How does online therapy work?

Julia Childs Heyl

By now, online therapy is more than a trend — it's a staple in mental health care. From enticing podcast ads to a surge in virtual therapy providers, the shift to online psychotherapy has been monumental. But what's the scoop?

Sparked by the COVID-19 pandemic, this new approach departs from traditional in-person sessions, offering numerous advantages. You can attend sessions in the comfort of your home without having to brave traffic or rearrange your schedule. Plus, online therapy provides greater flexibility with timing and makes it easier to find a therapist who truly fits your needs, no matter where they're located.

Considering online therapy? We consulted a practicing psychotherapist and checked out 16 platforms and directories to bring you the best information. Furthermore, this article is written by a licensed therapist who offers online therapy.

Content concerning mental health is for informational purposes only and is not intended as professional medical or health advice. Consult a medical professional for questions about your health. If you are experiencing a mental health emergency, call 911, local emergency services or 988 (the Suicide and Crisis Lifeline).

Online therapy, often called telehealth, is psychotherapy delivered through video, audio or chat instead of in-person office visits.

The best online therapy platforms host these sessions on their websites or through apps and provide video sessions via HIPAA-compliant video conferencing.

Online therapy offers the same level of professional care as traditional in-person sessions, with the primary difference being the screen between you and your therapist.

After selecting an online therapy provider, they'll send you a secure link via email or the platform's messaging system. You use this link to log in to the platform at your scheduled appointment time.

In your initial session your therapist will discuss the logistics of online therapy, including confidentiality and security protocols. They'll conduct a thorough assessment to understand your current situation, history and overall mental health. Together you'll outline your therapy goals, whether they involve coping strategies, addressing specific issues or pursuing personal growth.

Depending on the platform, your therapist may use various interactive tools such as screen sharing for worksheets, live chat for real-time communication or virtual whiteboards for exercises.

Your therapist will also discuss how you can communicate between sessions, be it through the platform's messaging system, via email or by other means. Additionally, they'll provide guidelines on what to do if you require immediate support outside of scheduled sessions.

There are multiple ways to engage in online therapy, including video and audio sessions. Some platforms also provide messaging-based therapy options. Despite research showing the effectiveness of text-based therapy, our experience found it less supportive than other methods.

Yes, research shows that online therapy is as effective as traditional approaches. One example is a 2023 study comparing online therapy with conventional face-to-face therapy for major depressive disorder. It concluded that both modalities were equally effective.

Nonetheless, if you are dealing with severe issues such as psychosis or suicidal thoughts, in-person therapy is advised as it provides a higher level of immediate support.

There are a number of high-quality online therapy service providers and directories that can help you find a good therapist, including low-cost options, therapy services for kids and those that are culturally sensitive. Once you've identified the platform or therapist you hope to use, it's important to do a little due diligence. First, confirm that your therapist is licensed by checking their profile on the therapy platform. If this information is missing, be cautious.

Ensuring the service is reputable and examining its client data and privacy policies is also vital. Take care because some platforms have had past concerns. For instance, in 2023, the Federal Trade Commission (FTC) accused BetterHelp of sharing users' sensitive health data without obtaining proper consent. As a result, BetterHelp agreed to pay $7.8 million and improve its privacy practices as part of the settlement.

We consulted Resha Altai, an associate clinical social worker in Los Angeles, to learn more about finding an online therapist. She emphasized, "An important aspect to consider [when looking for a therapist] is what actions the therapist is taking to prioritize your privacy, just as they would with in-person therapy." During your first session, you can ask how the therapist will honor your privacy and rights in therapy.

When choosing an online therapy service, use the same criteria you would for in-person therapy. Altai recommends assessing the therapist's style and their experience with your specific issues. Additionally, consider your monthly budget and preferred therapy format, whether video, audio or text.

Identifying your top priorities is essential. Whether you're seeking online therapy for couples, LGBTQ providers or an online psychiatrist for medication support, knowing what you need will help you make the best decision.

  • Resha Altai, MSW, ACSW, associate clinical social worker, Los Angeles

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