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What Is Online Therapy & Does It Work?

Jan 06, 2023

By Hillary Eames
Medically Reviewed by Haley Stricker, LPC
Reviewed by Kathleen Cameron, BSPharm, MPH, Senior Director, NCOA Center for Healthy Aging
Fact Checked

Online Therapy: Key Takeaways

  • Online therapy can be an effective way to manage your mental health in the comfort and privacy of your home.
  • There are several affordable online therapy platforms to choose from that offer video, phone, and messaging therapy.
  • Some online therapy providers will take private insurance, Medicare, or Medicaid. Others will offer financial aid or discounts, even if they don’t take insurance.

Since the start of the COVID-19 pandemic, online therapy has become more common. The American Psychological Association conducted surveys in 2020 and 2021 to understand how COVID-19 impacted mental health treatment. In 2021, psychologists reported a 10% increase in demand for the treatment of anxiety from the previous year and an 8% increase in demand for treating depression. Other diagnoses with increases in demand for treatment included stress-related disorders, sleep disorders, substance-related and addictive disorders, and obsessive-compulsive and related disorders.1 According to the U.S. Government Accountability Office (GAO), telehealth visits by Medicare recipients increased from 5 million between April and December 2019 to more than 53 million during the same months of 2020.2

If you’re considering online therapy, there are some important facts to consider, including its pros and cons, cost and payment options, effectiveness, and more.

Why you can trust our Reviews Team’s online therapy reviews

Our Reviews Team recommends products and services we believe provide value in the lives of our readers. We spent more than 1,000 hours carrying out in-depth research on mental health and online therapy to give you the most accurate review. To make our selections, we:

  • Consulted with mental health experts to understand online and in-person therapy best practices
  • Reviewed and mystery shopped more than 40 online therapy platforms
  • Read real reviews from verified customers on trusted third party sites, including the Better Business Bureau (BBB) and Trustpilot to understand users’ experiences
  • Kept up to date on the latest academic research on therapy and mental health
  • Surveyed 1,000 online therapy users, including older adults, about their experiences with different online therapy platforms

Read more about our online therapy review methodology.

What is online therapy?

Online therapy is a form of telehealth, which is why it is sometimes called teletherapy. Telehealth, according to the Health Resources & Services Administration, lets you connect with a health care provider online rather than in person. These virtual visits primarily take place over the internet with a computer, tablet, or smartphone.3 NCOA and other organizations continue to press for expanded telehealth access for older adults and address common barriers such as lack of internet access.

Although there are arguments for and against online therapy, it provides benefits that include increased access to psychotherapy, whether at home, at work, or while traveling.4 Depending on the provider and the platform, it may even be covered by private insurance, Medicare, or Medicaid.

How does online therapy work?

To start with online therapy, you’ll first need to choose a platform or a provider. Some online therapy providers offer online therapy through their private practice. How you pay for your therapy sessions will depend on the provider, who will also inform you of their preferred telehealth method, such as Zoom.

Some online therapy companies have their own group of therapists who work for them and who use the company’s platform to accept payment, send messages, and hold therapy sessions. BetterHelp, for example, is the world’s largest online therapy platform, with more than 29,000 licensed therapists. Using its website, you’ll sign up for therapy, pay for a subscription, and log on to the platform at your scheduled time to attend your session. You can also use the platform to send messages to your therapist between sessions.

Some online therapy platforms also offer psychiatric consultations, during which a psychiatric practitioner may prescribe medication for mental illnesses such as depression or anxiety if they deem it medically necessary.

Online therapy session formats and communication methods

Several online therapy platforms allow you to choose how you want to hold your therapy session. Video is the most common session format, but some platforms allow you to attend your session using audio alone through either your phone or computer.

Some platforms also offer synchronous or asynchronous messaging. Synchronous messaging is like live chat, where your therapist will respond to each message immediately during a live therapy session. Asynchronous messaging works more like an email or text message, where your provider responds to messages when they are available, whether after a few hours or a few days. According to our Reviews Team’s 2022 survey of 1,000 online therapy users, 50% of those who used asynchronous messaging received responses within a day, and 38% received responses within a few days to a week.5 It regularly took more than a week for 12% of online therapy users to receive a response from their therapist.

Types of online therapy

Many types of therapy provided in person can also be provided effectively online. According to the Anxiety & Depression Association of America, there are various types of therapy you may receive online, including the following:6

  • Cognitive behavioral therapy (CBT), which is a form of therapy that helps you recognize and change unhelpful ways of thinking.
  • Dialectal behavioral therapy (DBT), which is similar to CBT but includes an additional focus on mindfulness, emotional regulation, and acceptance.
  • Eye movement desensitization and reprocessing (EMDR) therapy, which is a type of therapy that can help you address moments from your past that still affect you now. Therapists use bilateral stimulation, such as looking from side to side, to help your brain heal from difficult memories.

Online therapy pros and cons

Pros

  • Allows for therapy sessions in the convenience and comfort of a home or any location with internet access
  • May provide access to providers with specific specialties who may not be local or accessible in person
  • Allows for more flexible scheduling, which can be especially helpful for couples or family therapy when accommodating multiple people’s schedules

Cons

  • Some platforms use location-based pricing, and prices may be higher in certain states
  • Technical difficulties or unstable internet can interrupt therapy sessions
  • May not be suitable for people more comfortable with in-person communication since it may take longer to build a relationship with their therapist online

Is online therapy effective?

Online therapy can be as effective as in-person therapy. One Frontiers in Psychiatry study found that both younger and older adults benefited from receiving care for depression via telemental health, suggesting that age is not a barrier to benefitting from online care.7

The American Psychological Association reported that 96% of psychologists who responded to its 2021 COVID-19 Telehealth Practitioner Survey agreed that teletherapy was an effective treatment, and 93% intended to continue to offer teletherapy post-pandemic.8

How much does online therapy cost?

The cost of online therapy will depend on which platform and provider you choose. Some platforms, such as Sesame and Zocdoc, let you pay per session. Others offer therapy using a subscription model and charge by the month. This includes providers like BetterHelp, Brightside, Calmerry, Online-Therapy.com, Monument, and Talkspace. You can compare the average prices of some common online therapy sites with our table below. The services included with these fees vary by provider with certain ones offering weekly video or audio visits, daily messaging, or combinations of therapy in different formats.

Therapy PlatformTherapy formatCost* Accepts insuranceOffers financial aid
BetterHelpVideo, audio, chat$240–$360 per month**NoYes
BrightsideVideo$299–$349 per monthYesNo
CalmerryVideo and chat$228–$$360 per monthNoNo
MonumentVideo and chat$0–$249 per monthYesNo
Online-Therapy.comVideo, audio, chat$200–$$440 per monthNoNo
SesameVideoDepends on providerNoNo
TalkspaceVideo, audio, chat$276–$$436 per month** for therapy plans; $249 for initial consultation and $125 per follow-up for psychiatry planYesNo
ZocDocVideoDepends on providerYesNo

*Without insurance or financial aid.
**Exact cost is based on your location and therapist preferences and availability.

Does insurance cover online therapy?

Insurance may cover online therapy, but it depends on the details of your insurance plan and the therapy platform or provider you choose. If you’re unsure whether online therapy is covered by your insurance plan or whether your provider is in-network, you should check with your insurance carrier.

If your provider is not in-network with your insurance, you may be able to request reimbursement for a portion of the cost as an out-of-network benefit. Talkspace, for example, can provide you with a superbill—a receipt for health care services you get from an out-of-network provider that you can submit to your health insurance company for reimbursement. The amount of reimbursement you receive depends on the details of your insurance plan.You can also use a Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for online therapy, and certain Employee Assistance Programs (EAPs) provide free online therapy.

Do Medicaid and Medicare cover online therapy?

Telehealth, including certain types of online therapy, is covered by Original Medicare.9 But since Medicaid is a joint federal and state program, eligibility requirements and benefits can vary from state to state.10 Check your state profile to see if you’re eligible for Medicaid and if it covers online therapy.11

What to consider when choosing an online therapist

Here are some things to consider when choosing an online therapy platform or teletherapist:

  • Your budget: Take some time to figure out the financial aspect of online therapy so you can address any concerns before you begin. Are you looking for a therapist who accepts insurance, Medicare, or Medicaid? Do you prefer to sign up for a subscription or pay as you go? Working out these questions before therapy helps you focus solely on your mental health once you are ready to begin.
  • The type of therapy: Do you prefer phone calls to video calls? Do you want the option to send text messages to your therapist between sessions or in place of audio or video sessions? Knowing how you prefer to talk with your therapist will help you select the right therapy platform and help you feel at ease during sessions as well.
  • Your insurance coverage: Certain online therapy platforms accept private insurance plans, as well as Medicare or Medicaid. Other platforms offer discounted subscriptions and financial aid options. Compare the total costs of each to see If your copay or deductible is higher than a monthly subscription or pay-as-you-go service.
  • Appointment times: Make sure that the provider offers appointment times that work for your schedule. A lot of negative customer reviews for online therapy point to the difficulties of scheduling appointments at convenient times.
  • Customer service: Look at the customer service contact options for each online therapy service. You should feel that you can easily find the support you need over the phone, through the website, or through the mobile app if a brand offers one.
  • Receipt for services: Even if an online therapy provider does not accept private insurance, you can request a receipt for services to submit to your insurance for potential reimbursement. The amount of money you get back will depend on the details of your insurance plan.
  • Changing and canceling appointments: Read the appointment policy of each brand you consider to make sure that you can change or cancel appointments if you need to, and if you are charged a fee for rescheduling.
  • Using the technology: Make sure that you are comfortable using the technology involved with any online therapy services, whether that is a desktop computer or a mobile app on your smartphone or tablet. The service should be easy to navigate and it should make it simple to connect with your therapist.
  • Choosing your therapist: Some platforms allow you to search for or request a therapist based on factors such as male or female, religion, ethnicity, and any professional specializations. This can be important as you look for a therapist that you will be comfortable working with, though certain brands do not guarantee that you will be matched with particular therapists. You can also look for sites that let you review the biographical information and professional credentials of therapists before you meet with them. Make sure that you also understand how to switch to a different therapist if you are not satisfied with the first therapist you are assigned.
  • Your therapy goals: What do you hope to achieve with online therapy? It’s OK if you don’t have an exact answer just yet. But it helps to have an idea of what you hope to accomplish, as well as how you’d like your therapist to help. Knowing your therapy goals also helps platforms assign you a therapist with the specialty or therapeutic style that can best help you reach your goals.

Bottom Line

While online therapy may not be the right fit for everyone, it can make it easier for some people to access help for anxiety, depression, and other mental health conditions. There are multiple studies that suggest online therapy can be just as effective as in-person therapy for certain issues. To find the right online therapy platform for your needs, consider your budget, preferred communication method, and the goals you wish to achieve from therapy.

Frequently asked questions

Have questions about this review? Email us at reviewsteam@ncoa.org.

Sources:

  1. American Psychological Association. Worsening mental health crisis pressures psychologist workforce: 2021 COVID-19 Practitioner Survey. Found on the internet at https://www.apa.org/pubs/reports/practitioner/covid-19-2021
  2. U.S. Government Accountability Office. Telehealth in the Pandemic—How Has It Changed Health Care Delivery in Medicaid and Medicare? Found on the internet at https://www.gao.gov/blog/telehealth-pandemic-how-has-it-changed-health-care-delivery-medicaid-and-medicare
  3. Telehealth.hhs.gov. What is telehealth? Found on the internet at https://telehealth.hhs.gov/patients/understanding-telehealth/
  4. Julia Stoll, Jonas Adrian Muller and Manuel Trachsel. Ethical Issues in Online Psychotherapy: A Narrative Review. Frontiers in Psychiatry. Feb. 11, 2020. Found on the internet at https://www.frontiersin.org/articles/10.3389/fpsyt.2019.00993/full
  5. NCOA Advisor Online Therapy Survey. 1,000 respondents. Conducted using Pollfish. Launched April 11, 2022.
  6. The Anxiety & Depression Association of America. What Are the Different Types of Therapy? Found on the internet at https://adaa.org/find-help/treatment-help/types-of-therapy
  7. Heather G. Belanger and Mirène Winsberg. Do older adults benefit from telepsychiatric care: Comparison to younger adults. Frontiers in Psychiatry. Aug. 22, 2022.Found on the internet at https://www.frontiersin.org/articles/10.3389/fpsyt.2022.998401/full
  8. American Psychological Association. Worsening mental health crisis pressures psychologist workforce: 2021 COVID-19 Practitioner Survey. Found on the internet at https://www.apa.org/pubs/reports/practitioner/covid-19-2021
  9. Medicare.gov. Telehealth. Found on the internet at https://www.medicare.gov/coverage/telehealth
  10. U.S. Department of Health & Human Services. What’s the Difference Between Medicare and Medicaid? Found on the internet at https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-difference-between-medicare-medicaid/index.html
  11. Centers for Medicare & Medicaid Services. State Profiles. Found on the internet at https://www.medicaid.gov/state-overviews/state-profiles/index.html
  12. American Psychological Association. Worsening mental health crisis pressures psychologist workforce: 2021 COVID-19 Practitioner Survey. Found on the internet at https://www.apa.org/pubs/reports/practitioner/covid-19-2021
  13. American Psychological Association. A growing wave of online therapy. Found on the internet at https://www.apa.org/monitor/2017/02/online-therapy.

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