When I first heard the words “onli..." /> When I first heard the words “onli..." />

Help at Your Fingertips: Is Online Therapy Right for You?

Young person with professional appearance uses video chat at homeWhen I first heard the words “online therapy,” I immediately thought of Lisa Kudrow’s character in the Showtime series Web Therapy. In the series, Kudrow plays Dr. Fiona Wallice, who starts an online therapy practice via Skype. She believes three minutes of therapy via webcam is better than 50 minutes of people “rambling on about dreams and feelings” in an office setting. It’s a comedy, mind you, and part of what makes it so funny is that it’s so, so wrong.

Today, online therapy—which falls under the so-called “telehealth” umbrella and is sometimes referred to as distance therapy—is exploding, and it’s very different from the way it’s portrayed on television.

There are pros and cons for both clinicians and people seeking help. From a therapist’s perspective, depending on your age and technical know-how, the idea of having a therapy session online might be daunting or perhaps even unthinkable. As a therapist in the 40-and-over crowd, I found it a bit intimidating in the beginning. After all, it requires a working knowledge of technology as well as an innovative spirit open to thinking outside the box.

As for the people I work with in therapy, those under age 30 seem to have no problem jumping online for a session. Of course, access to a computer and internet connection in a private setting is essential, and not everyone can make this happen.

For people who experience agoraphobia, travel often for work, have a chronic illness, or live in areas where pursuing therapy in person is impossible, online counseling can be a solution. As a therapist who works mainly with families affected by autism spectrum issues, I’ve found it is an easy way for people to get the help they need while they stay close by for whomever is watching their children. In fact, a recent study by Michigan State University found that parents of children with autism who conducted therapist-guided behavior and social interventions online experienced better results than those who conducted the interventions without a therapist’s help via video conferencing.

What to Ask a Therapist Before Starting Online Counseling

Many people don’t know what to look for in a therapist in general, and the online component adds a few more things the be aware of.

Skype is not an appropriate platform for therapy as it does not allow the therapist to be compliant with the Health Insurance Portability and Accountability Act (HIPAA).

1. What platform do they use?

Skype is not an appropriate platform for therapy as it does not allow the therapist to be compliant with the Health Insurance Portability and Accountability Act (HIPAA). Several other online platforms do allow for compliance and are just as convenient. If an online therapy platform is HIPAA compliant, it should say so on its website or promotional materials. It may not seem like a big deal, but your health information, including what you talk about in therapy sessions, is confidential. While it’s the therapist’s job to ensure it stays that way, some may not be aware that Skype is not a secure option.

2. What should you do in case of emergency?

Online therapy may not be the best form of treatment for people experiencing certain mental health conditions or emotional states requiring crisis intervention. Be sure to discuss what type of treatment is best for you and your particular diagnosis or treatment goals. Your therapist will need an emergency contact for you as well as knowledge of where your nearest hospital is; this information is typically gathered as part of any intake.

3. How can you reconnect if the connection is poor or dropped?

I once was in the middle of a session when the connection failed. It happens. If you don’t have a plan, you’ll both be trying to call/reconnect, and this can take time away from your session. My plan is that I will call the person back—either by reconnecting the call online or by telephone. It’s a real bummer when you’re in the middle of pouring your heart out to your therapist only to have the connection cut and then have to switch gears into problem-solving mode.

Considerations for Therapists

  • Where is the therapy considered to take place when online? In the U.S., psychotherapists are licensed by state. Since this method of therapy delivery is relatively new, some states have enacted (or are actively enacting) laws and rules regarding who can practice it, while others have done nothing. Why is this important? Online therapy is considered to happen where the person in therapy is when the session takes place. When I learned this, it was a game-changer. When I began looking up different states to find out where I could “see” people online, it became so daunting I simply decided to mainly see people in my state of Florida. On some occasions I’ve seen people who went off to college, but I made sure to check the telehealth laws in that state.
  • Beware of companies that promise “anonymous online therapy” but don’t protect the person in therapy or the clinician. There are a few companies out there that promise effective online therapy via email, text, or video chat, and even let you stay “anonymous,” but have no training or protection for the therapist or the person in therapy. I signed up with one early in my career and quickly realized the administrators could not answer basic questions about who I could see and who I could not, what needed to be done in case of emergency, and more. I was told it was up to me to understand the laws under which I practiced and they could not be held liable. I could not in good conscience work with such a company, and urge caution for both therapists and people who might try these services.

Whether you’re considering online treatment or you’re a clinician exploring the possibility, do your homework. There are some great places to find therapists who do online therapy, as well as resources for therapists to receive further training in this area.


Ingersoll, B, & Henion, A. (2016, May 24). Can Telehealth Fill Gap in Autism Services? MSU Today. Retrieved from http://msutoday.msu.edu/news/2016/can-telehealth-fill-gap-in-autism-services/?utm_campaign=media-pitch

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Janeen Herskovitz, MA, LMHC, GoodTherapy.org Topic Expert Contributor

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • Leave a Comment
  • Nellie

    July 12th, 2016 at 9:44 AM

    I would love to take advantage of this option! I have a job where it is nearly impossible to ever work with a medical provider’s schedule but if I utilized online tools then that wouldn’t be so much of a problem for me. I am definitely looking into that because I think that everyone can benefit from having someone like this to talk to every now and then.

  • janeen herskovitz

    July 13th, 2016 at 3:06 PM

    Nellie, thanks for your comment. It’s a great option for those who travel; however, so many states have restrictions, that you would need to make sure that you can find a therapist that is able to treat you where you are. onlinecounselling.com is a great place to find a therapist who works online. It’s similar to psychology today but for online therapists.

  • Roger

    July 12th, 2016 at 1:48 PM

    I sort of think that if you are the kind of person who needs to meet with someone face to face to be held accountable for your words and your actions then online counseling might not be the perfect choice for you. Sure it is more easily accessible but what happens when you need to meet with someone in person and you will not have that option if you are using an online counseling service? I think that there are some people for whom this will work beautifully and then fro others they will sort of find it lacking when they need a little more one on one support. But that’s just my perception.

  • janeen herskovitz

    July 13th, 2016 at 3:07 PM

    Absolutely. It isn’t a good fit for every client or every therapist.

  • Jane

    July 13th, 2016 at 7:50 AM

    Can you usually still file insurance for services rendered online?

  • janeen herskovitz

    July 13th, 2016 at 3:07 PM

    It all depends on the insurance company.

  • jeb

    July 13th, 2016 at 10:52 AM

    it might come down to a trust factor for me

  • Linda

    July 14th, 2016 at 8:28 AM

    And why isn’t Skype HIPAA compliant?

  • Charla

    July 14th, 2016 at 2:07 PM

    I am sure that for some people this is going to be a perfectly reasonable option for them that is going to make sense. For me though I like the personal interaction that I have with going into my counselor’s office and having that one on one time together. It is nothing against anyone who does it online, it’s just that I don’t think that for me it would be the best choice. But i am glad to see that there are more options than ever before so that more people can have access to therapy if they decide that they want or need to pursue that.

  • phyllis

    July 15th, 2016 at 10:11 AM

    My mother is afraid of leaving the house so this could actually be an option for her

  • Jayda

    July 17th, 2016 at 8:03 AM

    Personally I know what my own choice would be but it is nice to know that there are so many options available now that wouldn’t have been possible before. Everyone has their own specific things that they are seeking in therapy, and for some it might be some very deep work into the past while for others it might just be hashing out a few things that concern them right now. And the really great thing is that there is someone out there is some venue for all of us, no matter what we are searching for.

  • Sarah

    August 25th, 2016 at 5:22 PM

    Thanks for this, Janeen. I work as a psychotherapist online with those who live in my state, and I also work as a life coach online for individuals in other states and countries. Some of my clients choose online sessions on days when they can’t get away to come into the office. I use an encrypted HIPAA-compliant virtual office suite which is part of my website. It works very well for individuals who are comfortable with the technology.

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