Is an Online Therapy Service Right For You?
Like other forms of healthcare, mental health care has quickly moved online. Online therapy, also known as teletherapy or remote therapy, can take many forms: video sessions, phone calls, and text messages. You can experience online therapy directly through a private practice therapist, or through an online therapy service that hires a therapist for you (such as BetterHelp and Talkspace). This guide will help you understand which approach to online therapy is right for you.
What is the difference between an online therapy service and a private practice therapist for online counseling?
Like many online platforms, the major difference between an online therapy service and a private practice therapist is the existence of a company to manage the relationship you have with your therapist. Companies like BetterHelp and Talkspace find you a therapist or counselor (learn more about the difference between therapy and counseling). The companies also manage payments to that therapist, host the technology for teletherapy, and provide customer service to you. In exchange, those companies take some of your payment for therapy that would otherwise go to your therapist.
Can you use your insurance to pay at an online therapy site?
No, you cannot usually use your insurance to pay an online therapy site, but you can use insurance to pay for therapy when you book directly with a private practice therapist.
You can find individual therapists who take your insurance for therapy sessions, including for teletherapy and online therapy. With these therapists, you will only have to pay a co-pay or co-insurance once your deductible is met. Using insurance to pay for therapy can help make it more affordable.
With online therapy sites like BetterHelp and Talkspace, you pay a monthly subscription of hundreds of dollars that is usually not reimbursed by your health insurance (including Medicaid and Medicare). As BetterHelp writes in their FAQs, “We don’t cooperate or work with any insurance companies or employers.” Instead, you will likely have to pay for the services on your own.
What is online therapy?
Online therapy, also known as teletherapy, is mental health therapy where you meet with your counselor or therapist digitally instead of being in the same room together. There are many technologies used in online therapy, including some you can access from a mobile device or mobile app.
When you find an online private practice therapist, they will typically offer teletherapy through real time live chat, such as through a video call. If a video session is not available, they might offer phone therapy. Through both video calls and phone therapy, you meet with your virtual therapist in real time, where you will engage in live conversation.
Online therapy sites often use real time live chats, but they also offer asynchronous messaging, where you leave a message for your therapist and they respond when they are next available. Similar to text messaging from your mobile device, asynchronous messaging can be a good way to send quick reminders or ideas to your virtual therapist. However, this form of communication rarely leads to the in-depth, insightful conversations that create growth, understanding, and healing. In their online reviews of sites that use asynchronous messaging, clients often point out that this technology cannot replace the benefits of real time live chats as a form of therapy.
What is the difference between therapy online and in-person therapy?
Therapy works best when you feel a sense of connection, trust, and vulnerability with your individual therapist. To build the relationship needed for successful therapy, there is no replacement for in-person therapy.
As one therapy client of both BetterHelp and Talkspace wrote, “It wasn’t long before I discovered one of the big drawbacks of text-based therapy. When you aren’t chatting in real time, it can be hard to keep the flow of the conversation going, and you miss out on a lot of the non-verbal communication you’d normally have with in-person… Chatting to the best therapist in the entire world on the internet still isn’t going to be as therapeutic as actually seeing someone in person — especially if you’re going through a really difficult time.”
Multiple peer-reviewed studies have found that online therapy can support psychoeducation, where the goal is to learn about mental health, problem-solving, and communication. Psychotherapy, which is a deeper process of understanding yourself, your motivations, and your influences, is more difficult in an online platform where interactions feel more limited and distanced. A study of BetterHelp found that people who have experienced in-person therapy benefit less from online therapy than people who have never experienced being in the same room as their therapist.
More serious mental health concerns are not often adequately treated with an online therapy service. In fact, in a study of a text messaging therapy service provided by Talkspace, those with chronic depression or anxiety had their symptoms worsen throughout their participation. In the same study, nearly half of all participants ended their participation early, without completing the full recommended 12-week program with a virtual therapist.
Online therapy programs are often hard to stay engaged with. As one therapist wrote in a review of BetterHelp and Talkspace, “Many people have difficulty remaining engaged on online therapy platforms. In addition to the disconnect that asynchronous messaging can create, another reason it can be hard to stick with it is that it’s so easy to sign up and so easy to quit. The simplicity and the impersonal nature of the process makes it seem like leaving therapy is no more significant than deleting an app from your phone. It’s tempting to quit if you feel disconnected or when therapy gets uncomfortable—as it nearly always will.”
How experienced are the therapists in online therapy services?
Another major difference in finding an online therapist yourself and using an online therapy service like BetterHelp or Talkspace is the level of experience of the therapist you see. Online therapy services are notorious for underpaying the therapists they contract with. The result is that you often may be assigned a therapist who is very early in their career, working on the side as a therapist, or unable to develop and retain enough clients for their own practice.
As one therapist who worked for Talkspace wrote, “The most challenging thing about Talkspace is that, as a therapist, I want to provide a good clinical service to my clients. It is my opinion that Talkspace doesn’t make this a priority. This is because the emphasis is on things such as the number of words you write and how quickly you respond to people…Don’t get me started on the pay, because it’s degrading how bad it is, and how much Talkspace takes away from the clinicians.”
Even though these services require their therapists to be licensed, and you may change counselors at any time, you may find that the therapist you meet with through a service is not as experienced as one you can find on your own. BetterHelp requires all their therapists to have at least 1,000 hours of experience, which is less than the minimum required to even be licensed in some states. For example, Washington state requires all counselors to have at least 1,200 hours of direct counseling experience before they can apply to be a Licensed Professional Counselor.
There may also be dangers in online or phone therapy services for people who have more pressing mental health needs. One writer for Forbes notes that there are hidden dangers in the Talkspace model that put people at risk, can make severe problems worse, and can interfere with people getting the treatment they need. They write, “By trying to be an approach suitable for everyone regardless of the problems they present, Talkspace puts some users at risk.”
If you are looking for more in-depth therapy, a meaningful and deep relationship with your therapist, or therapy for issues such as trauma or eating disorders, you may want to consider finding your own therapist and skipping the online therapy sites.
Reviews of online therapy services
People’s reviews of online therapy services like Talkspace and BetterHelp are mixed. Many people and peer-reviewed studies show that these services can moderately help people who experience slight-to-moderate anxiety and depression.
Yet many others may experience negative interactions with the platform they choose. A review of over 150 Better Business Bureau complaints shows many concerns about BetterHelp. Some people were charged without being able to see a counselor for several weeks, which can be detrimental for people relying on the service for immediate support. Other reviews of BetterHelp show that you’ll have to negotiate with your therapist about how often you can meet, which can be a detrimental way to initiate a therapeutic relationship.
Reviews of Talkspace are also mixed. As one reviewer on Reddit wrote, “Signing up for Talkspace is a financial risk that I cannot recommend. Coming from a long relationship with traditional therapy, I found this method to be jarring and unproductive… most conversations would never build into something beyond a shallow introspective analysis.” This is a common concern for the text-based asynchronous messaging offered by many mobile apps.
In the Guardian, another participant of Talkspace wrote, “My [Talkspace] therapist could troubleshoot small problems, but I quickly discovered she could not tackle the roots of my low self-esteem… the world of text therapy likely attracts a certain kind of [counselor], the optimists who believe staring at a poster with the words ‘You are enough’ below a sunset can alter brain chemistry.”
No matter the online therapy company, you may find that your ability to develop new insights and grow is critically limited by the type of counselors and communication platforms available.
What are the benefits of finding your own online therapist?
When you connect directly with an online therapist, you have the ability to create a long-term, trusting relationship that leads to the growth, change, and insight that people go to therapy to develop. You also know exactly who you will be seeing and can be sure that they are competent and experienced in the issues you are facing.
Another benefit to finding your own online therapist is that you will have more options to find a therapist who accepts your insurance, or who can meet you either in-person or online. There are also a variety of therapists of all different fees, whom you can meet with on your schedule. Want to take a few weeks away from therapy? With your own therapist, that is no problem and you won’t have to pay per month no matter how many sessions you have.
Perhaps the best reason to search for your own therapist directly is to find someone who feels like a good fit for you. You can find a professional counselor or therapist whose experience, style, and background match your needs, which means you’ll feel more at ease with therapy and more connected to the virtual therapist supporting you.
What is best for me – an online therapy service or finding my own online therapist?
Online therapy services are good options for people who:
- Can afford to pay out-of-pocket without using insurance
- Have never been to therapy before
- Have minimal mental health needs
- Primarily need education and encouragement
On the other hand, you may benefit from finding your own private practice therapist if you:
- Want to use insurance to pay for therapy
- Desire more in-depth or long-term therapy to understand yourself and what influences you
- Have chronic or more concerning mental health needs
- Could benefit from accountability and relationship building
How can you find the best therapist who is right for you?
Mental Health Match is a free, confidential service that matches you to licensed therapists who best meet your needs. We consider four main traits to be the foundation for finding the right therapist for you:
- Relevant experience in the issues you are experiencing
- Style and approach that matches how you best learn and understand yourself
- Background such as gender, race, and age that help nurture a close, trusting relationship
- Price and affordability
At the end of the day, you want to feel that your online therapist is competent to meet your needs, that you trust them, and that you have a good rapport that allows you to be open and vulnerable. While that may be possible over text message, mobile app, or an informal ad-hoc online therapy service, the only way to be sure that you will find a therapist right for you is to go directly to the therapists themselves.