Online therapy: What you need to know

The term ‘online therapy’ refers to therapy done by video call.  It can also be referred to as telehealth, telemental health, teletherapy, telecounseling, or telepsychology.  Online therapy used to be a niche area, far outnumbered by in-person therapy sessions.  However, this changed during the pandemic, as clients and therapists saw that they could still do valuable therapeutic work together online.  Knowing how to find the best online therapist for your needs involves a few decisions and steps that we describe in this article.

Tips for finding the best online therapist for you

First, decide whether you prefer therapy in-person or online, or some type of hybrid approach.  Keep in mind that there is an tangible benefit to being present together with a therapist, much as would be the case in any relationship.  You also might feel more comfortable disclosing certain things in a private area that is neither at home, work, or in public.  On the other hand, you may prioritize the convenience of an online therapy session – no travel time! – and feel that this benefit outweighs the benefits of in-person.

Many of the strategies involved are the same as using the internet to search for a therapist you would see in person.  Nonetheless, here are a few specific tips for telemental health:

Ask your prospective therapist IF they offer online therapy.

It might seem obvious as the world changes, but not all therapists have made the switch to online therapy.   When visiting a therapist’s website, don’t make the automatic assumption that they provide telemental health.  Also make sure they offer online therapy in the form of a video call and not just regular phone therapy.  The visual dimension of face-to-face is an important aspect of therapy even if it is not in-person.  Next, and far more important…

Ask your online therapist HOW they would provide online therapy.

Now that more therapists than ever are offering online therapy, you should ask how your prospective therapist would offer this service.  The Health Insurance Portability and Accountability Act (HIPAA) has strict requirements about the privacy and security of video call applications.  Popular video call apps such as Facetime, Skype, and Google Hangouts are not HIPAA-compliant.  On the other hand, others such as Zoom, Vsee, Doxy.Me, and Google Hangouts Meet are HIPAA-compliant because of the encryption they provide and inability for call logs to be traced.

Read More: Do Therapists Have Therapists?

Fortunately, CMS relaxed this HIPAA requirement during the pandemic.  Despite this, it is still important to talk with your prospective online therapist and learn how they use technology in therapy.  Are they proficient in it?  Do they seem to understand the potential and pitfalls of this mode of therapy?

Make sure that all aspects of the telemental health process are secure.

As with regular in person therapy, it is important that every new patient understands and agrees to the process.  You should always review and sign an ‘informed consent’ agreement prior to starting teletherapy.  Such documents explain your therapist’s approach to treatment.  You should also be sure that any sensitive information that you provide is stored in a secure manner.  For example, ask your online therapist whether they use a secure online patient portal or encrypted email to send and receive such information.  Additionally, ask your telemental health provider how they process credit card payments and store any credit card information.

Now that we’ve discussed the technical stuff, lets get to the universal human side of this process…

As with in person therapy, make sure you have a good connection with your online therapist.

A fast internet connection isn’t the online important connection in online therapy.  The connection you have with your therapist is the most important factor to predicting the success of treatment.  Studies show that the therapeutic alliance or rapport developed in the first three sessions is predictive of the outcome of therapy.  If you like your online therapist, therapy is likely to go well.  If you feel lukewarm about your online therapist, it is much less likely to be successful.  It is always good to ask questions by email, phone, or even a brief video call prior to starting treatment.  Even if you don’t do that, use the first session as a ‘try-out’ session to see if it feels like a good fit.

Pay attention to the process of telemental health, not just the content of what you talk about.

How does it feel when you talk to your online therapist?  Do they do a good job of making eye contact and holding your gaze?  Do they pay attention to your nonverbals, including things like how you breathe, how you hold your body, and how you show (or don’t show) emotion?  Even though you can’t be in the room together, it is important to find a telemental health provider who is attuned to you and with whom you feel a secure attachment.

Find a telemental health provider with whom you can meet in-person, if necessary.

I suggest working with someone with whom you would have the possibility of meeting with for in person therapy sessions if these are necessary at any point.  While many people can and do choose to work with out-of-state providers for telehealth,  this doesn’t mean it is always ideal.  While the relationship and fit with your online therapist is the most important factor, make sure to have a backup plan in the event there is ever an emergent need for an in-person session.

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Eric Spiegel, Ph.D. is a licensed psychologist and practice director of Attune Philadelphia Therapy Group.  He was the President of the American Society of Clinical Hypnosis (ASCH) for 2018-2019, and has won numerous awards from ASCH, including their Early Career Achievement Award (2012).  Dr. Spiegel is the co-author of the book Attachment in Group Psychotherapy, published by the American Psychological Association.  He has also published journal articles and book chapters on subjects such as attachment therapy, hypnosis, group therapy, anxiety, trauma, and relationships.