfect. Many of the challenges of traditional therapy still apply:

• It may take some time to find a therapist who’s a good fit.
• You’ll still have to open up about some potentially uncomfortable topics.
• You get what you put into it! You get the most from therapy when you stick with it and attend consistently, not just when it’s most convenient for you or you feel most comfortable.

It also introduces some new challenges:

• Therapists design their offices to be comfortable, peaceful spaces. They may have soothing fountains, pleasant music playing in the waiting room, or use calming essential oils. If nothing else, they are private. But when you get your therapy online, you’ll need to find your own peaceful space. If you have lots of clutter, or if you have roommates that might be able to overhear what you say, it might be harder to get comfortable and share.
• Therapy is all about communication. And there’s no perfect substitute for communicating in person. If you’re video chatting, you still get to see some body language and facial expressions. But if you’re doing a voice call without video, you miss out on that. And if you’re texting, you also miss out on each other’s tone of voice.
• Technology solves a lot of problems, but it also introduces new ones. You’ll need a decent Internet connection and a device that can handle the conversation without lag. Even then, there may be technical difficulties from time to time that are outside of your control.

Online therapy comes in a few different forms:

Traditional therapy, but online

This kind of online therapy is basically the same as regular therapy, except it happens online instead of in an office. Sessions are typically an hour long. They may take place weekly, or at whatever frequency you and your therapist decide on. In between sessions, you may have limited contact with your therapist through text messages and email. But often, you may need to wait until your next session unless you are in crisis.

This type of therapy is usually paid for with health insurance. First, call your insurance company to make sure they cover online therapy. (They may call it something like teletherapy or telehealth services.) Most insurance providers have a list of providers they cover. This list will often include information about which therapists do online sessions. Otherwise, you can go the other way around—use online search tools like HelpPro or Psychology Today to find someone who provides online therapy, and then check to see if they are covered under your insurance.

If you can’t find a therapist who’s covered by your insurance, you may be able to pay for the sessions out-of-pocket and then be reimbursed by your insurance company. If you don’t have insurance or your insurance doesn’t cover online therapy at all, most therapists will provide a discount on out-of-pocket payments.

Therapy apps

You may have seen advertisements for services like Talkspace and BetterHelp. Each of these apps works differently, but they usually provide some combination of the following:

• Matching you with the right therapist. The app will ask you for some information about yourself, and use it to find a therapist who will (hopefully) be a good fit for you. This takes some of the work out of finding a therapist in the first place.
• 24/7 access to therapy. Many apps allow you to talk to someone anytime, not just in scheduled weekly sessions. There’s a catch, though: you may only be able to do this through text messages, and it might not be with the same therapist every time.
• Regular therapy sessions. In addition to perks like the ones described above, most of these apps also give you access to more traditional therapy sessions. The frequency and length of the sessions will depend on the app and on your mental health needs.

Most of these apps use a subscription model. You might pay monthly, or per session. It’s typically cheaper than paying for traditional therapy sessions out-of-pocket—but more expensive than using insurance to pay for traditional therapy. Some insurance companies will cover subscription costs. And some employers provide access to these services as part of their health benefits.

Other online mental health services

Traditional therapy is great—but it’s not the only way to improve your mental health. Some of the other resources you can find online are:

• Online support groups, where you connect with peers who are struggling with similar issues.
• Mental health apps that provide services other than therapy—there are chatbots that help you work through your problems on your own, or apps that help you build healthy habits like meditation.
• Self-help resources that teach you mental health skills. Many of these teach you about concepts based on Cognitive-Behavioral Therapy (CBT). CBT focuses on learning to think differently about your thoughts and feelings and to change your self-destructive behaviors. Most therapists nowadays also use CBT.

Check out our list of DIY mental health tools and platforms that help you support your mental health by connecting with others.

References

1. Hedman, E., et al. (2014). Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness. Expert Review of Pharmacoeconomics & Outcomes Research, 12(6), pp. 745-764. Retrieved from https://doi.org/10.1586/erp.12.67