10 Online Therapy Basics That'll Help You Get Started

It can be intimidating, but here's some info to help you take that first step.

Making the decision to try therapy is hard, and finding the right therapist is no walk in the park either. There are a lot of things to consider when you're looking for a therapist, from accessibility to your own comfort levels. Given everything going on today — from social justice to social distancing — online therapy is becoming increasingly popular. So, here’s everything you need to know about it.

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First things first: Even though you're not meeting your therapist face to face, online therapy can be just as personal. The work you need to put in and the process are the same.

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There's no barrier to entry for therapy. There's no threshold of depression, anxiety, stress, or trauma you have to hit. If you're struggling, you're struggling. Your feelings are totally valid. Besides, despite some antiquated stigma, there's absolutely nothing wrong with getting help. It's okay. We all know that life's hard, and it can be overwhelming. If you're even considering therapy, it's definitely worth checking out.

(Read more about how you know if you need therapy.)

1. Now, online therapy is usually done two ways: via video or text. Once you figure that out, you can decide if you'd prefer live or messaging sessions.

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The difference between video and text is pretty obvious. But different services allow you to have live video calls or text chats with a therapist, while others allow you to send video or text messages for a therapist to respond to at certain times.

2. Text therapy lets you take things at your own pace. It's great if you have unpredictable schedules, if face-to-face chats make you anxious, or if you don't have the privacy to speak freely at home.

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Text therapy isn't like texting your mom friend. While you can schedule live sessions (usually referred to as "chatting live"), text therapy usually lets you message your therapist whenever you’d like. Then, your therapist will respond an allotted number of times — usually once or twice a day. It’s important to understand your contact agreement, so you’re not expecting a text back every time you decide to hit up your therapist.

Of course, text therapy lacks the nonverbal aspects of communication — like your facial expressions, the tone of your voice, and your body language. As with any text-based communication, there’s always a risk of misinterpreting a message and a time delay between responses.

However, these might be the very things that attract you to text therapy. Maybe face-to-face conversations make you anxious, and you feel safer opening up over text. Similarly, writing out your thoughts can be therapeutic in and of itself, helping you reflect on and streamline your feelings. You can also do text therapy from virtually anywhere, without needing to speak out loud. And another pro? You can refer back to your sessions and reread them whenever you need. No memory required.

3. Video therapy is real-time. It's ideal if you're looking for a more free-flowing conversation that's closer to the IRL therapy experience.

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You can do video therapy from virtually anywhere with the internet, a camera, and some privacy. It closely mimics in-person therapy since you and your therapist can physically see each other and talk, live. Plus, you don't have to type your thoughts out and can get direct responses. (Some platforms do let you send video messages, though).

However, if you don't have the privacy, video therapy may be more stressful than helpful. For instance, even if you have your own room, will you feel nervous that someone could overhear you?

Because it doesn't differ too much from in-person therapy, the choice between video therapy and in-person therapy can come down to logistics. Will it save you money or time by not commuting to your therapist's office? Are you more comfortable talking to your therapist from your own couch or theirs? Do you have the privacy to forgo your therapist's office?

4. Online therapy has some seriously great perks — namely convenience (traffic? don't know her), comfort (your bed > therapist's couch), and accessibility (no car? no problem!).

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You never have to set foot in a therapist’s office — it's that convenient. More seriously, it can be more comfortable for you to do online therapy if you’re apprehensive about or have a difficult time physically going to therapy and a therapist's office, whether due to mental or physical reasons.

If you’re someone who is more comfortable communicating through technology, online therapy may be easier than speaking to a therapist in person.

Online therapy also makes mental health care more accessible. It lets you meet with therapists beyond your immediate area, so you're not limited to your town. And depending on which service you use, online therapy may make reaching out to therapists and booking appointments simpler than searching on your own.

5. While online therapy has lots of advantages, there are still some other things to consider before booking your first session.

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Most importantly, online therapy must be appropriate for your needs. For instance, if you’re experiencing thoughts of suicide, you most likely would benefit from more intensive and active services. In the case of an emergency, you should always call 911. To talk to more immediate support, you can call the National Suicide Prevention Lifeline.

Also a big deal: what kind of therapy are you looking for? Online therapy may be great for you, but if you’re looking for marriage counseling or family therapy, it could get complicated — even just trying to get everyone in frame for video therapy.

Next, licensing. You need to make sure that your therapist is not only licensed but licensed in your state. When you're looking for a therapist online, just ask them — or their practice — to verify that they're licensed in your state. (Most reputable online therapy services will vet this for you.)

Here's why: "therapist" is not a legally protected word in every state — so anyone could call themselves a therapist. Therapy licensure is regulated by your state laws, which hold a therapist to professional standards and requirements. Some counselors may hold certificates, but those are issued by private organizations that only cover certain requirements (set by the organization) and don't count as state licenses.

6. No matter what service or provider you choose, you should always check their privacy policy to understand how they'll use or protect your personal data. But if you know you won't, at least make sure they're HIPAA-compliant.

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Fortunately, most reputable online therapy services have FAQ pages where you can find a simple rundown on patient privacy and security policies. One thing these should touch upon is HIPAA.

At a bare minimum, your online therapy service should be HIPAA-compliant (that's therapist-patient confidentiality, among other things). The service you choose should also let you verify your therapist’s and your own identity. Additionally, you should check that the service is verified by the American Telemedicine Association.

Otherwise, privacy policies will often discuss the collection, use, and sharing of information, along with how they secure information. It can be intimidating to have to read a privacy policy, but most online therapy services keep them pretty cut and dry if you're willing to take a peek.

For video therapy, these compliances and verifications ensure your session isn’t being recorded and cannot be accessed by any company. For the record, Skype, FaceTime, and Google Hangouts are not HIPAA-compliant platforms.

For text therapy, your messages should be confidential and encrypted, and you should be required to log-in to access them. Be sure to check the service's terms of use to understand who, if any entity, can read your messages and under what circumstances.

7. And ofc, check out what payment options are available — like insurance or subscription-based services.

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Online therapy generally costs a bit less than in-person therapy, but it really depends on the service and type of online therapy. Some services are subscription-based and charge you on a weekly or monthly basis for varying levels of access. Others charge you by the session and your counselor's level of education.

As for insurance, while more insurance companies are covering the cost of mental health services, online therapy (especially through apps) often isn’t included. But it doesn't hurt to check with your insurance company to understand if your plan will reimburse you for online therapy costs. The other alternative in this time of social distancing: If you find a therapist that accepted insurance for IRL sessions, they may still take it for online sessions. Try searching your insurance company's website or giving them a call to find (covered) practitioners offering remote services right now.

If out-of-pocket costs are too high or insurance co-pays nonexistent, some research could help you find low-cost or no-cost therapy services. For instance, this BuzzFeed post on mental health resources for BIPOC covers sliding-scale therapists, online support groups, community-driven apps, federally-funded health centers, Medicaid, and more. And our how to start therapy guide delves into other free and more affordable therapy options. There are also non-profits like the Centre for Interactive Medical Health Solutions (CIMHS) that offer a select number of free self-guided sessions online.

8. Sure, online therapy is less mainstream, but there are a number of studies out there on its effectiveness. And they're pretty promising!

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The research on text therapy is limited, but the studies that have been done show positive results. In 2013, a study on online-text psychotherapy (comparing email and texting, both live and messaging, with in-person therapy) found that both patients and therapists rated text therapy just as strongly, if not stronger, than in-person therapy. Because the patients volunteered and weren't random, the results aren't as clear-cut as they could be. They're still encouraging though, especially if you're actively interested in text therapy!

On the other hand, there's already some solid research behind video therapy. From 2006 to 2010, the US Department of Veterans Affairs studied mental health patients before and after enrolling in VA telemental health services. They found that video therapy decreased the need for patients to be hospitalized. They didn't compare this to patients who did not use video therapy, so there's nothing to say it's better than in-person therapy. But overall, the VA's study supports the expansion of online therapy.

9. Great, how can you get started? By choosing a medium (text or video), then finding an online therapy service that specializes in your needs and whose treatment approaches work for you.

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For a list, see our rundown of the best online therapy services, where you can compare how each one works and consider which is best for you.

Or, to easily find therapists and compare costs, try Psychology Today’s Find a Therapist search feature. Depending on which online service you choose — should you not choose to find an online therapist independently — you'll either have to vet through therapists, psychiatrists, and psychologists to choose one yourself, or you'll be assigned one.

For more, see How do I pick the right therapist? in our Therapy Starter Guide.

10. In the end, it’s about getting the support that actually helps and works for you.

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In some cases, it can accommodate you better than in-person therapy. Technology has its advantages and nuances the therapeutic relationship in its own ways. It's a lot more natural for us to text or video call people now than it was even a decade ago — so choose whichever medium you feel most comfortable, natural, and safe using. And if you're still debating whether therapy is right for you and have lingering questions, here are some things you may want to know.

Ready to get started now? Here's a list of some of the best online therapy services.

You, ready to try online therapy for the first time:

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