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Does Online Therapy Work?

Does Online Therapy Work?

 We've covered online therapy from many angles here at OpenCounseling. We've studied it and reported the research results on it. We've tried it and believe in it because it worked for us. We saw its potential before the coronavirus pandemic made it more popular, and it doesn't surprise us that so many other providers and media outlets are now saying what we've been saying all along: online therapy is a powerful way to take care of yourself when things get rough. In this article, we'll help explain how it works and when it might be your best option.


When Is Online Therapy a Good Option?

There are times when life is so stressful you simply can't add another appointment with a round-trip commute to your hectic schedule. It can be tough to afford the rates local therapists charge. Sometimes, it can be hard to even afford the gas to get to a therapist's office. And local therapists aren't always easy to find. There's a nationwide shortage of mental health professionals, and in many places, the nearest therapist's office is hours away.


But online therapy isn't merely the last resort when geography, finances, or other issues make it hard to get to a therapist's office. I looked online for my therapist because I'm picky and had strong preferences about what kind of therapist I wanted. Thanks to my efforts, I found a great therapist who was a perfect match for me. I'm still working with her a year later and am so grateful for our connection. I believe I could have found a good therapist locally, but not one who would have been as good, or as perfect a match, as the therapist I found online.


When Is Online Therapy Not a Good Option?


That said, we know that online therapy isn't for everybody. The first time I did therapy in 2015, I did it in person, and that was exactly what I needed then. I needed to be able to go to a physical place that was set apart from the rest of my life. I needed the more intimate feeling of connection you get when you're in a room with someone.


I also don't think I could have found as good a match online at that time as I did locally. At that point, I was living in a city with many practicing therapists whose philosophies and methods were aligned with my needs. My therapist offered exactly the kind of therapy I was looking for and I connected with her immediately. I don't think I could have found as good a match online at that time, in that place, or in those circumstances.


There are more serious issues than personal preferences to consider when weighing online vs. in-person therapy. Sometimes, online therapy isn't just an inferior option, but an inappropriate one. While going online can often save you money, there are times it can cost you significantly more. And if you're experiencing serious symptoms, online therapists can't do as much to get you through a crisis or link you with local mental health resources as a therapist in your town or city.


Times we don't believe online therapy is the best option include:


  • When you're having serious symptoms
  • When you're having suicidal thoughts
  • When you're in a mental health crisis
  • When you need a type of therapy that doesn't work well online
  • When your home life is disruptive and not conducive to therapy
  • When you don't have a fast internet connection and can't use streaming video
  • When you can find a good match with a local therapist who takes your insurance, but your online options don't allow you to use insurance


It's important to consider the reality of how therapy would work in your home space. We don't believe voice-only or text-based therapy is in the same category as in-person and video therapy. We definitely recommend in-person over online therapy if you have local therapy options but the only way you can do online therapy is to do voice calls or chat sessions.


For streaming video therapy to work, you need a strong internet connection and a place where you feel safe and secure to focus exclusively on therapy for an hour. If you're fighting with a partner who doesn't respect your space, living with a parent you need to talk to your therapist about, or have children who constantly interrupt you, it's going to be harder to feel like you can open up completely to an online therapist.


That said, if you can arrange for childcare, have family members or housemates who respect your desire for privacy, or have a room where you can lock everyone and everything else out for an hour, it can work perfectly well to do online therapy in a shared home space. It might even feel like a triumph to work with a therapist in a space you can make completely yours for an hour.


Do Therapists Think Online Therapy Is Real Therapy?


In a word, yes. Therapists think online therapy is real therapy, even if many of them believe it's not quite as good as in-person therapy. But there's an important caveat. At OpenCounseling, we strongly believe real therapy requires a real-time connection. For online therapy to accomplish the same things in-person therapy can accomplish, you and your therapist need to be able to see and hear each other and respond to each other in real time. To understand why we say this, we'll need to explain a little bit about how therapy works.


Therapy is a healing process that is driven by your relationship with your therapist. While different therapeutic methods work in different ways, they all depend on your ability to trust and open up to your therapist and on your therapist's ability to understand you and respond to you in a healing, helpful way. The immediacy of your personal connection with your therapist is the fuel that helps you get further in therapy.


To do the best job possible, your therapist needs more than just your words popping up on a screen. They need to hear you, track where your tone changes, and notice when your voice wavers or breaks. They need to see you—the pain or hope in your eyes and the way you look. They need to see when you make eye contact and when you have to look away, when you cross your arms and when you relax. Following and responding to the subtle ways you communicate nonverbally helps them understand you on a deeper level and know what to do to make you feel heard and known.


The Importance of Creating and Holding Space in Therapy


Therapy involves practical problem-solving, but it's more than that. One important thing that your therapist does is "hold space" for you. In a world where everyone is constantly trying to fix you, therapy can be that one sacred time and space where you can be exactly who you are.


All day long, people are pressing on you to shift and adjust to accommodate them. You need to be a little less loud, a little more focused, a little less sensitive. When you're with your therapist, you don't have to make all these little adjustments. The space that both of you create for your self to emerge and be, well, itself, is an important part of the healing process in therapy.


The best way to experience that healing space is to share a physical space with a therapist. But you can come pretty close by having a physical space in your home where you and your therapist interact visually and verbally in real time. In our opinion, nothing else really comes close.


Online Therapy Options to Consider


Our first online therapy experiences were with the platform created by a sponsor, BetterHelp. But we've since experienced online therapy in other ways. My therapist moved to a different platform and I followed her to that platform, where I continue to meet with her to this day. During the pandemic in 2020, our CEO, Mark, did online sessions with the therapist he normally sees in person. What we've found is that the platform matters way less than which therapist you see. So our stance is that the best platforms are the ones that make therapy accessible and that connect you with the best therapist for you. This will vary from person to person, of course.


One of the reasons we work with BetterHelp as a sponsor is that they try to make therapy affordable to people who can't use insurance by offering financial aid and pricing their therapy at rates many people can afford. They've also been around a while and have built up a good network of therapists, which increases your chance of finding a therapist on their platform who's a good match for you. Most importantly, they offer, and emphasize, live video sessions.


One of the times we don't recommend BetterHelp is when you can use your insurance to get good therapy in person or online. BetterHelp doesn't accept insurance, and it can be hard to find an online platform that does. You can also sometimes get a more affordable rate than what BetterHelp offers if you can see a therapist online or in person who offers sliding-scale rates.


With the advent of Zoom and other streaming video tools, a growing number of therapists are figuring out how to offer online sessions independently instead of partnering with sites like BetterHelp. Sometimes you can even find a local therapist who offers both in-person and online sessions. This can give you the flexibility of enjoying the benefits of in-person sessions when circumstances allow and doing online sessions when that's a better option.


It's important to note that most insurance plans require your therapist to give you a diagnosis and file paperwork to get reimbursed for your sessions. If you don't think you have a mental health diagnosis and just want to meet with a therapist for personal growth, you might not be able to get your sessions covered. Even if you do have a diagnosis, you might not be able to get reimbursed for online sessions or even find a therapist who accepts insurance. That's when you should consider other options for affordable therapy, such as sliding-scale therapy providers, online platforms like BetterHelp, or even your state's mental health system if you're eligible.


However, at the end of the day, we come back to our most important point—the best option, and best platform, isn't necessarily the one that accepts insurance, or even the one that's the cheapest. It's whichever one connects you with the therapist who's the best match for you.




Online therapy works—at least live video therapy works. The research shows that the difference between therapy conducted in person and therapy conducted via video is subtle, not definitive. It's easy to feel seen and heard by a therapist who sees and hears you over video. To experience effective online therapy, you'll need a good internet connection, an online therapy option you can afford, and a space in your home where you can fully focus and open up to your therapist. When you have all that, online therapy can be not just effective, but life-changing.


But keep in mind that online therapy isn't always the best option. If your symptoms are severe and you need to connect to other local resources to meet your mental healthcare needs, a local therapist is a better choice. And if you've found a therapist near you who's a great match, who has an awesome therapy place close to where you live or work, and who takes your insurance or charges an affordable rate—what are you doing reading this? Give them a call!


Ultimately, the quality and success of your therapy depends on your relationship with your therapist. In our opinion, how well you connect with them, how easily you open up to them, and how well their method meets your needs matters a lot more than whether you're seeing each other in the same physical space or over video.


In conclusion, online therapy is a flexible, viable option that can work for many people in many different circumstances. We're glad it's catching on and that it's making it possible for more people to try therapy. If you've been thinking about it, we encourage you to give it a chance. It just might change your life!

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Stephanie Hairston, MSW
Posted on 01/12/2021 by Stephanie Hairston, MSW

Stephanie Hairston is a freelance mental health writer who spent several years in the field of adult mental health before transitioning to professional writing and editing. As a masters-level clinical social worker, she provided group and individual therapy, crisis intervention services, and psychological assessments. She has also worked as a technical writer for a medical software company and as an editor for a company that appeals denials of insurance coverage for behavioral health treatment. As a writer, she is motivated by the same desire to help others that brought her into the field of social work and believes that knowledge is one of the most essential recovery tools. She strongly believes in the mission of OpenCounseling and in making therapy accessible for everyone.