Table of Contents
Telehealth has become mainstream during the pandemic, but it seems like it is not a fad. In fact, many people have discovered the benefits of online therapy, such as flexibility, convenience, and affordability. Counseling via telehealth has also become a necessity for many individuals, whether they are struggling with stress and anxiety, financial difficulties, domestic violence, or many other issues. But the question is, how effective is online therapy?
How Does Online Therapy Work?
Traditionally, mental health services have been provided in person. People would schedule an appointment with their chosen specialist and go to their office for the session. Teletherapy, or online therapy, works in a similar fashion, but you meet with your specialist virtually via the Internet. Users can use their preferred device, including a laptop or mobile phone, to connect with their mental health specialist.
There are platforms, or websites, that typically offer a wide range of counseling services, such as Calmerry, where anyone can sign up, and complete a form that helps to find the right specialist automatically. Then, via the website, the user schedules appointments or chats with the specialist, based on the subscription they opt for. In other cases, platforms can be more targeted toward specific issues (such as Pride Counseling which offers online counseling to the LGBTQ community).
Just like in-person sessions, online therapists hold a variety of licenses, based on their area of specialization. In general, therapists can only provide services in the state where they are licensed, which solves accessibility issues for people who live in remote areas and may have to travel a long way to reach the nearby mental health care provider.
In the last few years, e-counseling has surged in popularity. For instance, in 2020, about 70% of all countries implemented teletherapy due to the pandemic, which prompted people to stay within their homes. To help people access such services, many sites like BetterHelp offer subscription plans for different budgets and include a varied number of sessions that can be conducted via phone calls, video calls, or even texting.
Types of Online Therapy
People can connect with their therapist in different ways, based on their budget, availability, and preference. This may also depend on the chosen mental health platform.
Online Text Therapy
Online text counseling essentially means that you can text (message) your mental health specialist. Usually, most platforms allow you to text them at any time (asynchronous messaging) and the specialist replies whenever they are available. Alternatively, online text counseling may also occur through a live chat.
Intuitively, this type of counseling is not highly effective if you have urgent issues in case of asynchronous messaging, as you may need to wait several hours for a reply from your specialist. However, if you go through a difficult time, sharing your emotions on the spot with your therapist could help you feel better and release the pressure exactly when you need it, without waiting for the next weekly session.
Unfortunately, in the case of text sessions, there are some clear disadvantages. The main one is miscommunication, as your therapist will not be able to pick up nonverbal cues; rather, they should be able to understand your emotions and feelings based on words, which can be misleading sometimes. Replying at a later time may also mean that users don’t receive the support they need when they need it.
Live chats could be better suited for some individuals, especially if they are not keen on face-to-face interaction because of subsequent problems, such as social anxiety. In general, text therapy comes in addition to other types of online counseling, such as video or phone call sessions.
Online Video Therapy
Video calling is one of the most common types and the experience is very similar to in-person sessions. Essentially, users purchase a subscription on the mental health platform with a specific number of sessions per month. Then, from the platform, they schedule the appointments at a time convenient for both themselves and the therapist.
Online video counseling is conducted via a secured connection in real-time, just like in-person meetings. This type of counseling is preferred by many individuals as it brings many benefits – such as saving time, as you don’t need to travel to the therapist’s office, flexibility, and comfort, since you can be at home or in any preferred location, as long as you have a device with a stable Internet connection. Also, since you can see and talk to your therapist directly, it’s easier to establish a personal connection with them, unlike texting.
A phone session is similar to video counseling and is preferred by people who are uncomfortable with face-to-face conversations. It may also be a replacement for video therapy if there is a poor connection that could interrupt a video session.
Online Group Therapy
Online group counseling is ideal for people who need support from other people who struggle with the same issues, such as addiction, domestic violence, and others. This type may be conducted via video sessions, phone sessions, or group chats. Typically, a licensed therapist conducts the sessions providing tips and support to the members who can share their experiences with other members.
Online therapy solves many issues for couples who want to see a specialist together but are unable due to scheduling issues or unavailability. There are many options available – you can both join a video or phone calling session together, or you join on a relationship-focused platform (such as ReGain) where you can invite your partner to make an account.
The main benefit is that your partner can join the session from another location and device. Also, you can opt for individual sessions with a therapist that will be all about your relationship.
Next, while there are some clear advantages to online therapy, there is still a lingering issue: is online therapy as effective as in-person therapy?
Is Online Therapy Effective?
While research is still in its infancy, there have been several studies looking at whether online therapy is effective and how effective it is compared to in-person counseling.
Research so far indicates that online therapy is effective, but it does have some caveats. On the good side, a study showed that it is just as effective as in-person counseling, especially when combined with clinical care.
On the bad side, many therapists are “people persons”, and they find that messaging with their patients makes it very difficult to establish a connection or a relationship with them. It also makes it nearly impossible to determine if the situation is critical – such as if the patient is suicidal – and provide life-saving help.
More research suggests that online counseling may actually be more effective than traditional therapy. This idea is based on the fact that broad accessibility reduces barriers to care. In other words, people who needed mental health support but were unable to access it because of their location, unavailability, or budget, can now find the right services via the Internet.
This paper is a review of 17 studies and concludes that online cognitive behavioral therapy (CBT) is more effective than face-to-face CBT for patients struggling with depression. Based on patients’ level of satisfaction, it was found that video conferences with mental health specialists were highly useful. Patients also reported that video therapy was more cost-effective than face-to-face CBT.
Another literature review supports the idea that online CBT helps with anxiety and depression, PTSD (post-traumatic stress disorder), phobia, and panic disorder. This study further confirms the effectiveness of online CBT for patients struggling with social anxiety, panic disorder, depression, OCD (obsessive-compulsive disorder), and even compulsive gambling disorder, along with improving the lives of patients in terms of stress levels and chronic fatigue symptoms.
Overall, early studies so far indicate that e-counseling can be just as effective as in-person traditional therapy. Video sessions are found to be the most efficient, while texting has less research to back up effectiveness – instead, text therapy is seen as an addition to therapy sessions, not a replacement. Phone sessions may be helpful for certain individuals, especially those who feel uneasy during face-to-face interactions.
Advantages of Online Therapy
There are robust advantages of e-counseling that help boost its effectiveness in treating multiple issues. Firstly, many individuals opt for this form of therapy due to increased convenience. As we live in a very fast-paced world, saving time on traveling to and from the specialist’s office is a great advantage for some people. This is even more helpful for people with mobility issues who cannot travel. Parents also find it easier since they do not need to plan for child care, while working professionals can schedule the appointments at convenient times for them, so they don’t need days off.
Secondly, safety has been one of the main catalysts when it comes to online therapy. During the lockdowns because of the COVID-19 pandemic, going to public spaces came with the risk of getting infected. Online therapy helped individuals see the specialist from the comfort and safety of their own homes. Also, some people may feel intimidated or vulnerable in an unfamiliar place, such as the specialist’s office, and being at home makes them feel safer and open up easier, especially if they struggle with mental health issues like agoraphobia or social anxiety.
A third benefit is the multiple options you have. When looking for in-person therapy, you need to seek a specialist in your area, which could limit your choice significantly. However, there are many online platforms with specialists licensed in all US states and many other countries, too. This means you are more likely to find a therapist who is specialized in the issue you’re having. An additional benefit of online therapy is that, if you’re unhappy with your therapist, you can usually change them with a few clicks and free of charge.
Next, online therapy is more flexible in terms of communication. Most platforms allow you to book weekly sessions, but you can also text your specialist 24/7 in between. This is a huge benefit as you can keep track of your progress (or lack thereof) and state your problems as they arise in real-time rather than wait for the weekly session. This is where text therapy is useful when used as an addition to video or phone sessions.
Some individuals still avoid mental health services because of social stigma – such as the fear of being recognized by someone they know when they are at the office. With online therapy, you can get the help you need while staying anonymous or contacting the specialist from the safety and privacy of your own home.
There are benefits for therapists, as well. For instance, they save time related to commuting to the office and there is no need to spend money on renting an office. Therapists can also complement their regular work hours with additional online sessions whenever they are available. Hence, this means being more productive and more relaxed while doing so.
Why Is Online Therapy Not Effective?
While online counseling seems highly beneficial, the truth is that it is not a universal solution for just about everyone. For example, it is not effective if your assigned therapist is not properly educated, trained, and licensed. As with any Internet-based service, falling prey to a disreputable provider or unqualified therapists is always a risk. People must check all credentials before deciding on a mental health services provider and picking a specialist.
This type of counseling is difficult to regulate since therapists can work from anywhere in the world, and there are no global standards for the scope of practice, education, and training. Hence, people need to carefully choose their platforms and specialists, and make sure they are regulated within their state.
If you choose the wrong type of e-counseling, it may not help you with your issues. For instance, text messaging alone has not been proven to be highly beneficial on its own – only when it is paired with video or phone sessions. Also, not all therapists may be good for such type of counseling – especially if they are “people persons” and if they need to establish a personal connection with their patients to understand their problems.
As e-counseling occurs via an Internet-enabled device, it may not be efficient if your internet connection is not stable. For instance, if you cannot stream movies online, most likely you won’t be able to have a video session with your therapist. Such technical issues can create frustration as they disrupt your experience.
Virtual sessions may also be marked by a loss of emotional connection and perceived empathy. This is because some body language signals can be lost, so you may not be able to feel your therapist’s empathy. This could be a real problem for people who are not so comfortable with technology or have difficulties using it.
Finally, but most importantly, e-counseling fails in the case of people with severe symptoms or those who need urgent care. In such cases, people need to access in-person medical services, but there are no proper guidelines or actions for therapists who encounter patients online who need urgent care.
Best Platforms for Online Therapy
If you’d like to know more about platforms for online therapy, here is a short list of some of the main providers in the US.
Calmerry is a relatively new platform, but it is one of the most cost-conscious ones. It offers both text and video therapy and they treat a wide range of issues, including emotional abuse, relationship problems, eating or sleep disorders, post-traumatic stress disorder, and many more. If you’d like to know more about Calmerry, you can check out this thorough review.
Talkspace is one of the first mental health platforms. Apart from being able to talk to a mental health therapist, the platform also provides psychiatry for an initial evaluation and even medication management, couples therapy, and teen therapy (for individuals between 13 and 17 years of age).
BetterHelp, with its sister companies ReGain (for couples) and Teen Counseling (for children), is also one of the most popular platforms right now. There are nearly 30,000 licensed therapists to choose from who cover a wide range of mental health issues and employ various therapies.
- Teen Counseling
Teen Counseling is a platform dedicated to teenagers. The platform requires the parent’s or guardian’s approval, but once the account is created, there will be separate chat rooms where the specialist discusses with the child and, separately and privately, with their parent.
Overall, online therapy is effective and more beneficial in some cases. Based on research, it is as efficient as in-person therapy – with some studies even finding it more efficient than traditional sessions.
There are robust advantages to it, such as convenience, flexibility, and affordability. People who opt for e-counseling make as much progress as those who opt for traditional in-person sessions. If you have a steady Internet connection and don’t mind using technology, you may find online therapy more convenient than in-person appointments.
However, online therapy is not for everyone. People who prefer to be in the same room as their therapist will not report the same benefits. For many therapists and patients, the experience of going to the therapist’s office is important. Also, teletherapy is not recommended for people struggling with severe symptoms or need urgent medical care.
Dr. Evelo's practice has focused extensively on gay, lesbian, and bisexual issues; feminist therapy; and trauma recovery. Other areas of practice have included depression; anxiety; grief and loss; EMDR; and couple therapyRead more