Does Online Therapy Work? It Depends on These Things
We’ve covered online therapy from many angles here at OpenCounseling.
We’ve studied it and reported the research on it.
We’ve tried it and believe in it because it worked for us.
We saw its potential before the pandemic made it more popular.
So, it doesn’t surprise us that so many other providers and media outlets are now saying what we’ve been saying all along: online therapy is a powerful way to take care of yourself when things get rough.
In this article, we’ll help explain how it works and when it might be your best option.
When Is Online Therapy a Good Option?
Online therapy can be a good option when you want to go to therapy but face obstacles to getting in-person therapy.
Local therapists aren’t always an option because they’re not always easy to find. There’s a nationwide shortage of mental health professionals, and in many places, the nearest therapy office is hours away.
But online therapy isn’t merely the last resort when geography, finances, or other issues make it hard to get to a therapist’s office. As we’ve experienced at OpenCounseling, online can be a great place to look when you’re picky and have strong preferences about the kind of therapist you want to see.
Looking online expands your search radius from therapists within driving distance to therapists licensed to practice in your state, increasing the number of therapists you can pick from—and the likelihood you’ll find one that’s a great match.
When Is Online Therapy Not a Good Option?
That said, we know that online therapy isn’t for everybody. We know from personal experience that there are times when seeing someone in person is important.
You might need more intensive support or just need to be able to go to a physical place that’s set apart from the rest of your life. You might want the more intimate feeling of connection you get when you’re in a room with someone.
You might also be living somewhere that you can find a better match locally than you can online. You might be living in a city with many practicing therapists whose philosophies and methods are aligned with your needs.
If you find a therapist who offers exactly the kind of therapy you’re looking for and you connect with them right away, that’s your best option, no matter where you meet them.
But there are more serious issues than personal preferences to consider when weighing online vs. in-person therapy. Sometimes, online therapy isn’t just an inferior option, but an inappropriate one.
While going online can often save you money, there are times it can cost you significantly more. And if you’re experiencing serious symptoms, online therapists can’t do as much to get you through a crisis or link you with local mental health resources as a therapist in your town or city.
Online therapy is often a great option, but not always. Online therapy isn’t the best option when:
- You’re having serious symptoms
- You’re having suicidal thoughts
- You’re in a mental health crisis
- You need a type of therapy that doesn’t work well online
- Your home life is disruptive and not conducive to therapy
- You don’t have a fast internet connection and can’t use streaming video
- You can find a good match with a local therapist who takes your insurance, but your online options don’t allow you to use insurance
In general, local, in-person options are better when you’re looking for more intensive support, dealing with severe symptoms, or want to have a place you can go to get out of your home.
We strongly recommend in-person over online therapy if you have local therapy options but the only way you can do online therapy is to do voice calls or chat sessions. Without a live visual connection, you lose something vital.
It’s also important to consider the reality of how therapy would work in your home space. Online therapy works when you have a space to do it in that’s private and that allows you to speak to your therapist without distractions or interruptions.
So, think about whether you’d feel safe and relaxed speaking candidly with a therapist at home. Would spouses, partners, children, or roommates be passing by or making noise in the background? Is home a stressful environment for you? If so, it’s probably better to find a therapist with a local office.
Make Sure Your Home Is the Right Place for Therapy Before You Sign Up Online
For streaming video therapy to work, you need a strong internet connection and a place where you feel safe and secure to focus exclusively on therapy for an hour.
If you’re fighting with a partner who doesn’t respect your space, living with a parent you need to talk to your therapist about, or have children who constantly interrupt you, it’s going to be harder to feel like you can open up completely to an online therapist.
That said, if you can arrange for childcare, have family members or housemates who respect your desire for privacy, or have a room where you can lock everyone and everything else out for an hour, it can work perfectly well to do online therapy in a shared home space. It might even feel like a triumph to work with a therapist in a space you can make completely yours for an hour.
Do Therapists Think Online Therapy Is Real Therapy?
In a word, yes. Therapists think online therapy is real therapy, even if many of them believe it’s not quite as good as in-person therapy.
But there’s an important caveat. Your therapist has to be able to be as present with you as possible. Messaging back and forth at different times of the day just isn’t the same thing.
Real Therapy Requires a Real-Time Connection
Most therapists agree that real therapy requires a real-time connection. For online therapy to accomplish the same things that in-person therapy can accomplish, you and your therapist need to be able to see and hear each other and respond to each other in real time.
Therapy is a healing process that is driven by your relationship with your therapist.
While different therapeutic methods work in different ways, they all depend on your ability to trust and open up to your therapist and on your therapist’s ability to understand you and respond to you in a healing, helpful way.
To do the best job possible, your therapist needs more than just your words popping up on a screen. They need to hear you, track where your tone changes, and notice when your voice wavers or breaks.
Your therapist needs to see you—the pain or hope in your eyes and the way you look. They need to see when you make eye contact and when you have to look away, when you cross your arms and when you relax.
Following and responding to the subtle ways you communicate nonverbally helps them understand you on a deeper level and helps them know what to do to make you feel heard and known.
The Importance of Creating and Holding Space in Therapy
Therapy involves practical problem-solving, but it’s more than that. One important thing that your therapist does is “hold space” for you.
All day long, people are pressing on you to shift and adjust to accommodate them. You need to be a little less loud, a little more focused, a little less sensitive.
When you’re with your therapist, you don’t have to make all these adjustments. The space that both of you create for your self to emerge and be, well, itself, is an important part of the healing process in therapy.
The best way to experience that healing space is to share a physical space with a therapist. But you can come pretty close by having a physical space in your home where you and your therapist interact visually and verbally in real time. In our opinion, nothing else really comes close.
Online Therapy Options to Consider
Our first online therapy experiences were with therapists on BetterHelp (a sponsor). We enjoyed and had successful experiences with them and have since experienced online therapy in other ways.
My therapist moved to a different platform and I followed her to that platform, where I continued to meet with her for two years. During the pandemic in 2020, our CEO, Mark, did online sessions with the therapist he normally sees in person.
What we’ve found is that the platform matters way less than which therapist you see. So our stance is that the best platforms are the ones that make therapy accessible and that connect you with the best therapist for you. This will vary from person to person, of course.
There are several online therapy platforms that can connect you with a therapist, and thanks to the advent of Zoom and other streaming video tools, a growing number of therapists now offer online sessions independently.
Sometimes you can even find a local therapist who offers both in-person and online sessions. This can give you the flexibility to enjoy the benefits of in-person sessions when circumstances allow and to do online sessions when that’s a better option. You may be able to use your insurance for both kinds of sessions, too.
Try an Online Therapy Platform that Accepts Insurance
An increasing number of online platforms are accepting insurance. These can be a great option if you’re having trouble finding a local therapist who accepts your insurance and is a good match. Online platforms that accept insurance include:
After you confirm that the platform accepts your specific insurance plan, it’s important to check whether all therapists on the platform accept your insurance or only certain ones.
You’ll also want to know how billing works for that platform. For more information on how to use these platforms, you can read our article on how to use insurance to get online therapy.
It’s important to note that most insurance plans require your therapist to give you a diagnosis and file paperwork to get reimbursed for your sessions. If you don’t think you have a mental health diagnosis and just want to meet with a therapist to work on personal growth goals, you might not be able to get your sessions covered.
Even if you do have a diagnosis, you might not be able to get reimbursed for online sessions or even find a therapist who accepts insurance. That’s when you should consider other options for affordable therapy, such as sliding-scale therapy providers, online platforms like BetterHelp (a sponsor), or even your state’s mental health system if you’re eligible.
However, at the end of the day, we come back to our most important point—the best option, and best platform, isn’t necessarily the one that accepts insurance, or even the one that’s the cheapest. It’s whichever one connects you with the therapist who’s the best match for you.
Online therapy is a flexible, viable option for therapy that can work for many people in many different circumstances.
And online therapy works—at least live video therapy works. The research shows that the difference between therapy conducted in person and therapy conducted via video is subtle, not definitive.
To experience effective online therapy, you’ll need a good internet connection, an online therapy option you can afford, and a space in your home where you can fully focus and open up to your therapist. When you have all that, online therapy can be effective—even life-changing.
Local Is Better If You're In Crisis
Keep in mind that online therapy isn’t always the best option. If your symptoms are severe and you need to connect to other local resources to meet your mental healthcare needs, a local therapist is a better choice.
And if you’ve found a therapist near you who’s a great match, who has an awesome therapy place close to where you live or work, and who takes your insurance or charges an affordable rate—what are you doing reading this? Give them a call!
Ultimately, the quality and success of your therapy depends on your relationship with your therapist. In our opinion, how well you connect with them, how easily you open up to them, and how well their method meets your needs matter a lot more than whether you’re seeing each other in the same physical space or over video.
We’re glad online therapy is catching on and that it’s making it possible for more people to try therapy. If you’ve been thinking about it, we encourage you to give it a chance. It could even change your life!
Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments.