What is Teletherapy? (A Helpful and Definitive Guide)

More and more people are learning that tending to your mental health is just as important as monitoring your physical condition. However, there are certain situations in which an office visit for a face-to-face therapy session with a mental health professional just isn’t feasible. People shouldn’t have to give up mental health treatment just because they live in rural areas with limited mental health resources, have non-traditional work schedules, or can’t leave home due to disabilities or current COVID-19 pandemic precautions. In these situations, teletherapy, or telepsychology, is a great option.

What is teletherapy? 

The American Psychological Association (APA) describes telepsychology as the “provision of behavioral and/or mental health care services using technological modalities in lieu of, or in addition to, traditional face-to-face methods (e.g., provision of therapy using the phone, diagnostic interviewing via video teleconferencing, use of applications to track mood states, consultations via email).” In other words, it’s a session with a mental health counselor that’s conducted other means than in person. 

In addition to telepsychology and teletherapy, this kind of therapy session has also been called e-therapy, cyber counseling, web therapy, online therapy, or online counseling. There are several different channels therapists use for counseling sessions conducted outside the confines of an office. They may communicate via telephone, email, video conferencing, live chat on a website, or text message. Some online therapy platforms even offer a mobile app for video chat or text sessions.

History of Online Therapy  

You may think that online therapy is a relatively new idea. It’s true that much-advertised teletherapy services like TalkSpace and Betterhelp have only been around since 2012 and 2013, respectively. Yet, online therapy has been available since the 1980s, and the concept of remote therapy was born well before then.

Sigmund Freud, who practiced psychoanalysis in the late 19th and early 20th centuries, was known to correspond with his patients via postal mail. By the 1950s and 1960s, some therapists were conducting sessions by telephone (including manning newly-created suicide hotlines). At least one psychiatric institute was using “early video conferencing to provide group therapy, long-term therapy, consultation-liaison psychiatry, and medical student training.” 

With the advent of the internet in the early 1980s, individuals began setting up chat rooms to discuss their mental health issues. The first semi-authoritative online site was a mental health question-and-answer forum called “Dear Uncle Ezra,” which was created in 1986 by Cornell University. In response to the growing popularity of online therapy options, several mental health professionals formed the International Society for Mental Health Online in 1997 to provide guidance and support for teletherapy services.

 Today, in addition to dedicated online therapy services like Betterhelp and TalkSpace, many professional therapists have added the option of online counseling to their scope of practice instead of or in addition to traditional in-office therapy sessions.

Teletherapy and Patient Privacy

 One significant bump in the teletherapy timeline occurred in 2000 when the United States Department of Health and Human Services added the Privacy Rule to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The Privacy Rule (a short name for the Standards for Privacy of Individually Identifiable Health Information) was introduced to protect the privacy of a person’s medical records (including treatment for mental health conditions).

HIPAA requires health care providers to verify that any vendors who could encounter a patient’s personal information to be HIPAA-compliant, proving that they were safe and secure. This requirement includes video conferencing platforms, email services, and other technology online therapists were using to connect with patients. Several of them discovered that their favorite channels, including video chat tools Skype and FaceTime, weren’t HIPAA-compliant (and, according to most sources, they still aren’t). These therapists had to quickly pivot to voice, text, or video chat options that were safe, secure, fully encrypted, and fully HIPAA-compliant.

Today’s professional therapists are aware of the compliance status of their online platform and software to ensure the confidentiality of their patients’ personal information. All counselors, whether practicing online or face-to-face, are also ethically and legally bound to not share any details of a patient’s therapy session. The same rules apply to medical professionals conducting telehealth or telemedicine online sessions with patients.

How Online Counseling Works

A live online therapy session via video, online chat, or phone is similar to a session in a therapist’s office. The most significant difference is that the therapist is not in the same location as the patient, who is often participating from the comfort of their own home.

In most cases, you will have an appointment for your phone call or video session with your therapist, which gives you time to prepare. To ensure the best results and privacy on your end, you’ll want to find a private space with little background noise and the least chance of distractions or interruptions. It’s also a good idea to test your technology, whether that’s your webcam for good quality video appointments, internet connection for reliable live video or online chats, or your mobile phone battery to ensure it doesn’t die during your session.

Your therapist will provide a secure login link or contact information for you to use at your appointment time, sometimes within a confirmation email. When your session starts, you’ll interact with your therapist very much as you would have in their office; they can use the same treatment approaches and have the same conversations. At a predetermined time, your counselor will end your call, chat, or video session, and you’ll disconnect from whatever channel you’re using.

Some online sessions don’t require appointments. Talkspace, which provides text therapy via a mobile app in addition to scheduled video therapy, encourages patients to text their therapist whenever they want. According to the Talkspace website, Talkspace therapists respond to texts from their patients one to two times each day. This process is sometimes referred to as “unlimited messaging therapy.”

Benefits of Online Counseling for Patients 

There are numerous reasons more and more people are opting for teletherapy over in-person therapy. In a 2019 Psychology Today article, Goal Auzeen Saedi, Ph.D., a clinical psychologist in private practice, listed 14 reasons she believes online therapy benefits a wide range of clients. Saedi cites several benefits stemming from the simple fact that patients don’t have to commute to and from video therapy sessions or phone calls as they would for an in-person session. They no longer have to worry about travel-related safety issues like dangerous weather or car accidents, and they won’t be delayed by hassles like traffic jams or flat tires, so their appointments are more likely to start on time. With an all-online, appointment-based telepractice there are no wait times, so patients get immediate help. 

Conducting therapy sessions from the comfort of your own home has other perks, Saedi says. In addition to being a viable option for patients living in remote locations, people with demanding schedules, or disabled populations with accessibility needs, phone, text, or video therapy is an excellent solution for patients who aren’t feeling well or are suffering from a contagious illness. Saedi also likes that patients have access to food, drinks, and “the facilities.” 

Saedi also believes online therapy services provide a “low barrier to entry” for people who are nervous about making their first counseling appointment. Compared to traveling to a new physical location and waiting in an unfamiliar lobby to meet with a therapist for the first time, “you can have your cozy blanket, your special mug, all the things that make you feel at ease” the first time you talk to an online counselor.

Additionally, counseling through an online therapy program like Betterhelp or TalkSpace can be more cost-effective than traditional in-office visits. This is an important consideration for patients whose health plans don’t include insurance coverage for mental health expenses. Your best option is to check with your insurance company to see what type of therapy, if any, is covered before making your first appointment.

Online therapy sessions have been especially embraced by speech-language pathologists (SLPs) and occupational therapists. A projected shortage of SLPs in the United States is expected to cause issues for school districts, especially those in rural areas. Teletherapy with children through a live video connection can alleviate this problem, eliminating travel times for speech therapists and allowing them to serve more students and their family members in real-time than they could help with in-person visits.

Effectiveness of Online Therapy Programs

Despite these rather obvious benefits, many people still question whether therapy sessions conducted over a computer or mobile device is an effective way to provide mental health treatment. Quite a few research studies have tested the efficacy of online psychotherapy in the treatment of specific mental health issues, with promising results overall.

A 2014 study of internet-based interventions for depression found no significant differences in outcomes compared to traditional therapy. In 2011, a study of mobile phone-based interventions found that “participants’ symptoms of stress, anxiety, depression and overall psychological distress were significantly reduced” after six weeks of participation in a mobile mental health program. One study in 2014 even saw positive evaluations after therapists used telephone calls and text messages to treat patients who have schizophrenia, a serious mental illness. One telepractice refers to more than 40 academic published studies over the last 20 years, which have supported teletherapy as “an effective and appropriate therapeutic delivery mode” for many mental health concerns.

Finding the right therapist is still key!

Online counseling services may offer benefits for patients and as effective as in-office psychotherapy with a traditional therapist for a variety of mental health conditions. Still, it’s not everyone’s cup of tea. Perhaps you’re more comfortable with face-to-face interactions, where you can more easily read body language or other nuances. That’s perfectly ok. Online therapy sessions can be a great alternative or complement to traditional office visits, but they aren’t going to completely replace them anytime soon. Plus, in-person therapy treatment when available is still the best option for more serious mental illnesses like post-traumatic stress disorder (PTSD) or bipolar disorder.

With any therapy, the most crucial consideration is the quality of your therapeutic relationship and finding a counselor who is the right fit for your specific needs and preferences. You’ll want to be sure your mental health professional is a licensed therapist in the state where you live, even if you’re working with an online counselor. Each state has its licensing requirements for psychologists, psychiatrists, therapists, social workers, and counselors, and it’s well within your rights as a potential patient to request verification of a practitioner’s license to practice where you’re physically located 

The type of service and treatment a therapist offers is also essential. If you’re having relationship issues, you might seek out a therapist specializing in couples counseling. Maybe you’re looking for a family therapist or someone who can help with teen counseling. Or perhaps you want to be sure your counselor offers a particular kind of therapy, like cognitive-behavioral therapy (CBT), which is an effective treatment approach, in addition to many other forms of talk therapy. These are considerations and questions for both in-person and online therapy options.

Even the best online therapist won’t be able to help you if you’re not comfortable with them. You may want to seek out an on-site or online therapist of a certain race, ethnicity, sexual orientation, or gender identity. The mental health professionals of the Therapy Group of NYC understand the importance of finding a great fit therapist, and we’re also familiar with the particular challenges of living and working in New York City. If you’re looking for the best online counselors in NYC during these unusual COVID-19 conditions, consider the Therapy Group of NYC.