Online Therapy

What is online therapy?

Online therapy — also called teletherapy or virtual therapy — is psychotherapy delivered remotely. You connect with a licensed mental health professional through:

• Video sessions, which are closest to in-person therapy
• Phone sessions
• Live chat
• Asynchronous messaging, where you and your therapist exchange messages over time

Some people see a local therapist who offers video sessions; others use dedicated online therapy platforms that match clients with therapists.

Does online therapy work?

Research on video-based therapy for common mental health conditions is generally encouraging, with many studies finding outcomes similar to in-person care for conditions such as depression and anxiety. Evidence varies by format — messaging-only therapy has been studied less than video therapy — and by condition.

Benefits

• Access: helpful if you live far from providers or have mobility, transport or scheduling barriers.
• Choice: a wider pool of therapists, including specialists.
• Comfort: some people find it easier to open up from home.
• Flexibility: evening, weekend or messaging options may be available.

Limitations

• Not appropriate for emergencies or crises. If you are in danger, call your local emergency number or see Get Help Now.
• May not suit people with severe symptoms who need closer monitoring or more intensive care.
• Requires a private space and a reliable internet connection.
• Therapists must usually be licensed in the state or country where you are located.

What to check before you sign up

• Licensing: is your therapist licensed where you live? Can you verify their credentials?
• Privacy: how is your data stored and shared? Is the platform used for advertising?
• Cost and billing: what is the total monthly cost, and how easy is it to cancel?
• Insurance: is the service in-network, or can you get a superbill for reimbursement?
• Fit: can you choose or switch therapists easily?
• Crisis policy: what happens if you need urgent help?

See our comparison of online therapy services and our guide to online therapy without insurance.

To see how real services handle these points, check the pricing, licensing and privacy pages of BetterHelp, PlushCare and Sesame, or our online therapy comparison.

How online therapy works, step by step

Although services differ, most follow a similar path. You create an account and complete an intake that asks about your concerns, history, goals and preferences, and sometimes a short symptom questionnaire. You are then matched with a therapist or choose one from profiles. After that you schedule sessions or begin messaging. Live sessions usually run 30 to 60 minutes through a secure video platform; messaging-based services may promise replies within a set time. Between sessions you may receive worksheets, exercises or readings. Most services let you change therapist, pause or cancel, though the terms vary, so read them before you pay.

Formats compared

• Video: closest to in-person care, with the strongest research base; good for seeing body language and building rapport.
• Phone: convenient and less demanding, useful when video is difficult.
• Live chat: real-time text, which suits people who find typing easier than talking.
• Messaging: asynchronous, flexible and good for reflecting before replying, but evidence is thinner and replies aren’t immediate, so it’s best viewed as a complement to live sessions for many people.

Mixing formats from week to week is common.

Who tends to do well online

People with mild to moderate anxiety, depression, stress, grief, relationship problems or life transitions often do well with online therapy, particularly when they have a private space and a stable connection. It can also suit people with social anxiety, mobility problems, caregiving duties, rural locations or unpredictable schedules. Structured treatments such as CBT translate well to video and digital formats.

When in-person or higher-level care may be better

• Active suicidal thoughts, or recent self-harm; in an emergency, see Get Help Now.
• Severe depression, psychosis, mania or other conditions needing close monitoring.
• Eating disorders with medical risk, or substance withdrawal.
• Situations where a safe, private space isn’t available, such as when you live with someone who is abusive.
• When you need physical examination or tests as part of care.
• Court-ordered therapy, which many online services don’t provide.

Privacy and security

Good online services use encrypted video and messaging, and most say they are HIPAA-compliant in the US. Still, privacy depends on both the service and your own setup. Check what data the service collects and whether it shares data with advertisers or analytics providers; some health apps have been criticized or sanctioned for sharing data. Use a private room, headphones and a secure network, avoid public Wi-Fi, keep your device updated and protect your account with a strong password. Ask your therapist about confidentiality and what would require them to break it, such as imminent risk.

Making online sessions work

• Pick a quiet, private spot, and tell household members you shouldn’t be interrupted.
• Test your camera, microphone and connection before the first session.
• Have a plan for a dropped connection, such as switching to phone.
• Write down what you want to cover, and take notes afterwards.
• Treat sessions as real appointments: put them in your calendar, and avoid multitasking.
• Give the therapist honest feedback about whether the format and fit are working.

Cost and insurance

Prices range widely: from per-session fees to weekly subscriptions that bundle messaging and live sessions. Some online services are in network with insurers, and others are cash-pay only, sometimes with receipts for HSA/FSA or out-of-network claims. For help with comparing, see our guides to online therapy, online therapy without insurance and affordable therapy, plus our reviews of BetterHelp, Talkspace, PlushCare and Sesame.

Next steps

If you’re considering online therapy, decide what you want help with, shortlist a couple of services, check licensing and privacy, and plan to try a few sessions before judging fit. Our article on how to find the right therapist lists questions to ask, and our find care page explains where to begin.