Online Therapy: Is Virtual Care Right for You?
Teletherapy has exploded in popularity. This guide covers how it works, benefits and drawbacks, and how to find quality online care.
What Is Online Therapy?
Types of Online Therapy
Video therapy:
- Live video sessions via secure platform
- Most similar to in-person therapy
- See and hear your therapist in real-time
Phone therapy:
- Talk therapy over phone
- No video component
- Good if you lack privacy or prefer not being on camera
Text/messaging therapy:
- Exchange messages with therapist
- Asynchronous (not real-time usually)
- Write when convenient
- Therapist responds within timeframe
Chat therapy:
- Real-time text conversation
- Live but text-based
Benefits of Online Therapy
Accessibility
- Access care from anywhere
- No transportation needed
- Good for rural areas with few therapists
- Good for those with mobility issues
- Easier to fit into busy schedule
- No commute time
Convenience
- Attend from home, office, car
- More flexible scheduling
- Easier to find appointment times
- Can continue therapy when traveling
Privacy
- No one sees you going to therapist office
- Good for those concerned about stigma
- Attend from private space
Comfort
- Many people feel more comfortable at home
- Easier to open up in familiar environment
- Can have comfort items nearby
Cost
- Sometimes less expensive than in-person
- No transportation costs
- No childcare needed during session
Availability
- Access to therapists in other states (if licensed in your state)
- Larger pool of potential providers
- Easier to find specialized care
Drawbacks of Online Therapy
Technical Issues
- Internet connection problems
- Audio or video issues
- Platform glitches
- Disrupts flow of session
Reduced Non-Verbal Communication
- Harder to read body language on video
- Small screen limits what therapist can see
- Slight delay can affect natural conversation
- No non-verbal cues with text/phone
Privacy Concerns
- Need private space for session
- Others in home may overhear
- Technology security concerns
Not Appropriate for All Situations
- Active crisis or safety concerns
- Severe mental illness requiring intensive care
- Court-ordered evaluations (usually must be in-person)
- Some insurance does not cover
Connection Quality
- Some report therapeutic relationship not as strong online
- Harder to feel truly present with each other
- Some people prefer in-person connection
Distractions
- Home environment has more distractions
- Easier to be less engaged
- Harder to create therapeutic container
Online Therapy Platforms
Subscription Platforms
BetterHelp
- Largest platform
- 240-360/month for weekly sessions
- Text, video, phone, chat
- Match with therapist or choose your own
- Can switch therapists anytime
- Some insurance accepted
- Financial aid available
Talkspace
- Similar to BetterHelp
- 260-396/month
- Text, video, audio
- Psychiatry services available
- Some insurance accepted
Cerebral
- Focus on medication management
- 85-325/month
- Prescribers and therapists
- Good for anxiety, depression, ADHD
Brightside
- Depression and anxiety focused
- Psychiatry and therapy
- 95-299/month
- Insurance accepted
Session-Based Platforms
Teladoc, MDLive
- Pay per session or through insurance/employer
- Often included in health insurance
- Quick access
- Good for one-time consultations
Amwell
- Pay per session (~99)
- Psychiatry and therapy
- Some insurance
Traditional Therapists Offering Teletherapy
Many traditional therapists now offer video sessions.
- Use platforms like SimplePractice, Doxy.me, Zoom for Healthcare
- Same quality as in-person
- Usually covered by insurance if therapist is in-network
- Continuity of care if you already have therapist
Finding them: Psychology Today - filter for teletherapy
Choosing an Online Therapy Option
Consider Subscription Platforms If:
- You want low-cost option
- You like unlimited messaging
- You want flexibility to message anytime
- You prefer text communication
- You want easy access without managing appointments
Consider Traditional Therapist Offering Video If:
- You have insurance that covers it
- You want consistent therapist
- You prefer scheduled live sessions
- You need specialized care
- You want more traditional therapy structure
Consider Specialized Platforms If:
- You primarily need medication management (Cerebral, Brightside)
- You need quick access for one-time issue (Teladoc, MDLive)
- You have specific condition they specialize in
Is Online Therapy Effective?
The Research
Extensive research shows online therapy is as effective as in-person for many conditions.
Effective for:
- Depression
- Anxiety
- PTSD
- OCD
- Eating disorders
- Substance use
- Many other conditions
Satisfaction rates are high. Most clients report positive experience.
Making Online Therapy Work
Create Good Environment
- Find private, quiet space
- Use headphones for privacy
- Minimize distractions
- Good lighting for video
- Comfortable seating
- Have tissues, water nearby
Technical Preparation
- Test technology before first session
- Strong internet connection
- Charged device
- Backup plan if connection fails (phone number)
- Close unnecessary programs
Set Boundaries
- Tell others in home you need privacy
- Put phone on do not disturb
- Block off time before and after for transition
- Treat it like in-person appointment
Engage Fully
- Give full attention (do not multitask)
- Look at camera when speaking for eye contact
- Be present mentally and emotionally
- Take it as seriously as in-person session
Questions to Ask Online Therapist
- What platform do we use? Is it HIPAA compliant?
- What happens if technology fails during session?
- Can I contact you between sessions? How?
- Are you licensed in my state?
- What is your experience with online therapy?
- How do you handle crisis situations remotely?
- Do you offer phone sessions as backup?
Licensing and Legal Issues
Therapist Must Be Licensed in Your State
Rules:
- Therapist must hold license in state where you are physically located during session
- Some states have compacts allowing cross-state practice
- Always verify therapist is properly licensed
HIPAA Compliance
Platforms must be HIPAA compliant to protect privacy.
Acceptable platforms:
- SimplePractice
- Doxy.me
- Zoom for Healthcare
- VSee
- Thera-LINK
NOT acceptable:
- Regular Zoom, Skype, FaceTime (not HIPAA compliant)
Insurance Coverage
Most Insurance Now Covers Teletherapy
- COVID-19 expanded coverage significantly
- Many states require parity (same coverage as in-person)
- Check with your insurance
- Usually same copay as in-person
Subscription Platforms and Insurance
- BetterHelp, Talkspace now accept some insurance
- May still be cheaper to use insurance with traditional therapist
- Some platforms provide superbill for reimbursement
When to Choose In-Person Instead
In-person may be better if:
- You have severe mental illness requiring intensive treatment
- You are in active crisis
- You need physical presence for safety
- You strongly prefer face-to-face connection
- You lack private space for online sessions
- You do not have reliable internet
- Your therapist recommends in-person for your situation
Hybrid Approach
Many people benefit from combination:
- In-person for some sessions, online for others
- Start in-person to build relationship, then move online
- Online when convenient, in-person when need more support
Ask your therapist if they offer flexibility.
Bottom Line
Online therapy is legitimate, effective treatment. For many people it is more accessible and convenient than in-person. Quality of therapist matters more than format.
If online therapy allows you to access care you otherwise could not, it is excellent option.