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Online Therapy: What is it?


For the last century, talk therapy has risen as a prominent treatment method for an array of mental health concerns. With every home in the developed world being wired for internet service, talk therapy has been able to move out of the clinic and into the patient's very own living room.

You'll hear lots of names for online therapy: e-counseling, virtual therapy, digital therapy, remote counseling, and many more. Don't worry, these all refer to the same basic idea. You can meet with your therapist from anywhere, at any time, with a phone call or video conference.

But is this as effective as meeting your counselor in-person?

Online therapy is pretty new. While there isn't much consensus, some research is starting to show that virtual therapy can be just as effective as face-to-face meetings. On the other hand, ​some therapists believe​ the inherent risks of online therapy outweigh its rewards, however significant they may be.

The Benefits of Online Therapy

We've explored some of the greatest benefits online therapy has to offer… along with the most notable drawbacks. Here's what you need to know.

More Anonymity, Less Stigma If you've ever thought about going to therapy, you've worried about the concern that troubles every new patient. What if I can't trust my therapist?

In talk therapy, you can only get the help you need if you're brutally (and completely) honest with your counselor. You're placing your trust in the hands of a stranger. And, even the most qualified mental health care professional is still a human being. Don't we all make mistakes?

Privacy is a top priority in the talk therapy field. So much so, in fact, that the law forbids therapists from disclosing any information you share with them except in the most dire of circumstances. You can, and should, tell them everything there is to know about you. They're only required to reveal information if you indicate that you or another person is in immediate physical danger (especially if that other person is a child or disabled senior citizen).

In fact, even your insurance company is restricted to information regarding your appointment dates, times, and general diagnoses. If your therapist reveals details about conversations you've had in your sessions, this is a breach of confidentiality. (Kids under 18 – be aware that it can be legal for your counselor to involve your parents in your treatment. Check your state's laws for more details).

Can My Therapist Ever Talk About Me?

Your therapist can only legally reveal your sensitive information if they have convincing reason to believe you may put yourself at harm, or you may represent an immediate harm to others. This way, if someone is dangerous, they can be treated before their condition causes them to hurt somebody.

Additionally, your therapist may discuss your case with other licensed mental health professionals involved in your care.

Read every word carefully, there: “other licensed mental health professionals involved in your care.”

This means your counselor can seek guidance about your treatment from their supervisor or department chair. However, it also means they're barred from discussing your case with, say, their behavioral psychology students.

Only individuals who are actively involved in your treatment process can have access to your sensitive information. And, if your therapist does approach their manager to talk about your case, their manager is also bound by the same confidentiality rules.

Anonymity in Online Therapy

The online therapy environment gives you more anonymity than any traditional therapist's office ever could. The simple fact is when you're sitting in a waiting room, you're there for any of your therapist's patients to see as they come in and out.

When you meet online, you never leave the house. Nobody ever has to know that you're seeing a doctor. This is especially comforting for patients suffering stigmatized disorders like drug & alcohol abuse.

Online counseling has been so beneficial for recovering addicts of all types that there are entire communities of recovering substance users that exist solely online. ​SMART Recovery​, for example, is a leading volunteer-based online support group with weekly meetings, a 24/7 live chat, and message boards. Not only is anonymity a key feature, but it's encouraged; SMART Recovery recommends that its members keep their private lives separate from their activities in the program.

It's Easy to Find and Communicate with Therapists
With a quick Google search, you can find an expert in practically any field. This is especially beneficial when seeking out a therapist.

Mental health professionals are often highly specialized. Their scope of service will only cover so many issues. One therapist may specialize in family and parenting issues, while another may focus on anxiety and panic disorders.

Instead of rolling the dice and calling the first counselor you find in the yellow pages, you can read real reviews about different online counselors written by other patients. BetterHelp has a great user-friendly review section where you can learn more about the help that's out there.

With so many therapists available, it can be tricky to know who to pick. Fortunately, you're not committing. With online therapy, you can meet with a new therapist any time if you decide that your existing counselor isn't meeting your needs.

Making Contact With a New Counselor

Reaching out to a new care provider can be intimidating. Fortunately, with online therapy, you don't even have to make a phone call in most cases. You can break the ice with a simple email or direct message to let the counselor know you're looking for care.

A good therapist will make your feelings a priority. They'll reply in a way that's inviting, caring, and respectful of your boundaries. If a new counselor seems pushy or asks you for too much up front, don't hesitate to explore other options. Be respectful of your counselor's time, but don't work with anybody you aren't comfortable.

Lower Cost

One of the biggest reasons that patients fail to seek treatment is the exorbitant costs associated with all-things-healthcare. These patients don't realize that in the digital age, e-counseling makes talk therapy far more accessible to the average consumer.

​​It takes years​ to get even the lowest-level certifications necessary to become a licensed therapist. New counselors spend a lot of time and money on their schooling, and then on continuing education throughout their careers.

This is true of all therapists, but an in-person counselor faces even more costs. The very presence of a physical office, even out of their own home, adds significant costs to operate their practice. Then, add on the high cost of insurance and business services, and it's no wonder that talk therapy is so pricey.

Online therapy makes it easier than ever for you to get therapy at a low price. Since all your therapist needs is a phone or computer to connect to you, they aren't passing on the heavy cost of doing business in their hourly rates.

You Get What You Pay For

There's always a caveat when talking about low-priced services. Many help seekers are attracted to the low prices that some counselors offer online. And, why not? It's a great perk of online therapy!

However, you need to consider what would make a therapist offer such a low rate. Is this individual qualified? Are they experienced? Do they have good reviews?

You need to do your due diligence, especially when selecting a budget therapist. While many of these individuals are perfectly qualified to help you, others may be under-performers taking a cut rate because they can't stand out among the competition.

When it comes to your mental health, no price is too great. Enjoy the cost-savings that online therapy has to offer, but be wary of the quality of help you'll get if you choose to pay the very lowest prices you find. Buyer beware!

This is part of why we highly recommend using BetterHelp when finding an online therapist to ensure your counselor is fully qualified.

Am I Covered Under My Insurance?

Unfortunately, the answer is usually “no.”

Many insurance plans skimp out on mental health coverage to begin with. Those plans that offer mental health benefits most often have a list of approved care providers you must choose from in order to receive your benefits.

In most cases, these providers are established practitioners within a healthcare network, and they offer in-person talk therapy services. Your online therapy sessions aren't typically covered by insurance. Check your individual plan details for more complete information.

That's not to say you're out of luck. Look through the list of approved providers on your health plan. Any one of them may run a private practice that can accommodate online therapy. And, it never hurts to ask.

Broader Choices

As we mentioned, online therapy offers the benefit of a huge selection of therapists. But that's not the only benefit of using the internet to find your perfect counselor.

When you search for therapists on Google, you can find providers to suit your exact needs. For example, many individuals prefer their therapist to be the opposite sex. Using online catalogues and search engines makes it quick and easy to filter in your preferences.

Does It Matter Where My Therapist Lives?

On the one hand, it's a huge advantage of online therapy that you can live far away from your care provider. On the other hand, you'll want to be sure it's ethical for your therapist to offer care across state or country lines.

Different locales have different licensing standards for mental health workers, so it's important to make sure your therapist is well-credentialed. You should be able to ask your therapist directly what certifications or licenses they have.

If they aren't comfortable answering this question, that's a big red flag that you should meet someone else. Don't work with a counselor who isn't willing to be upfront about their experience.

What's the Best Way to Connect?

This is a matter of your preference, more than anything else. There are a few popular formats that work well.

Emails and direct messages are great for check-ins and reminders, but aren't a great way to keep up an ongoing dialogue about in-depth issues. Stick to planning and sharing quick-hit bullet points in emails. This won't be your primary method of talking with your counselor.

Phone calls work much better, since you can have an easy live dialogue with your therapist. They're fast, inexpensive, and easy to take anywhere. Phone therapy is the best choice for when you have to meet on the fly or in a location with limited internet access. Keep in mind, many therapists keep phone calls shorter than standard appointments, so you may not want to have phone therapy on a routine basis.

The most popular method of remote therapy is video conferencing. This way, you can see your therapist face-to-face as if you were in a live therapy session. This also helps your therapist pick up on certain visual cues (more on this later). The drawback with video therapy is that you need to be in a place that's not only private, but that has a stable internet connection you can use by yourself for a whole hour.

Some patients even like to use text-based chat to talk with their therapist. Remember our talk about anonymity? If you're sensitive about your choice to try talk therapy, chat therapy can be a great way to ease into the experience. You can say everything to your counselor in a live environment just like the phone or video call, but even the therapist has no idea what you look or sound like. However, unless you and your counselor are fast typographers, chatting is far less efficient than speaking. You may lose a lot of time to slow typing.

Flexible Hours & Locations

Given a blend of all the methods discussed above, you can see how easy it is to conduct a therapy session anytime, anywhere. This flexibility makes online therapy far more accessible than traditional face-to-face therapy.

Your mental health is so important that Harvard Business Review recommends taking time off work for your mental health if necessary. But with online therapy, you can get appointments in the earliest hours of the morning, and the latest hours of the night.

In fact, the appeal of e-counseling work for many therapists is the off-hours scheduling that allows them to perform other duties during business hours. Flexible scheduling is a benefit for everyone involved.

Twenty years ago, it was unheard-of to have a therapy session outside the confines of a quiet, secluded clinic office. However, with teletherapy, you can have a session on your drive home from work!

That's not to downplay the seriousness of your therapy. You should only take appointments when you have the time and attention to pay to your care. So, maybe not while driving your car. You get the point.

Drawbacks


Absence of Nonverbal Communication

Remember what we said about video conferencing? Your therapist does want to see you, if they can. Your words are important, but by themselves, they paint an incomplete picture of your thoughts, moods, and feelings.

Nonverbal cues are an important component of your communication. And this goes for everyone, not just your therapist. If you only ever speak on the phone or via web chat, your counselor can't get a full read on your attitude and your subliminal responses to the thoughts you're expressing.

If you're paying for therapy, you should get the fully capable service that your counselor has to provide. They can only work with as much information as you give them. If you choose not to let them see your nonverbal communication, you're choosing to limit how effective your therapy will be for you.

Adherence to Treatment Plans

When you visit a therapist in-person, it's an important event in your week. You take time out of your day, you drive to an isolated location you don't visit for any other reason, and you talk seriously and critically about yourself in a way that you never do anywhere else.

When you take online therapy, it's a little bit more like taking medicine at home. Do you know the biggest reason medicines don't work? People don't stick to the routine!

Just like a pill can't save your dying heart unless you swallow it, your therapist can't save your ailing mind unless you call them. You have to put a real effort into maintaining an ongoing therapy schedule.

It's important to keep to a routine as much as possible. If you can't see your therapist at the same time every week, then try to keep it to the same day. Can't swing that? Try to keep it at the same time no matter what day it is. When it comes to adherence, consistency is key.

Set reminders to make sure you don't forget about your appointments. To make your appointments feel like more of a special event, dedicate a space in your home you don't often use as your therapy room. This will make it feel more like an in-person session that's more ingrained in your week.

Information Security

Anytime you're communicating online, there's some risk (however small) that your communications could be intercepted. Hackers and scammers will try just about anything to get their hands on your information. And when you're in online therapy, your information is extremely sensitive.

So, what steps can you take to protect yourself?

Many therapists are setup with confidential and secured lines for phone calls. If you're worried about the content of your therapy sessions being vulnerable, a secure phone line is probably your best bet. You can also specifically request your therapist not keep any notes about you digitally. Rather, they should be written down on paper (and locked away) where they can't be hacked into.

The very fact that you attend therapy can make you a target, in some cases. If you're worried about people finding out what you do, you can inform your therapist that you'll be using phony information when communicating over email or on your therapy platform. After all, if your insurance isn't paying on your behalf, this won't pose any administrative issues.

Your therapist is required to take reasonable steps to protect patient information in order to remain HIPAA compliant. However, it's important that you be vigilant with your own information to protect yourself at all times. After all…

Reliability of Service & Counseling

Until you've really gotten to know your therapist, you can't know just how trustworthy, professional, and competent they are. One of the most significant drawbacks of online therapy is the risk of engaging with an under-qualified therapist.

Not everyone is cut out to be an online therapist. Not only do you need to be properly credentialed as a counselor, but you need impeccable business and time management skills as well. For a young freelancer (which is what many online therapists are) this can be a lot to take on.

That's why we always recommend platforms like BetterHelp so you can be confident you've found a legitimate online therapist. Platforms like BetterHelp screen therapists and have rigorous standards for their remote counselors to ensure you don't get left behind, or worse, ripped off.

Technological Breakdowns

Even if your counselor is reliable, it's important for your technology to be reliable, too. If your internet or phone signal is constantly dropping, it's going to interrupt your therapy sessions. And you can bet your therapist won't be refunding your time because of your poor internet connection.

If you're video conferencing, it's a good idea to plug into a hard line connection to avoid any wireless signal problems. If you're on the phone, check that you're in a location with strong service and that your battery is charged.

This is also where a platform like BetterHelp is a big advantage. Legitimate online therapy platforms help you avoid technological concerns, and if there are ever disputes about service, they're there to help you resolve these conflicts.

Technological concerns can be especially prohibitive in group settings. SMART Recovery's online group format has been nailed down for years, and their meetings can still get bogged down by users dropping and by microphones acting up. If you want to get the most out of your online therapy, make sure your technology can stand up to the demands.

Online Therapy vs. Face-to-Face Therapy

Given the significant benefits of online therapy, we believe it's worth the minor drawbacks that are better addressed by face-to-face therapy. Especially in the year 2019 and beyond, technology has only gotten more reliable and more secure.

Online therapy gives you far greater access to your therapist, and far broader choice about whom to work with. It more cost effective, and it offers you more anonymity.

In-person meetings do give your counselor more of a chance to get to know you intimately. But, they can be so time-consuming and difficult to accommodate on a regular basis. If you have the time and money, then consider yourself lucky.

For all the rest of us, online therapy is a legitimately practical choice in the 21st century. Feeling down? Get help now.​​

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