Cognitive Behavioral Therapy (CBT)
How it can help with anxiety, depression, PTSD, substance abuse, and more
Whether you’re seeking psychotherapy for stress, relationship difficulties, bereavement, depression, anxiety, or another mental health problem, online counseling or teletherapy may be an effective solution. Here’s all you need to know.
Online therapy is the provision of professional mental health counseling via the internet, usually through live video chat, messaging app, email, or over the phone. Also known as teletherapy, telemental health, e-therapy, or online counseling, the practice has grown rapidly in popularity since the start of the COVID-19 pandemic, allowing a patient to connect with a qualified therapist from the safety—and comfort—of their own home.
Traditional, in-person therapy usually takes place in a therapist’s office, and has long been used as an effective treatment for many different mental and emotional health problems. Talking to a professional can help you overcome obstacles in your life, gain awareness of the root cause of your problems, manage symptoms, and heal. As an example, studies have shown that cognitive behavioral therapy (CBT) can be as effective as antidepressants in treating moderate to severe depression—but without the risk of harmful or unpleasant side effects.
You don’t have to be dealing with a diagnosed mental health problem such as depression or anxiety to benefit from therapy, though. If you’re going through a difficult time in your life, such as a bereavement, divorce, or unemployment, therapy can help. Even if you’re facing everyday concerns like overwhelming stress, low self-esteem, or trouble sleeping, the right therapist can provide expert support and guidance and help you make positive changes.
While online therapy is a much newer form of therapy, current evidence suggests that for many people it can be just as effective as in-person therapy. Talking from the security of your own home may even make it easier for you to open up about your problems. Online therapy also enables you to communicate with a qualified specialist from anywhere in the world, while avoiding the expense, travel time, and inconvenience of having to meet in-person.
Of course, there can be some significant drawbacks to online therapy as well. While connecting via text or messaging app, for example, may be a more comfortable way of communicating for some, especially younger people who grew up using the technology, the lack of face-to-face interaction robs the therapist of gauging your all-important body language and tone of voice. It can also make it much harder to build trust and a supportive rapport between therapist and patient which is crucial to the success of therapy. That can really only be achieved in-person or via a live video link.
Ultimately, how well online therapy works often depends on the same factors that determine the success of any type of therapy: the level of connection you make with your therapist, how much you’re able to open up, and the work you’re willing to put into the process. In addition to attending your sessions, you need to apply what you’re learning to real life situations and make the healthy lifestyle changes that can support your mood and emotional health. While no therapist—online or in-person—can do the hard work of healing and growth for you, a good therapist can use the available technology to help you gain new insights and change your life for the better.
Online therapy can take different forms—and the benefits and drawbacks compared to in-person therapy can vary with each. Some therapists offer online therapy through their own private practices, while others use third-party websites or directories to connect with patients. Some of these services limit the contact between therapist and patient to messaging or live texting, while others also include weekly phone calls or live video chats. It’s the latter that provides the closest experience to traditional, in-person therapy—and is therefore most likely to offer the same rewards.
While being able to call, email, or message your therapist between live sessions can be extremely helpful, experts agree that it’s most effective when used in addition to face-to-face interaction—either in-person or via video—rather than as a replacement for it.
Body language and other nonverbal cues play an important role in how we communicate as human beings. Your facial expressions, mannerisms, posture, and tone of voice can communicate far more than your words alone. In a therapy setting, the subtleties of nonverbal communication can be crucial in helping the therapist pick up on any inconsistencies between your verbal and nonverbal responses. It can also help them to recognize the things that you may be unwilling or unable to put into words, and understand the true meaning behind what you’re saying.
[Read: Nonverbal Communication and Body Language]
Similarly, interacting face-to-face with a therapist—even on a video screen—can help forge a connection between you that’s so important to the success of therapy. It’s much easier to build a sense of trust with someone when you can see the emotions and empathy they’re communicating nonverbally—rather than just reading their written messages or listening to a faceless voice.
In addition to the importance of face-to-face interaction, there are other aspects to consider when comparing online to in-person therapy.
Convenience. Online therapy means you can access help from anywhere you have a fast Internet connection. You don’t need to spend time and money traveling to appointments, fighting traffic or dealing with public transport, parking, sitting in a waiting room, paying for child care, or taking time off from work. Many of the obstacles that prevent people from seeking in-person therapy are eliminated by the convenience of online therapy.
Comfort and safety. Seeing an online therapist from the comfort and security of your own home can often help you to open up, be more vulnerable, and better cope with difficult emotions that may arise during a therapy session. If you have mobility issues, chronic illness, or a condition that can make it difficult to leave your home—such as agoraphobia or social anxiety disorder, for example—online therapy can be the ideal solution.
Selection. Online, a qualified therapist is accessible to you even if you live in a remote area. No matter where you live, the greater selection of specialists online also means that you’re more likely to find a therapist with experience dealing with your specific problem. (While in theory you have access to therapists from all over the world, in some areas you are limited to providers licensed in the state or country where you live.) With increased choice comes another important benefit of online therapy: it’s often easier to keep changing therapists until you find the right match for you.
Ease of communication. When you meet with a therapist for just an hour a week, it’s sometimes difficult to recall everything you’ve been through in the preceding week. Being able to email or message your therapist between live sessions enables you to articulate your emotions and problems in real time as they arise. The messaging aspect of some online therapy services can also be useful in keeping track of your progress and monitoring any setbacks.
Privacy. Many people still feel a stigma about getting treatment for mental health issues. It’s easier to receive treatment online anonymously than it is visiting a therapist in-person. Connecting online, there’s never any fear of bumping into someone you know in the therapist’s parking lot or waiting room, for example.
Technical issues. With online therapy, you’re reliant on the speed of your internet connection and reliability of your electronic devices. If you’re unable to stream movies online, it’s unlikely you’ll be able to sustain an uninterrupted video chat with a therapist. Of course, even the best connections and equipment can experience problems at times, disrupting or curtailing your therapy session.
Loss of emotional connection. As effective as video conferencing can be, when you’re not physically sharing the same space as the therapist, it may be harder to connect emotionally. Even when talking via video, some body language signals can be lost. The therapist may not see your tapping leg under the table, for example, or you may find it harder to pick up on the therapist’s empathy and caring.
Unqualified providers. As with seeking any service online, there’s always the risk of falling prey to an unqualified or disreputable provider. It’s important to always check a therapist’s credentials or use a reputable third-party service that screens all the counselors on their list.
There are still some situations where in-person therapy is preferable to online therapy. If you’re currently suffering from a severe mental illness such as schizophrenia, or you’re feeling suicidal or facing another crisis situation, a therapist will be in a much better position to help you working in-person, rather than remotely.
The key to any type of therapy—online or in-person—is to find the right therapist for you. Qualifications, experience, and philosophy can be important, but it’s the relationship you develop with the therapist that will often define the success of your therapy.
Finding the right online therapist can take some time and effort, so don’t be afraid to ask questions, read reviews, and take advantage of any free introductory sessions. An online therapist will become your partner in healing, recovery, and growth so it’s important to choose someone who makes you feel understood, supported, and cared about. You need to trust this person enough to talk comfortably about intimate and often difficult subjects and to be honest about what you’re thinking and feeling.
Compare online counselors, platforms, and the services they offer. But give preference to therapists who provide weekly live video sessions where you can connect face-to-face in real time. Text and messaging services may be useful if you already see an in-person therapist and are just looking for additional support, but they’re unlikely to be an effective way to build the necessary bond with a therapist.
[Read: How to Find a Therapist Who Can Help You Heal]
Do your research first—but be open to change. It can sometimes feel overwhelming to scan a long list of available online providers. Understanding a little about the different types of therapy and therapists can make it easier to make a selection. But once you’ve chosen a therapist, be open to making a change if it doesn’t feel right. Trust your instincts. An advantage of selecting an online counselor from a third-party service is that it’s easier to keep changing therapists until you find one that’s a good fit for you.
Understand what you want to achieve from therapy. The clearer you are about your goals for starting online therapy, the easier it will be to measure your progress and ensure you’re getting the most out of the process. You may be seeking help to address a specific mental health problem, for example, or cope with a particular aspect of your life that’s not working. Whatever your reasons, make sure you communicate them to your therapist and ensure they’re being addressed during your time together.
Be open and honest with your therapist. It’s common for disturbing or painful emotions to arise during therapy. Open up and share your feelings with your therapist. If something is too difficult to talk about, let them know. The more open and honest you are, the better your therapist will be able to help you.
Be prepared to put in the work. Online therapy requires more than just logging on to talk once a week. A counselor may give you homework to do between sessions or ask you to try out techniques in real-world situations. To get the most from the experience, be prepared to put in the time and effort. And if you find yourself frequently skipping therapy sessions, ask yourself why—and discuss it with your therapist.
Limit distractions at home. Talking to a professional from the comfort of your own home is extremely convenient—but you’re not going to get as much from therapy if your sessions are disrupted by kids, other family members, noisy neighbors, phone calls, or other interruptions. Choose a time for therapy when your home is at its quietest, ask other family members not to disturb you, turn off your phone, and mute any other apps.
Ensure you have a fast and reliable internet connection. Your therapy experience will suffer if your sessions are frequently interrupted by connection or computer problems. Address any technical issues you experience, whether that’s by upgrading your internet speed or updating the software or app you’re using.
While online therapy is often cheaper than in-person therapy, the cost can vary considerably according to where you live in the world, the benefits you have access to, and the type of service being offered.
In the United States, for example:
Whatever country you live in, you also have the option of paying for online therapy privately. Many third-party services offer monthly or yearly subscriptions to reduce the cost, or packages that allow you to purchase multiple sessions at a discounted rate. Some online therapy services even offer free trials so you can sample interacting with a therapist to help gauge if it’s right for you. Others deliver free or reduced rates by connecting you with trained volunteers rather than professional therapists.
Any of these methods can help lower the cost of online therapy and make it as affordable as it is convenient.Last updated or reviewed on February 22, 2023
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