What is Online Therapy? - Depression Alliance

What is Online Therapy?

Online Therapy

Online therapy is a general term used to describe mental health services provided to people through online technology. This can include video chatting, online text messaging, or voice messaging. Some patients are able to utilize this as their primary form of therapy, while others utilize these services in combination with face-to-face meetings with their therapist.

Benefits of Online Therapy

There are many benefits to utilizing online therapy to help manage your mental health condition. Some of them include:

  • Accessibility: Utilizing online therapy through app or web-based services allows people to have access to their therapist with fewer limitations on time and location. This creates more opportunity for those who live far away from any therapists to receive the care they need, and it facilitates easier communication between patients and their therapists. Additionally, most people in today’s society have access to the Internet or have a smartphone making this technology attainable.
  • Privacy: Some patients dread going to their therapist’s office for fear they will run into someone they know while they are on their way in or out. By receiving care online, patients can avoid any run-ins they may experience while attending a face-to-face visit. They may also feel an extra level of privacy if they utilize a therapist who does not live in their community.
  • Therapist selection: As mental health services and practitioners continue to develop a presence online, there are a variety of practitioners for patients to choose from. People can go online and search for different practitioners with relative ease. If they do not like the one they originally start working with, they can transition to another therapist on the same platform or on a different network.
  • Variety of therapy: There are many different forms of therapy available to people online. Some services offer individual therapy, group therapy, or couples therapy. Different therapists also utilize diverse therapy styles, such as cognitive-behavioral therapy or person-centered therapy. Online therapy can also be associated with peer support groups for those who are looking to connect with others with their disorder.

Styles of Therapy

There are a variety of therapy styles utilized to improve mental health and help people understand their condition. While not all of these styles translate well to online therapy, there are still many proven methods utilized in online therapy.

Cognitive-behavioral therapy focuses on a person’s thought process and how that affects the way they behave. Psychodynamic therapy helps people evaluate their emotions and past experiences and how those relate to their current relationships with others and everyday problems. Person-centered therapy is an approach where the patient guides the discussion while the therapist facilitates without changing the direction of the conversation or providing advice. These are all methods that work well in online therapy because they are implemented through patient-therapist conversations which can be achieved through online systems. These methods have been proven effective for many mental health conditions such as managing stress and anxiety, depression, and grief.

Online Therapy Use Cases

A 32-year old woman has trouble making it to her therapist’s office regularly because her work schedule is erratic and the office is far away. She likes visiting her therapist in the office, but she finds there are times she needs to talk with the therapist but cannot make it in. Her therapist suggests they work through an online platform to improve the woman’s access to the therapist. This allows the woman to chat online with her therapist when she is having trouble managing her anxiety but does not have time to make an appointment.

A 55-year old man recently lost his wife and has been struggling with his grief over the last year. His friend suggested he see a therapist to help him manage his symptoms, but he is too embarrassed to see the only therapist in town. He looks online and finds a variety of therapy options available. After finding a platform he feels comfortable with, he reaches out and is able to connect with a therapist who helps him develop healthy coping strategies.

Finding the Right Platform

There are a variety of models available for online therapy, and it is an important piece to consider when choosing on online therapy option.

Some online therapy groups are developed as a network of providers. These groups operate similarly to a clinic where each practitioner practices under the guidelines created by the “network”. The network typically creates standards of practice for the group and may allow the practitioners access to more resources. The network often plays a major role in maintaining patient records and privacy.

There are other online therapy services that operate more like a platform. These models are similar to a network in that they provide one location to find a variety of practitioners. However, in this model, each practitioner is independent and practices under their own set of standards and guidelines. The platform is simply created to connect the user to a variety of practitioners, but they are not involved in the practitioners’ therapy sessions.

Finally, there are some individual practitioners who offer online services but have no affiliation with a network or platform. Often these individuals offer combined face-to-face and online therapy services. These practitioners can be harder to find, especially if they practice outside of your community, and they practice under their own standards.

Online Therapy

Ethics of Online Therapy and Counseling

Before utilizing any online service, it is wise to evaluate the credentials of the therapists you might be working with. These sites are required to provide an honest representation of the credentials and capabilities of their providers. If you cannot find any information on providers’ credentials, reach out to the provider or the site to confirm this information. This can help you identify the type of provider you are working with and evaluate which therapy providers might be most appropriate for you to work with.

Online therapy options are held to the same ethical standards as face-to-face therapy services. Therapists practice under their own license and are bound to the code of ethics defined by their governing boards. As part of these ethics and due to state laws, therapists are often required to report certain situations that they feel represent a danger to a patient or someone else. For example, if they discover an unsafe environment for a child during therapy sessions, in most states they must report that situation so it can be investigated. If a person participating in therapy is feeling suicidal or homicidal, the therapist needs to be able to contact emergency services or an emergency contact in order to prevent harm. In these instances, it is imperative that the therapist has some knowledge of each patient’s contact information and name.

Online therapy does have some limitations, and in some cases, patients may need to be referred to a higher level of care. Online therapy providers should be trained to identify cases in which their patient needs a face-to-face appointment or acute care in a mental health facility and make referrals to appropriate resources in the patient’s area as needed.

Security and Privacy in Online Therapy

One of the biggest concerns about utilizing online therapy is privacy. Fortunately, online therapy providers must follow the same HIPAA privacy laws as they would if you had an in-office visit. To ensure an online therapy group has a policy on HIPAA and protecting your privacy, you can look for their policy on their website or ask them to see it. This policy should describe their efforts to protect your privacy on the Internet. These efforts may include utilizing a third-party auditor to ensure HIPAA compliance or having a Business Associate Agreement with their video chatting software provider which requires the software provider to keep information obtained through video chatting private.

By law, therapists are required to keep medical information for a certain number of years after they work with each patient. This applies to online visits as well. To help ensure your privacy, you should check with the website to determine what information they store and what security measures are in place to protect it. For example, their website should be encrypted and their servers should have a high level of security in place to prevent information from getting out.

The Growth of Online Counseling

Online therapy and counseling have grown exponentially over the last ten years. There is a higher demand for online counseling services, especially with the younger population who have grown up utilizing this technology. With a shortage of mental health providers, this option also allows better access to providers for many more people.

Frequently Asked Questions

-Is online therapy legitimate?

Online therapy is a legitimate way for people to receive therapy and consulting that they need to help manage their mental health. Licensed mental health professionals are held to practice standards, even when they practice online. That being said, there are some steps you can take to ensure you are working with a legitimate therapy platform and therapist. Check the website or app for information about each therapist’s credentials and double check their policy related to privacy. This information can help you determine if you feel comfortable working with a certain group.

-Is online therapy covered by insurance?

Online therapy may or may not be covered by insurance. As these services grow, more and more insurance agencies are adding online therapy to their plans. To identify if online services are covered by your insurance, talk with your benefits coordinator or call your insurance company. Another point to consider is that some websites do not require insurance, and in some instances, it may be cheaper to receive therapy without insurance.

-How effective is online therapy?

Evidence for the efficacy of online therapy continues to emerge as more platforms are developed. Currently, there is evidence available to support the use of online therapy for certain conditions, such as depression or eating disorders. BetterHelp online services have been proven to be as effective as face to face counseling for most situations by the independent Berkeley Wellness Institute study, except for specific issues concerning self-harm, extreme mental illness.

-What kinds of online therapy are there?

One of the biggest benefits of online therapy is its flexibility. Patients are able to utilize the software that best fits their lifestyle to improve their mental health. Currently, there are a variety of ways to interact with therapists online. Some apps and web-based services utilize video conferencing to set up a chat between patients and providers. Others have providers utilize online texting or chat rooms to communicate, and some prefer to connect patients and providers through phone conversations. You may also find that many online platforms use a combination of these methods to improve the patient-provider relationship and experience.

Online therapy is an effective, flexible way to provide many people with the help they need. There are a variety of methods and therapy styles utilized to help patients manage their mental health disorders. When selecting an online therapy platform, it is important that patients are diligent in confirming therapists’ credentials and the platform’s privacy standards. When utilized and evaluated appropriately, online therapy provides an effective solution for patients needing alternative or additional therapy services.

What is the best online therapy platform?

Our top pick is BetterHelp 

BetterHelp is the largest e-counseling platform worldwide.  Their mission is: “Making professional counseling accessible, affordable, convenient – so anyone who struggles with life’s challenges can get help, anytime, anywhere.”

 Pros and Cons of the BetterHelp Platform

PROS:

  • Flexible: Users have a wide range of multi-modal options including messaging, phone calls, live chat, and video chat to access the services
  • Reasonably priced: At $65 a month, which is comparable to other online therapies like TalkSpace at $ 65-$99, and ReGain at $40 to $70 
  • Backed by clinical results: BetterHelp has been found to be comparable to face-to-face counseling(details below)
  • Personalized: Profile match of clients to therapists are managed based on the therapists skills sets and the clients’ problem area

CONS:

  • They do not have a suicide or self-harm hotline

 How does BetterHelp vet the therapists?

BetterHelp has a database of 3000 licensed and accredited psychologists, psychologists (PhD / PsyD), marriage and family therapists (LMFT), clinical social workers (LCSW / LMSW), and licensed professional counselors (LPC). The advantage that BetterHelp has over sites like TalkSpace is that the profiles of the therapists are available for the clients to view.

The induction requirements are strict to ensure only experienced and thoroughly qualified therapists are made available through their platform: 

  •       Each of them must necessarily possess a Masters Degree or Doctorate
  •       They must have a minimum of 3 years and 2,000 hours of in-clinic work
  •       The screening includes:
    • Correct licensure documentation
    • Proof of identity
    • Medical references from licensed therapists
    • Verified licensure information from the state licensing board.
    • Completed case study exam by a licensed clinician
    • Evaluation by a video interview

Induction requirements at BetterHelp: https://www.betterhelp.com/faq/

What do BetterHelp therapists specialize in?

BetterHelp offers its services within a defined range of mental health issues: including: 

  • Stress, 
  • Anxiety, 
  • Relationships, 
  • Parenting, 
  • Depression, 
  • Addictions, 
  • Eating, 
  • Sleeping, 
  • Trauma, 
  • Anger, 
  • Family conflicts, 
  • LGBT matters, 
  • Grief, 
  • Religion, 
  • Self-esteem and more.

They state clearly that they are not the right platform for cases involving:

Minors, self-harm or suicidal issues, emergency, severe mental illness, psychiatric care, court ordered therapy and such.

What type of clients are BetterHelp therapists best for? 

The BetterHelp services are geared towards individual therapies, couples counseling, as well as teen counseling (they offer added assistance for teen counseling through their sister site TeenCounseling.com).

How does BetterHelp work?

Since it’s an online service, the process starts with a series of questions that you need to fill online. The questions cover vital aspects of the issue you need help with, your medical history, as well as certain basic demographics like gender, age, and marital status. The counselor to client match is made within 24 hours, based on the profile you described, your specific issues as listed, and your wellness goals.

Once the therapist match is done, you are allotted a secure chat room where you can share your thoughts and concerns via messaging at any time. BetterHelp online services are available in four modes: You may use any platform that suits your mood, accessibility, or need of the moment. You could select the messaging or chat options for a more anonymous interaction, or use phone and video calling options for a more personalized experience.

The online services are available through these mediums: phone, tablet, or computer.

  •     Chat room messaging:
    • You can log-in and post your queries, thoughts, concerns at any time, without waiting for an appointment.
    • Once active, you are assigned a dedicated chat window where you can message your assigned therapist.
  •     Live chat:
    • This is a scheduled live interaction, using a dedicated chat window
    • You have a defined period of time where you may connect with your therapist in real time
  •     Phone:
    • As with the live chat, you will need to log in to the chat room at a pre-scheduled time
    • The system will ask for your number and call you at the scheduled time (please note, your number is never shared with the therapist)
  •     Video conferencing:
    • The video chat is the most personal, live interaction option available
    • You may log into your chat room at the scheduled time

How much does BetterHelp cost?

The entire range of online therapy services can be accessed at a subscription of $65 per month. This entitles the client to unlimited messaging and chatting, 24/7.

BetterHelp online services have been proven to be as effective as face to face counseling for most situations by the independent Berkeley Wellness Institute study, except for specific issues concerning self-harm, extreme mental illness, etc. They do have an offline alternative where one can visit the office for a face to face consultation, for an approximate fee of $150 per session. 

While some clients use the services for a certain period of time and pause when they start feeling the positive effects of the therapy, many go on to making BetterHelp a part of their regular lives.

Why we like BetterHelp?

BetterHelp is our top pick counseling platform for a few reasons:

  • An independent Berkeley Wellness Institute study has found BetterHelp to be an effective alternative to face-to-face therapy* 
  • 98% of BetterHelp clients made significant progress 
  • 94% actually prefer BetterHelp over face to face therapy for reasons like BetterHelp’s quality of therapy, anonymity, affordability, and ease of access anytime\
  • 70% of the clients showed reduced depression symptoms with the use of the platform’s services
  • The most progress was exhibited by clients who used BetterHelp’s services without having tried any face to face therapy previously
  • BetterHelp has the largest database of therapists 
  • BetterHelp therapists are screened through a stringent process which only 15% of applicants pass
  • The complete licensing information of each therapist is disclosed to the client for transparency and comfort in the assigned counselor. BetterHelp makes it easy for the client to switch counsellors at any point.

*The results are based on a validated Patient Health Questionnaire (PHQ) that is a self-reporting measure frequently used in clinical studies to monitor depression symptoms and anxiety. There is a series of questions around 10 benchmarks that assess how the patients have been feeling over the past two weeks. The PHQ was filled in by the respondents at the beginning of the study and then again after 90 to 104 days of online counseling. Both results were plotted against each other to understand the improvement in the mental health of the patient. 

Questions to Ask a Potential Therapist

Here’s a couple of questions you can ask your potential future online therapist:

  • How does online therapy work?
  • For how long have you been practicing online therapy?
  • What happens if the platform/communication channel goes down?

References:

  1. R. Zwerenz, J. Becker, R. J. Knickenberg, M. Siepmann, K. Hagen and M. E. Beutel, “Online Self-Help as an Add-On to Inpatient Psychotherapy: Efficacy of a New Blended Treatment Approach,” Psychotherapy and Psychosomatics, vol. 86, pp. 341-350, 2017.
  2. L. M. Ritterband, F. P. Thorndike and K. S. Ingersoll, “Effect of a Web-Based Cognitive Behavior Therapy for Insomnia Intervention With 1-Year Follow-up,” JAMA Psychiatry, vol. 74, no. 1, pp. 68-75, 2017.
  3. C. Guille, Z. Zhao and J. Krystal, “Web-Based Cognitive Behavioral Therapy Intervention for the Prevention of Suicidal Ideation in Medical Interns,” JAMA Psychiatry, vol. 72, no. 12, pp. 1192-1198, 2015.
  4. M. E. Levin, J. A. Haeger and B. G. Pierce, “Web-Based Acceptance and Commitment Therapy for Mental Health Problems in College Students: A Randomized Controlled Trial,” Behavior Modification, vol. 41, no. 1, 2016.
  5. C. Knaevelsrud, J. Brand, A. Lange, J. Ruwaard and B. Wagner, “Web-Based Psychotherapy for Posttraumatic Stress Disorder in War-Traumatized Arab Patients: Randomized Controlled Trial,” Journal of Medical Internet Research, vol. 17, no. 3, 2015.
  6. K. Cherry, “Ethical and Legal Issues in Online Therapy,” Verywell Mind, 01 November 2018. [Online]. Available: https://www.verywellmind.com/online-therapy-ethics-2795227.
  7. https://www.theverge.com/2016/12/19/14004442/talkspace-therapy-app-reviews-patient-safety-privacy-liability-online
  8. http://www.apa.org/helpcenter/online-therapy.aspx
  9. https://www.psychologytoday.com/us/blog/between-the-lines/201802/is-online-therapy-worth-the-money
  10. https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2009.09071012
  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3837629/
  12. https://www.ncbi.nlm.nih.gov/pubmed/20183695
  13. https://www.tandfonline.com/doi/abs/10.1080/15228830802094429
  14. https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/blog/apa-and-ata-release-new-telemental-health-guide
  15. https://www.psychologytoday.com/us/therapy-types/person-centered-therapy
  16. https://www.goodtherapy.org/learn-about-therapy/types/psychodynamic
  17. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.201700477
  18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749954/
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    Depression Alliance Staff


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