Online Therapy: A Mental Health Guide for Older Adults

When Ms. Kim, 71, lost her husband to COVID-19, her entire world shattered.

Since emigrating from Korea with her family years ago, Ms. Kim had depended almost entirely on her spouse for language, social, and emotional support. Now on her own—and isolated by pandemic restrictions from her children, neighbors, and church community—she lacked the tools she needed to weather the storm of death and bereavement.

“What concerned us most was how her grief and sadness seemed to intensify over the weeks,” said a director at Hanul Family Alliance in Oak Park, Illinois, where Ms. Kim lives.

Ms. Kim’s experience isn’t unusual. Among people age 65 and over, it’s estimated more than 70 percent of have experienced bereavement in the last 2.5 years.¹

“This is significant, because older people tend to grieve differently than younger people,” explained Kathleen Cameron, senior director of NCOA’s Center for Healthy Aging. “And in some cases, the grief response among older adults can be a risk factor for depression and other mental health disorders.”

The good news is that the percentage of older adults with depression is actually pretty low: between 1% and 5% among those living in the general community, like Ms. Kim does. “But that doesn’t mean that other emotional struggles are any less real or valid,” Cameron asserted. “As we age, each of us faces a number of life changes and circumstances—such as the death of a loved one—that can cause anxiety, sadness, stress, or all three. And there’s no reason to navigate those things without help.”

That’s what Ms. Kim discovered. After a caseworker at Hanul Family Alliance provided culturally sensitive information about mental health counseling services for older adults, she eagerly agreed to give professional grief therapy a try.

Could you or an older adult in your life benefit from similar assistance? With the advent of evidence-based online therapy and related growth in virtual counseling services, finding and getting help is now much easier than before.

Here’s what older adults and caregivers need to know when navigating online therapy for better mental health.

What is online therapy?

Also known as telehealth therapy, this form of mental health counseling allows patients to visit with licensed providers from the comfort of home. Much like a virtual doctor’s appointment, patients use a computer, smartphone, tablet, or other internet-enabled device to log in to a secure meeting space where they interact with a therapist.

What can online therapy help with?

Virtual counseling can be effective for nearly everyone who receives in-person care, regardless of age. According to the American Psychological Association, a convincing 96% of psychologists agree or strongly agree that online counseling is a proven therapeutic tool—and 93 percent plan to offer it permanently in their practice.²

Plus, said Cameron, the broader availability of mental health care particularly benefits those who otherwise might struggle to access it—including older adults limited by geography, transportation, physical and cognitive challenges, lack of available providers, and other barriers.

With that in mind, virtual therapy can particularly be well suited for addressing the unique mental health needs of older adults. While they experience many of the same stressors as younger people do, seniors also face a host of situations that go hand-in-hand with growing older, including emotional challenges related to:

• Death and bereavement
• Caregiving stress
• Chronic illness
• Loneliness
• Functional limitations
• Financial worries

And because isolation further increases the risk for depression and anxiety, online counseling for older adults can truly be a win-win,” said Cameron.

How does online therapy work?

The specifics of care largely depend on the online platform or provider—and there are many of them—but virtual therapy generally shares these common features:

1. Completing a secure online survey

Patients answer a series of questions designed to identify their specific needs and to match them with a provider who’s a good fit. Sometimes the match happens automatically; others, the patient can choose from among several therapists. “The important thing to know is that you’re not locked in to your first match, or even your second or third,” Cameron explained. “Just as with in-person care, you can try different therapists until you feel that ‘click.’”

2. Attending sessions

Following a successful match, patients schedule and agree to participate in regular appointments with their counselor. Most commonly, these virtual sessions happen in real-time (that is, on a specific day at a specific time when both parties are present), though some platforms support asynchronous access (see #3 for more).

Online counseling sessions typically involve a video meeting (think Zoom, FaceTime, WhatsApp, and similar technologies). This allows therapists to see and gauge facial expressions and body language, which helps them better understand their patients. Some patients prefer audio-only appointments, though, and instead talk to their provider over the phone or through their device with video features turned off.

3. Accessing 24/7 support

Many of the best online therapy platforms offer the ability to connect with a counseling professional outside of regular appointment hours. Sometimes called “asynchronous access,” this bonus feature allows patients to send a text, email, or voice message to a provider, who commits to respond within a specific period of time. Sometimes this provider is the patient’s regular therapist, but not always. That’s why it’s important to understand how each platform handles asynchronous support before making a choice for care.

What will an online therapist ask?

Because every individual situation is different, and every client–therapist relationship is unique, it’s impossible to anticipate exactly what a counselor will ask. However, there are some general therapy questions intended for older adults that can help frame the goals and direction of therapy. These can include, but certainly aren’t limited to:

• What brings you to therapy at this point in your life?
• Have you worked with a therapist before? What was that like?
• How would you describe your overall mental health?
• Do you feel anxious or depressed? If so, can you explain why?
• Have you noticed any trouble with your memory? Your sleep? Your family relationships?
• What’s your physical health like? Do you have any chronic illnesses?
• Are you caring for someone with a chronic illness, or who depends heavily on your help?
• What is your living situation? Do you live alone? In a house or apartment? With a child or other family member?
• What medications are you taking?
• Do you drink alcohol or use other substances?

Online counselors may also inquire about a client’s work history, social connections, and hobbies in order to form a clearer picture of their circumstances and needs and build rapport.

Is it easy to use online therapy?

Older adults who have reliable internet service, access to a connected device, and a general comfort with using technology should find it easy to participate in online therapy—whether through video meetings, live text chat, or audio-only sessions. And many platforms include tech support for those inevitable situations when something just isn’t working right.

Telehealth counseling also must be HIPAA-compliant—meaning it’s protected by the same patient privacy and data protection laws that in-person therapy sessions are.

How does someone choose an online therapy website?

There are many virtual counseling platforms out there, and not all of them are created equal. Before choosing an online provider, ask the following questions and compare the answers to help determine the best option:

• How much does it cost?
• Does the provider accept insurance payment—including Medicare and/or Medicaid?
• What features are included?
• When are therapists typically available?
• What do other users have to say about their experience?

How do you pay for online therapy?

Most online counseling platforms either operate according to a subscription-based model or as a pay-as-you-go service. Most accept credit cards and may even require having one on file (this is particularly true for subscription-based models). Some providers will accept PayPal, Venmo, or other electronic payment methods as well.

Actual costs can vary, and some providers are more affordable than others. Be sure to investigate all charges and fees, and whether they’re covered by insurance, before choosing a telehealth therapy platform. If online therapy is covered by your insurance, you may be responsible for a copayment for each session. Occasionally, providers offer financial aid or will charge on a sliding scale.

Speaking of insurance: it’s worth checking with each online counseling platform to see if their therapists are eligible to bill Medicare and if so, whether the platform handles that or if clients are responsible for paying up front and seeking reimbursement later. Medicare Advantage plans may offer telehealth therapy but from specific companies only. If you have Medicare Advantage, check with your plan to find out what telehealth companies are part of your benefits.

Some providers may also accept Medicaid, but the availability of this option also depends on individual states. Medicaid beneficiaries should consult with their care manager before choosing an online therapy platform.

Where can I find evidence-based online therapy for older adults?

NCOA Adviser’s Reviews Team regularly ranks the best virtual counseling sites for older adults based on over 1,000 hours of in-depth research on mental health, substance use disorders, and online therapy. Among the 8 best online therapy services chosen, our Reviews Team found that the top three choices among adults age 54+ are, in order:

1. Talkspace (16.7%)
2. BetterHelp’s Faithful Counseling (11.54%)
3. Online-Therapy.com (6.41%)

Bottom line

Online counseling services may not be a good fit for all older adults seeking mental health care. But they can help reduce common barriers—such as transportation or physical limitations—and therefore improve access to therapy for older adults with depression, anxiety, and other unique mental health needs. The overwhelming majority of surveyed psychologists agree that virtual counseling is a proven therapeutic tool and that it can be as effective as in-person sessions. When choosing which online therapy platform to use, consider its costs (including insurance coverage), features, appointment availability, and reviews from other clients.

Sources

1. Beverly Rosa Williams, et. Al. Bereavement among African American and White older adults. Journal of Aging and Health. April 2007. Found on the internet at https://pubmed.ncbi.nlm.nih.gov/17413138/

2. American Psychological Association. Worsening mental health crisis pressures psychologist workforce: 2021 COVID-19 Practitioner Survey. Oct. 19, 2021. Found on the internet at https://www.apa.org/pubs/reports/practitioner/covid-19-2021