Reading: Online Therapy: Is It For You?

From remote work to porch parties, the pandemic brought many changes to daily life, some of which have gone back to the days before quarantines, and some have stuck around. One pandemic “innovation” that caught traction and has been full speed ahead ever since: online therapy. During nationwide coronavirus restrictions, seeing a mental health professional virtually — rare before the lockdown — was usually the only option. Now that the world has fully reopened, teletherapy seems here to stay.

I started seeing my local therapist pre-pandemic. Once a month, I enjoyed walking or biking to her nearby office and relaxing on her couch while we talked about my feelings about being an empty nester and my deep unrest caused by the political climate in the country. When the COVID-19 crisis started and she offered me the option of connecting with her from my laptop, I said yes. I am fortunate to have my own space in a shed outside my house and loved being able to talk with her from my private space. We worked through issues that arose during those scary early days of the pandemic and I found comfort in her consistency. 

I haven’t been back to her office in four years. I still talk to her once a month, but always from my own home even though her office is just 10 minutes away.

How Online Therapy Became Popular
More people than ever before are seeking mental health counseling, according to the American Psychological Association. Some are even calling this current time the Age of Anxiety. A recent Pew Research Center survey found that roughly 4 in 10 US adults experienced high levels of psychological distress at some point during the pandemic, and a recent report issued last fall noted that anxiety and depression are at all-time highs. In early 2023, Surgeon General Vivek H. Murthy issued an advisory about the loneliness epidemic in this country. These emotional issues are continuing to plague Americans and highlighting the need for mental health awareness, positive connection with others, and accessible therapy options. 

Counseling psychologist Bonnie Wims, PhD, of New York City, says she believes more people are open to therapy these days: “There is a public conversation going on that is making therapy more acceptable. I also feel we have new generations who aren’t willing to suffer or be in pain. They recognize things can be different and better and the rules can change.” 

More and more studies are confirming that people are increasingly open to seeking out the help they need, due in part to easier access and the comfort of being at home through increased teletherapy options. I, for one, agree.

How to Get Started with Online Therapy
Of course, the transition to online therapy was easy for me because I already had a therapist who quickly pivoted to the online platform Doxy for her clients during the shutdown days of the pandemic. 

For those new to therapy, online provider networks like Rula — which I am familiar with because my niece works for them and sees her own therapist she found through Rula — can help people find a licensed therapist that accepts their insurance and meets their individual needs. Top sites recommended by Forbes and Wirecutter include MDLive and BetterHelp. 

Therapists have had to make their own transitions with the widespread use of teletherapy. “Before I started work as a therapist, I couldn’t imagine seeing clients on a screen,” says Maggie Stang, LMFT, who trained as a marriage and family therapist before the pandemic and started work as a counselor specializing in eating disorders during the pandemic. “Now I truly see the value of telehealth. Online therapy allows so much more flexibility for my clients with various health concerns like severe depression or agoraphobia.”

Wims acknowledges that, like many therapists, she transitioned her practice to online during COVID and today finds that “it works as well as in person, if not better at times.” She believes people just feel more comfortable speaking from the comfort of their own home at a time that doesn’t stress them out. 

Pros and Cons of Online Therapy
I am 100% a fan of online therapy. I have even encouraged friends and family to give online therapy a try. But, it is not for everyone. Here are some things to consider if you are looking into whether teletherapy is right for you:

The Pros

• Convenience (for both client and provider). One friend of mine says, “It has been extremely convenient to be able to see a therapist online. I can wear pajamas with a blanket wrapped around me with my cat in my lap. It’s also nice if I am not feeling up to the drive. I love the comfort of being at home.” Therapist Sarah Schurman Eberly, LCSW, says she works from home on Mondays so she can do laundry in between seeing clients. She is also able to save on office rent.

• Ease of accessibility for clients. Stang finds online therapy has completely changed accessibility for clients. Folks with mobility and transportation issues can access mental health services from home. Also severely depressed or anxious persons who have trouble leaving their home can see therapists in the place they feel most safe.

• More choices for therapists. Another advantage is that online therapy allows clients to see therapists outside their city. This is helpful for those in rural areas with a scarcity of providers or those in need of a specialist. Also, patients in a large urban area who find the commuting difficult now have the option of seeing a therapist over their device without the drive. “It’s the overall access that feels like such a potential game changer to me,” says Eberly. (One thing to note here: People mistakenly believe that online therapy allows them to see therapists anywhere in the country, but state license requirements prohibit therapists from seeing out-of-state clients. So, keep your searches to in-state only.)

• More flexibility in scheduling. One client explains her work schedule makes it much easier to see a therapist online. She doesn’t have to add in the time to get to the appointment and get back to work. She can fit in her therapy appointment at a time and a place more convenient for her schedule. 

The Cons

• Lack of a safe space. One disadvantage of online therapy can be that clients are not able to find a place for therapy that is private enough to have an open and honest conversation with a therapist. This is especially true for those clients seeking therapy due to unsafe relationships. 

• Too many distractions. According to Stang, clients can get distracted by their phones or because they schedule sessions at inopportune times, like lunch break in their car. These settings don’t always provide the right frame of mind for productive therapy. 

• Too much distance. Body language and eye movement are harder to discern online, says Stang. One 31-year-old I spoke with who has been in therapy (in-person only) since she was 18, notes, “There is a quality of presence that I believe simply cannot be achieved online. There is a connection and therapeutic power … in person.”  

• Poor internet connection. Eberly says that sometimes the internet connection can be flawed and that bothers some clients more than others. “One older client never went virtual. They just didn’t see me during the pandemic,” she says.

It’s good to know that therapists who offer their services online do receive special training, depending on their certification. For instance, licensed clinical social workers don’t have to be certified to deliver online therapy, but LPCs (licensed professional counselors) do have specific training required to conduct therapy over the internet. When, and if, you find a therapist who is licensed and takes your insurance, you should not hesitate to ask them these important questions:

• Do they have experience treating patients with your particular issues, concerns, or condition? Ask what their speciality is and what kinds of patients they generally treat. 
• How long are the sessions, and how frequently do they run sessions?
• What are the costs and any associated fees? (Be sure to also inquire about penalties for missed sessions or cancellations.)
• Is there a limit to the number of sessions covered by your insurance?
• Which platform do they use, and what technology does it require on your end?
• Can you try an initial session to see if you are comfortable with this therapist, and if it’s a good fit for you both? 

Maybe also ask if you can you wear pajamas with a blanket wrapped around you and a cat in your lap? (Kidding, but why not find out about their rules regarding therapy from your home.) The privacy of my shed has been a lifesaver for me!

Harriet Riley is a New Orleans–based freelance nonfiction writer focusing on personal essays and journalism. She has her MA in print journalism from UT Austin and taught creative writing for 11 years with Writers in the Schools Houston. She has published articles in 64 Parishes, Mississippi Folklife, Minerva Rising, and the Wanderlust anthology. You can reach her on Instagram @hatrireads or on X @hatriri.