Digital technology has transformed the way many people receive healthcare, including mental health therapy services. Online counseling, conducted using digital tools, has become a popular option for clients looking for affordable and convenient access to mental health services.
The most common tools for delivering online counseling services include email, text messages, online chat, video conferencing, and mobile apps. While online counseling may not be suitable for everyone, this guide explores the various kinds of online services, including their advantages and disadvantages compared to traditional in-person therapy.
What is Online Counseling?
Telehealth encompasses an array of applications that use digital communication technology to deliver healthcare services remotely. Online counseling, often referred to as teletherapy, online therapy, or virtual therapy, has emerged as one of the most widely-accepted uses of telehealth, providing a convenient alternative or supplement to traditional forms of in-person counseling.
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Patients who live in areas with limited access to mental health professionals, or those whose work or family responsibilities interfere with their ability to schedule in-person sessions, may find that online counseling offers a more affordable and convenient way to get the help they need.
The length of online teletherapy sessions depends on the patient's needs and the counselor's recommendations. While some clients prefer to communicate with counselors by email or text, others may opt for regularly scheduled video calls similar to traditional counseling sessions, typically requiring 45-60 minutes for each session.
Dawn Friedman, an Ohio-based licensed professional clinical counselor with supervision designation, suggests that the various forms of teletherapy can offer "a good fit for most candidates if they are comfortable with the technology around it." The basic technological requirements consist of a secure internet connection, access to a computer, laptop, or mobile phone, and a quiet and private space to talk with the therapist.
Is Online Counseling Effective?
Skilled licensed therapists can treat many mental health conditions as effectively online as in face-to-face sessions. Although some issues do not lend themselves to online forms of counseling, recent scientific studies provide evidence of the comparable effectiveness of online cognitive behavioral therapy, especially for the treatment of depression and social and generalized anxiety and panic disorders.
An experienced specialist in anxiety, trauma, and stress disorders, Michelle Paiva argues that online counseling works effectively for adults, while the treatment of children and adolescents may require in-person therapy. She also cautions that adults "in abusive, controlling situations do best with in-person sessions, for privacy purposes."
According to Amanda Villaveces, a licensed marriage and family therapist, online counseling is as effective as traditional in-person approaches, "with the exception of some modalities that are more complicated to practice across the telehealth platform," such as eye movement desensitization and reprocessing therapy or child-directed play therapy.
Other Types of Teletherapy
As teletherapy options continue to expand, patients may choose messaging therapy formats, such as email or texting, or counseling through phone or video apps. As Villaveces observes, "having multiple options for therapeutic delivery is only a plus,” given the variations among clients' personal circumstances and their comfort level with technology.
The popularity of email and texting as methods of communication has contributed to the acceptance of messaging therapy. This kind of affordable online therapy appeals to busy clients who prefer the convenience of communicating with a therapist at any time or place.
Synchronous online platforms, such as TalkSpace, enable patients and therapists to interact through texts, audio, and video in real time. While convenient, private, and relatively inexpensive compared to face-to-face sessions, messaging may not work for all. Individuals with seriously threatening mental, emotional, or behavioral conditions should seek in-person counseling.
Video conferencing allows counselors to observe facial expressions and physical responses not visible over phone or messaging platforms. Friedman stresses the importance of the visual cues available in video assessments: "A client’s body language and presentation has a lot to say about their mental health so, while phone can be an appropriate way to connect in an emergency or when it's the only means available, I feel it's best used in conjunction with video or in-person therapy."
However, the interactive technology used in video apps like Zoom, FaceTime, and Google Meet can make patients feel uncomfortable or exposed. Paiva finds phone sessions more productive than video conferencing, because clients may become distracted and uneasy by their displayed image: "[being] in front of a screen is very vulnerable....[patients] feel sometimes under a microscope."
Pros and Cons of Online Therapy
Online counseling expands access to mental healthcare services in a variety of convenient formats. Teletherapy provides options for individuals with physical disabilities affecting their mobility and for those without transportation. Flexible scheduling appeals to clients whose hectic lives make it difficult to arrange in-person appointments.
Some people avoid seeking mental health services because of the stigma associated with traditional therapy. Those who feel shy or uneasy in face-to-face sessions prefer the privacy and social space provided by teletherapy.
Virtual therapy offers much needed services to residents in rural areas or other locations with limited access to providers. Villaveces describes how online counseling can broaden access to mental health providers. "If you live in a smaller city or town, you may not want to run into your therapist at the grocery store, or can't find a therapist with the training you’re looking for."
The sense of anxiety and depression that grips many people as a result of the COVID-19 pandemic has increased the demand for mental health services and the need for socially distant healthcare formats. Online formats help meet this need by providing a safe alternative to face-to-face meetings.
Online counseling may not work for everyone. Individuals exhibiting symptoms of severe mental illness---those at risk to themselves or others---should seek intensive in-person therapy. Clients seeking help with addictions may benefit from more traditional counseling methods.
Some virtual formats may not be appropriate for treating conditions that require the therapist to assess specific physical behaviors, such as personal mannerisms or eye contact. While video conferencing may help therapists to read these visual cues, some clients may feel uncomfortable with the intimacy of video sessions.
Can You Use Insurance for Online Therapy?
In-person sessions typically cost about the same as teletherapy, although traditional therapists who maintain staffed offices may charge higher rates. Before the COVID-19 shutdown, most insurance providers limited telehealth coverage, including online counseling payments. However, the pandemic has amplified the demand for all kinds of telehealthcare services, not just virus-related treatment. Consequently, private insurance providers broadened their telehealth coverage and waived co-pays for many online counseling services.
The Centers for Medicare and Medicaid Services also expanded benefits to cover both online and in-person therapy, though the duration of the expanded insurance coverage remains uncertain. Friedman advises clients who intend to use their insurance for teletherapy to "contact their provider and make sure they have coverage."
Is Online Therapy Popular?
The widespread popularity of technology, in the form of laptops, notebooks, smart phones, and an array of interactive applications, has precipitated a revolution in how people receive mental health services and support. In addition to the access, convenience, and flexibility that virtual counseling offers clients, therapists also benefit from telehealth offerings. Counselors who provide online services can reduce their business and commuting expenses, take advantage of home office tax deductions, and expand their practice beyond its physical location.
Remote therapy has proven itself a safe and effective treatment option for the many individuals experiencing psychological stress during the COVID-19 pandemic. According to a recent survey of over 2000 clinicians conducted by the American Psychological Association, 76% have provided only remote services since the onset of the pandemic, primarily by mobile phone, telehealth platforms, and video conferencing apps. Another 16% responded that they have offered both online and in-person therapy.
Because remote delivery of mental health services has worked so well during the pandemic, clients and therapists express their willingness to continue online therapy even as social distancing restrictions ease. While Friedman maintains the importance of face-to-face sessions, she views the acceptance of online counseling as a positive trend. "Clients deserve more options and those who want online counseling should have a wide variety of talented clinicians from which to choose."
Preparing for Your Online Therapy Visit
Clients who benefit the most from online counseling take the time to prepare themselves and their environment, ensuring that the treatment method does not interfere with the therapy itself.
Before engaging in an online counseling session, perform a technology check-up. Technical difficulties, such as slow internet speed or software glitches, can interfere with the quality of the counseling experience. Make sure to use a password-protected high-speed network and a fully charged computer or mobile device. Close out any tabs or apps that might distract you, and test the therapy platform prior to the start of the session.
Concentration is key to a successful session. Clients should choose a quiet, well-lit space that offers privacy, preferably with a door that closes. Ask family members and roommates to avoid your space and ask them to limit external noise to a minimum.
Because sessions can last as long as 60 minutes, pay attention to your comfort level. Set up your devices so that you can easily operate them while seated on a comfortable chair. Keep tissues and a glass of water nearby but refrain from eating during the appointment.
Before the session begins, mute notifications on your phone or laptop, and refrain from answering calls or emails during the session. Clients using video conferencing for the first time may feel uncomfortable seeing themselves or their therapist up close; it may take time to accurately interpret information using both non-verbal and verbal cues.
Clients just beginning online counseling should fill out required documentation prior to the first session to save time. During the session, take notes to remind yourself about useful tools or questions posed by your therapist to review at the end of the appointment.
In-person and virtual therapy both offer effective treatment, revealing difficult emotions and rewarding insights. However, online counseling poses its own challenges. Whatever you intend to accomplish through virtual therapy, advance preparation will enhance the quality of your experience.