Confessions of a Virtual Therapist: Pros and Cons of Online Therapy

Rear view of person with curly hair using laptop next to coffee cupI’ve been conducting therapy exclusively online for the past two and a half years, the last year of which has been in my own private practice. Prior to that, I conducted therapy in a traditional face-to-face format for nearly a decade. My initial reaction upon first hearing of online therapy years ago was curiosity. I wondered the same things many of us do when considering trying something new: How does this work? What can I expect? Is this vastly different than what I’m used to? What are the possible pros and cons?

Seeing that distance counseling is still gaining momentum, I feel that sharing what I’ve learned may be of use to both therapy seekers and providers.

My digital therapy journey began shortly after having my first child. I started to long for a more flexible work schedule that would allow me to be more present as a mother. A close friend of mine, aware of my dilemma, passed along a link to an established teletherapy company that was hiring. I jumped on the opportunity.

I was thrilled and terrified at the same time when I received a job offer. Excited because of the potential I saw in this modality to better match my lifestyle, and scared because I didn’t know what the heck I was doing or what to expect. Like anyone in the throes of anxiety, off I went on a quest to attain certainty and reassurance. This resulted in me acquiring the Distance Credentialed Counselor (DCC) certification, which I highly recommend for anyone interested in offering any of the various modalities of cybertherapy—including text, messaging, and video chat.

I remember working to finish this course at a furious pace, thinking I’d be working with people any day. Well, much to my dismay, this was my first lesson in how being a virtual therapist differs from being a face-to-face therapist. Cue cricket sound effects. I was under the assumption getting on board with a well-known, online therapy platform would immediately equate to making connections with plenty of people needing therapy. But, ironically, while more people have access to your services online than in the “real” world, you are like one tiny star in a vast cyber sky.

I finally started working with someone after about three months, and I’ll never forget how nervous I was. I was so worried it may be more difficult to accurately track shifting emotions, facial expressions, or body language via video chat. I was also concerned I may come across as more clinical, less warm or empathetic, making it more challenging to build rapport. I had conjured up these fears that since it was online, some crucial element would be missing—but I couldn’t pinpoint what that would be, exactly.

It was quickly revealed all these fears were unfounded. If anything, I find that both myself and the individuals I work with probably project more authentic versions of ourselves from the comfort of our own homes. The thing I place the most emphasis on—the integrity of the therapeutic relationship—is not diluted in any way because we are connecting through a screen. In fact, people often tell me that their online experience has been more satisfying than their previous in-person therapy.

Other beneficial aspects of virtual therapy include:

  • Flexibility in scheduling
  • Convenience, which seems to result in fewer cancellations than in face-to-face settings
  • Saving time from commuting to and from appointments
  • Generally less expensive than traditional therapy
  • Eliminates fears of running into known others in waiting area of therapy office
  • Potentially feeling more comfortable in a familiar setting, enhancing vulnerability and disclosure

The thing I place the most emphasis on—the integrity of the therapeutic relationship—is not diluted in any way because we are connecting through a screen. In fact, people often tell me that their online experience has been more satisfying than their previous in-person therapy.

Of course, there are disadvantages—perhaps the most notable being technological glitches such as inconsistency in internet connection strength or problems with the video chat platform. Understandably, frozen screens, echoing, low-resolution video feeds, and dropped calls are not conducive to the therapeutic experience. Internet strength, weather, and other variables all play a role in disruptions, and this is undeniably a con on both sides.

Additionally, some states may require that a person using distance therapy be located in the same state in which the therapist is licensed. Depending on the regulations where you live, this could limit your options as either the provider or the person seeking services.

Finally, as a consumer, in some cases it may be difficult to tell whether an online therapy service is credible, reputable, or safe to use. This is where it is important to do some research and insist on evidence of proper credentials and HIPAA compliance.

As you can see, online therapy, like traditional therapy, is imperfect. Is it better or worse than face-to-face therapy? I’d say that depends on perception. Does it have limitations? Sure. But it does appear to be effective for a certain subset of the population (non-suicidal individuals or those not in the midst of a major crisis requiring more intense intervention).

The experience of online therapy is apparently a reinforcing one; otherwise, it wouldn’t be a rapidly expanding means of providing and receiving therapy. But I leave it to you to decide if teletherapy is the right fit for you, either as a consumer or a provider. There is certainly more to say about this emerging field, but the parts I’ve shared are the ones that have impacted me the most. All I request, like the old saying goes, is “don’t knock it ’til you’ve tried it.”

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  • Jake

    Jake

    July 19th, 2017 at 10:57 AM

    Goodness I would love to have a job where I could work remotely and really set my own times and hours, as well as determine how many things that I would do in one day.
    That is the wonderful thing when you are self employed particularly in a field like this is you are in charge of so much of your own time and that concept very much appeals to me.
    Now if I only had a skill set that I could use to translate into those hours for me.

  • Melissa Stringer, LMHC, NCC, DCC

    Melissa Stringer, LMHC, NCC, DCC

    July 20th, 2017 at 7:49 PM

    Jake,
    It certainly sounds as if creating more flexibility in your work flow would be something of value to you. It’s true not all occupations/skill sets are online compatible, but I’d encourage you to continue exploring your options. Best wishes to you and thank you for sharing your thoughts!

  • Priscilla

    Priscilla

    July 20th, 2017 at 7:53 AM

    As an online therapist do you ever think that you are missing out on some key aspects of patient interaction that may help you when working with them by not being in a face to face work situation?

  • Melissa Stringer, LMHC, NCC, DCC

    Melissa Stringer, LMHC, NCC, DCC

    July 20th, 2017 at 8:16 PM

    Priscilla,
    That’s a great question, and certainly one I became preoccupied with when just starting out. I’ve come to peace with that worry, though, through consistent positive outcomes for those I work with online. I would say, specifically, pieces that are potentially missing are the subtlties of body language, or inflection of voice if the sound quality is poor. I do not suggest that online therapy is or ever should be a replacement for face to face therapy. Ultimately, how the individual in therapy perceives the experience as either beneficial or not is the most crucial element in my opinion. I can have my own personal worries/fears around what is being “missed”, but being able to separate that from what is actually happening (progression and improvement) is key. Thank you so much for both taking the time to read and sharing your question!

  • Hazel

    Hazel

    July 21st, 2017 at 6:56 AM

    I didn’t even realize that there was a special credentialing for long distance therapists. That is good t know and has to make people feel better.

  • Melissa Stringer, LMHC, NCC, DCC

    Melissa Stringer, LMHC, NCC, DCC

    July 25th, 2017 at 8:46 AM

    Hazel,
    I didn’t either until I started researching. Although the credential is certainly not required to practice tele-therapy, like you said, hopefully sends the message to clients the the therapist is making their best effort to offer ethical and quality services. Thanks for sharing you feedback!

  • Racquel

    Racquel

    July 21st, 2017 at 12:17 PM

    I provide online and in office therapy. I prefer doing online therapy but most clients seem to want in office. I’m hoping this will change soon.

  • Melissa Stringer, LMHC, NCC, DCC

    Melissa Stringer, LMHC, NCC, DCC

    July 25th, 2017 at 8:52 AM

    Racquel,
    That’s great to hear you are providing both formats for your clients. I would imagine whatever modality of therapy clients begin with is the one they prefer to stick with, so I could see how a full conversion may be challenging. Best wishes to you in establishing the modality that fits your preferences! Thank you for reading and sharing your comment :)

  • Angela

    Angela

    April 19th, 2018 at 12:42 PM

    I found this article reassuring and interesting as my organization is starting Telemed chemical dependency counseling. I wan to learn as much about this new field, the effectivness, client satisfaction and how we can be the best in this journey. Thank you for your honesty!

  • Melissa Stringer, LMHC, NCC, DCC

    Melissa Stringer, LMHC, NCC, DCC

    April 23rd, 2018 at 8:45 AM

    Angela,
    I’m so glad to hear you found this helpful! It can be daunting to transition over to new modalities with all the unknowns. I highly recommend the training provided by the Center for Credentialing Education for the DCC (Distance Credentialed Counselor) – I believe the credential title is being changing to Board Certified TeleMental Health Provider. The training was invaluable in preparing me in what to expect and best practices. Best of luck to you and your organization on this new venture!! Thanks for sharing your comment :)
    Take Care,
    Melissa

  • Yuya

    Yuya

    April 25th, 2018 at 11:32 AM

    Hi
    Thank you for the interesting article!
    I’d like to ask you something.
    There are many online therapy platforms and each platform has only 1000 or more therapists registered.
    Why do you think the number is so low??
    There are 3 reasons from my perspective.
    1, Online therapy tends to be less profitable than face-to-face therapy(Mentioned as ‘affordable’ for consumers)
    2, Therapists already have enough clients so they don’t have to find clients in online.
    3, Insurance companies often don’t support online therapy.( For example, betterhelp and talkspace therapies are not covered by insurance or they are unlikely to cover)
    I will really appreciate if you give me your opinion :)

  • Melissa Stringer, LMHC, NCC, DCC

    Melissa Stringer, LMHC, NCC, DCC

    April 27th, 2018 at 10:05 AM

    Yuya,
    You are quite welcome! Pleased to hear you found it informative. Although I’ve not personally researched the number of therapists registered within online platforms (I’ll take your word for it), I agree with the reasoning you have provided around why it may be low. Especially #3…many folks, understandably, are looking to use insurance to assist with cost of mental health care. Since online therapy is still relatively new, I’ll be curious to see in the coming years how consumers/providers/insurance companies evolve. Thanks for reading and commenting!
    Take Care,
    Melissa

  • Linda

    Linda

    June 9th, 2018 at 10:33 AM

    Hi Melissa, I would like to work about 20 hours a week with online clients. Did you ever find out why it took so long to get a client? Did your caseload build faster after that? Thanks!

  • Melissa Stringer, LMHC, NCC, DCC

    Melissa Stringer, LMHC, NCC, DCC

    December 6th, 2018 at 11:56 AM

    Linda,
    My apologies for the much delayed response! It seems I missed the notification for the question. My best guess is that it took so long to get my first online client is that the online platform was a new business. And yes, things really took off after that 3 month mark! So much so that I had to request my profile be taken down because I was nearing an undoable caseload. Thanks!

  • Nadia

    Nadia

    July 3rd, 2018 at 2:23 PM

    Hi Melissa,
    Thank you for your article! I recently passed my licensing exam and am now an LCSW. I’ve mulled over the idea of joining an online therapy platform. I was wondering, did you have to get your own liability insurance to practice online? Thank you for the help!

  • Melissa Stringer, LPC, NCC, BC-TMH

    Melissa Stringer, LPC, NCC, BC-TMH

    December 6th, 2018 at 11:59 AM

    Nadia,
    Congrats on becoming and LCSW! Yes, I do have to purchase my own liability insurance to practice online. Thanks for reading and commenting.

  • Kelly

    Kelly

    August 14th, 2018 at 8:56 AM

    Hi Melissa. Thank you for all the info and sharing your experience. I wonder if you know what any of the guidelines Are for treating someone out of the country. I have a long-term client moving to the UK for a year. She wants to continue therapy online while she’s away. Any insight as to liability or any worries I should be aware of are welcome. Thank you.

  • Chelsea

    Chelsea

    August 14th, 2019 at 4:17 AM

    Hello, and thank you for the article. I wonder, do you find that your online services attract a certain type of client (demographics, diagnosis, etc.) or presenting issue? If it’s a fairly general spread, is it skewed towards anything specific? My thanks in advance!

    -Chels

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