What you need to know before choosing online therapy

With the click of a mouse or the tap of an app, you can have instant and inexpensive access to a therapist, or so make the claims of many new tools and technologies that want to take psychotherapy out of the therapist’s office and into whatever location you are connected to the Internet.

With the click of a mouse or the tap of an app, you can have instant and inexpensive access to a therapist, or so make the claims of many new tools and technologies that want to take psychotherapy out of the therapist’s office and into whatever location you are connected to the Internet. Using the Web can be convenient for the many people who are comfortable using the Internet and looking for help.

But before you sign up, log in and start chatting, there are points to consider about telepsychology.

Psychologists commonly refer to any therapy delivered by telecommunication tools or devices as telepsychology. You may hear it called Web therapy, phone therapy, text therapy or online therapy. Anytime you’re interacting with a psychologist using a website, a phone or a mobile app, you could be taking part in telepsychology services.

Technology can contribute to an evolution in how people receive psychotherapy or work with a psychologist. Researchers are taking great interest in telepsychology and telehealth, evaluating how well it works, especially compared to in-person, in-office psychotherapy sessions. But much like the technology, the research is still new, and there is a lot science doesn’t yet know. There are a few points to consider before signing up for any services that are offered exclusively online or by telephone.

Why people like Web therapy

Web therapy has a lot of promise and offers benefits compared to in-person psychotherapy.

It can be convenient. Online therapy can take less time away from the office or your workday or worry about traffic. No need to travel miles to meet up with your psychologist. Dial a number or log in to a site, and the session can happen wherever you are comfortable.
Compared to traditional in-person therapy, it can sometimes appear less expensive. Some apps will advertise pricing that provides unlimited use for a weekly or monthly fee. Or the online session may seem significantly lower than in-office visits. If you’re not interested in using health insurance for psychotherapy, this can be a benefit. More about insurance and online therapy is discussed in the next section.
Online communication is very comfortable for many people, especially younger adults or those who use technology often. More people are using email, webinars and text messaging to communicate, and it can seem more comfortable or easier than talking to someone in person, especially when revealing personal or private information.
It can provide access to those who can’t get to an office. In some rural communities, the nearest psychologist office may be an hour or two drive away. Some people with chronic illnesses or disabilities may not be able to drive or easily able to leave their home. In these situations, Web- or telephone-based therapy may be their only option for help.

What you need to think carefully about regarding Web-based therapy

Despite the potential benefits, psychologists caution that Web-therapy may not be the best option for everyone or every situation in need of professional support. Here are a few points to consider or ask before signing up:

Is this the right tool to help me? The research hasn’t yet shown that stand-alone therapy online or via texting is effective for everyone in every situation. Some sites advertise that they offer therapy, but those claims may be misleading or false. For example, the people behind the apps may not be licensed or qualified to provide therapy.
Is the therapist licensed? Licensing protects you. Therapist and psychotherapist are not legally protected words in most states, meaning anyone can claim to be a therapist and offer services that may appear as therapy. It may not always be easy to know that you are receiving evidenced-based psychotherapy.
All psychologists and other professional health providers must be licensed by the state in which they practice. Licensure laws protect you by ensuring only those who are trained and qualified to practice receive a license. It also ensures that you have recourse if there are problems with your treatment. Before you sign up for any Web services, find out who you are working with, if he or she has a license, where that license is held and the license number. Most states offer an online, searchable directory of professionals licensed in their state.
Is the psychologist licensed in the state you live? Licenses are granted by each state with their own laws and rules, much like each state determines what residents must know to earn a driver’s license. But unlike driver’s licenses, which allow you to legally operate a car in all states, a health care provider is limited to providing services in the state in which they are licensed. The provider must be licensed in the jurisdiction where you are located, and making that determination may be difficult to do if you don’t know where he or she is physically located.
Is the site or app secure? Will the information I provide remain confidential? Psychotherapy works in part because psychologists ensure that clients have a safe, private space to share deeply personal and sometimes difficult stories, thoughts or emotions. What happens and is said in a therapy office stays there, with the exception of a few situations. The site or app you use should, at a minimum, be HIPAA-compliant and have the ability to verify your identity and your therapist’s identity.
How will you pay for the service? Many insurance companies cover the treatment of mental health and substance abuse disorders — treatment that includes in-person psychotherapy. If you work with a psychologist in her office, your insurance could cover most or all of the fee, depending on whether you need to meet a deductible or have a co-pay. Psychologists will often provide an invoice that you can submit to your insurance company for reimbursement. But online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.

More psychologists are exploring online sites and apps just as more patients are interested in using them. Research does show that some technological tools can help when used in conjunction with in-office therapy. Many psychologists and patients are finding text messages helpful for quick check-ins or reminders. Some apps can help track and log moods or thoughts. Web-conferencing and streaming in real time can offer continuity when a patient is on vacation or not able to make a regular session. There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people. But for now, with the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy.

Research articles related to online therapy

Assessing the effectiveness of online therapy:

Andersson, G., & Cuijpers, P. (2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38(4), 196-205. http://www.ncbi.nlm.nih.gov/pubmed/20183695

Barak, Azy, et al. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26.2-4: 109-160. http://www.tandfonline.com/doi/abs/10.1080/15228830802094429#.VI8vaCvF_hs

Nagel, D. (2011). The future of online therapy. Psychotherapy Networker Symposium, Washington, D.C. http://dx.doi.org/10.1037/e561872012-001

Neimark, G. Patients and text messaging: A boundary issue. (2009). The American Journal of Psychiatry. 166(11), 1298-1299. http://dx.doi.org/10.1176/appi.ajp.2009.09071012

Wantland, D. J., Portillo, C. J., Holzemer, W. L., Slaughter, R., & McGhee, E. M. (2004). The effectiveness of Web-based vs. non-Web-based interventions: a meta-analysis of behavioral change outcomes. Journal of Medical Internet Research, 6(4). http://www.jmir.org/2004/4/e40/

Online therapies for various conditions

Depression

The effectiveness of face-to-face therapy for depression was compared to online therapy. Online therapy was composed of online therapist mediated CBT assignments, and text-based consultation with a therapist. Refer to complete study for results.
Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. (PDF, 389KB)

Depression, anxiety and stress

The effectiveness of a CBT self-help program, where therapists provided feedback over text, was assessed. Refer to complete study for results.
Mobile mental health: Review of the emerging field and proof of concept study.

Panic disorder

The effectiveness of face-to-face therapy to a guided online CBT program (composed of techniques such as cognitive restructuring and exposure therapy) was assessed. Written feedback was given by therapists on program assignments, and further therapist consultation for the online program was over texting platforms. Refer to complete study for results.
Internet-versus group-administered cognitive behavior therapy for panic disorder in a psychiatric setting: A randomized trial.

Schizophrenia

Texting therapy for addressing symptoms of schizophrenia and enhancing patient medication adherence to schizophrenia pharmacotherapy was studied. Refer to complete study for results.
Mobile Assessment and Treatment for Schizophrenia (MATS): A pilot trial of an interactive text-messaging intervention for medication adherence, socialization, and auditory hallucinations.
A comparison of telephone and texting interventions for persons with schizophrenia spectrum disorders.

Diabetes management

Nurse management of diabetes patients via text messaging was assessed. Nurses utilized text messaging to manage the behavioral health of patients through promoting correct administration of diabetes treatment. Refer to complete study for results.
A nurse short message service by cellular phone in Type-2 diabetic patients for six months.

Health promotion for weight loss

Email-based therapy’s effectiveness in promoting behavior change for weight loss was assessed. Email was conducted solely via mobile phones. Refer to complete study for results.
Development and effects of a health promotion program utilizing the mail function of mobile phones.