Our Handbook Team thoroughly examines online therapy platforms to understand how they can contribute to bridging the treatment gap. Let us show you exactly how we test, study, and review them.
Who are we?
The Handbook Team is made up of writers, editors, designers, medical reviewers, and fact-checkers dedicated to researching, testing, and reviewing health products and services.
We’ve spent over 7,500 hours and counting evaluating online therapy platforms. We consult with more than 60 licensed mental health care providers, such as therapists, psychologists, counselors, nurse practitioners, and psychiatrists. And we keep up with the latest published research on mental health and therapy.
We also continuously survey online therapy users and host focus groups with both users and therapists from these platforms. So far, we’ve researched more than 70 different online therapy platforms, directories, and practices, and we continue to evaluate and test new online therapy platforms monthly.
What goes into our review process?
In-depth research
Our Handbook Team conducts ongoing research into online therapy platforms, directories, resources, and apps.
We gather data on each platform’s treatment options, costs, plans or subscriptions, features, provider availability, insurance acceptance, privacy policies, and app functionality. We also contact customer support with questions to gauge responsiveness and helpfulness. We document our findings and compile our data to decide which platforms to test.
Real user testing
Members of our Handbook Team personally test online therapy platforms to gather hands-on experience and insights. We test each platform over a minimum of four weeks. For each, we lay out a series of milestones in our testing process to uniformly assess each platforms’ affordability, availability, usability, and customer satisfaction.
Our testers rigorously examine things like the sign-up processes, features, apps, video conference technology, therapist switching processes, and customer service. So far, we’ve tested more than 14 platforms and we identify and test new ones each month.
Professional insights
We consult with licensed mental health providers for every article we write to gain their professional perspectives on mental health care and the online therapy platforms we review.
Licensed therapists and psychiatrists give us insights into how online sessions work compared to in-person therapy, various app features, and the different types of therapy available. Each of our articles are also medically reviewed by an expert.
Meet one of our online therapy experts:
Surveys
We conduct surveys quarterly to learn more about real users’ experiences with online therapy platforms. We ask questions to find out:
- What their experience was like using online therapy.
- What matters to users while choosing a platform.
- How users leverage features included on a platform.
- The impact of online therapy on different aspects of users’ lives.
- How users feel about data privacy on these platforms.
We use our findings to inform our testing plans and how we evaluate platforms.
Focus groups
We conduct focus groups to interview both online therapy users and practicing therapists. We ask users about the factors that made them choose a particular platform and what is most important to them when using online therapy in general. We also interview therapists who provide care through online therapy platforms. We ask about their experiences and any advantages or disadvantages of teletherapy.
Our testing process
Fill out the intake assessment.
Subscribe as a new user.
Review provider match options.
Evaluate appointment availability.
Research what types of medications the platform can prescribe.
Contact customer support with questions.
Explore platform features such as journals, worksheets, and symptom trackers.
Cancel subscription.
Members of our Handbook Team personally test the most popular online therapy programs for at least one month. Our testers go behind the paywall to see what the platform offers and how it impacts their experience. Our team evaluates the platforms based on objective criteria. We log data points about features, user experience, affordability, and availability for each online therapy platform we evaluated.
Here are some of the questions we ask when we test online therapy programs:
- Are the plans on the online therapy platform affordable? Platforms may offer monthly subscriptions for online therapy, but how financially accessible are they? We compare the monthly cost commitment of each plan and look at whether platforms accept insurance, offer discounts, or have financial aid.
- How quickly can you start with a new therapist? We note how long it takes to match with a therapist, book a new appointment, and whether therapists are available at times that work with a tester’s schedule.
- How easy is it to find a therapist who is a good fit? Finding a professional you’re comfortable with can make a huge difference in your mental health journey. We test how easy it is to match with and switch therapists.
- What features are included? Journals, activity logs, or workshops may be additional resources included with online therapy platforms. We ask whether these extras make a monthly subscription more valuable in supporting users’ mental health.
Our online therapy rating indexes
In addition to our research and hands-on testing, we also rank brands based on their affordability, privacy practices, how quickly you can make an appointment, and how easy it is to find and match with therapists of different genders, ethnicities, and identities. Each rating index score is out of 10 possible points.
Affordability
To measure the affordability of online therapy platforms, we review a variety of information on pricing, payment, and overall value. We use this data to compare platforms against the other platforms we’ve already tested. These comparisons help us create an overall affordability score based on the following:
Pricing and transparency (50%)
- If the average cost for video therapy falls above or below the average cost of all the platforms we tested.
- If the platform makes their pricing structure clear on their website and if you can view these prices before completing an intake assessment.
Insurance (20%)
- If the platform accepts insurance and if users can check their insurance coverage before signing up.
Financial aid (15%)
- Financial aid options and how quickly the platform responds to financial aid applications.
Platform value (15%)
- The number of therapy formats available, including video, voice, messaging, and group therapy options.
- The number of tools and features, like digital journals, symptom trackers, or video lessons, included with a paid subscription.
- If the platform offers free mental health content and tools.
Data privacy
We research each online therapy brand’s data privacy practices and procedures to learn more about what information they collect and how it is handled.
Privacy policy (20%)
- We examine each platform’s data privacy policy and compare how frequently they updated the policy.
- We read closely to see if it clearly explains how the platform handles your data, and how you can request that your information be deleted.
- We look to see how brands collect and use personally identifiable information (PII) and if they speak about the difference between PII and protected health information (PHI) in their privacy policy and terms.
If this information is not clear on a brand’s website, we reach out to them directly for comment. For example, we asked Talkspace about the data they collect and if they use it for advertising purposes. Here is what Talkspace told us: “We share very limited information about the individuals who visit our website with companies that provide advertising services on the web or on social media. We do not share any therapeutic health care information or even information about a consumer’s potential interest in specific therapy conditions or potential diagnosis on Talkspace’s site. We do not sell user data nor share PHI (protected health information) or treatment data for marketing or advertising purposes.”
Privacy protocols (55%)
- We look for data processing standards like the Health Information Trust (HITRUST) alliance certification and if their practices follow the requirements of the HITECH act. This act regulates the electronic transmission of health information.
- We pull the SSL serving rating for each site from SSL Labs. This is a measure of a site’s security and encryption standards to ensure that it is safe to connect to and send sensitive information over that connection.
User security features (25%)
- We investigate whether or not platforms encrypted your data and the type of encryption they used.
- We look to see if the platform asks for consent to collect your data and at what stage in the process they ask for your permission.
Finally, if any brand has previously been subject to fines or penalties related to data privacy violations, we clearly outline the details of the violation and the steps the brand has taken to become compliant in our reviews.
Data privacy concerns aren’t limited to online therapy platforms. We recommend reading through the privacy policies of any online app or platform to understand what data will be collected, how it will be collected, and what the platform does with your data.
Availability
We evaluate each platform on the availability of its providers and how quickly you can make an appointment for therapy. This includes factors like the total number of therapists in their network, the number of states they operate in, the intake process, the process for switching therapists, and the responsiveness of customer service.
We also research the availability of each platform in five states, Ohio, Oregon, Utah, Washington, and West Virginia, that rank the lowest in mental health coverage and access, according to our research. We determine these rankings through a number of sources. First, we gather each state’s total population numbers from the United States Census Bureau. Next, we find the prevalence of mental illness in adults for each state in 2022 from data collected by Mental Health America. Finally, we use the IPUMS USA database, which compiles and organizes U.S. census data so it can be used for research purposes, to find the number of therapists per 100,000 people in each state.
Here are the specific data points we collect on each brand:
Therapist workforce (15%)
- Total number of therapists in the network.
- Percent of states served.
Intake process (10%)
- The length and detail of any intake forms.
Scheduling and therapist switching (15%)
- If you can switch therapists on your own, or if you must go through customer service.
- If you can see therapist time slot availability when selecting a therapist.
Customer service (25%)
- The average time it takes for a customer service response.
- If a customer service inquiry was ever ignored.
Availability in underserved states (35%)
- The number of therapists available per 100,000 people in each of the five most underserved states.
Inclusivity
To measure if each platform offers an inclusive experience and a diverse selection of therapists for all users, we evaluate them based on a specific set of factors. We developed these factors after surveying users of 10 of the most popular online therapy platforms in January 2024 to learn what mattered to them the most in terms of identity and inclusion. These factors include:
Therapist choice (25%)
- The ability to browse therapist profiles before booking a therapy session.
- If the platform lets you filter your therapist choices by gender identity.
- If the platform lets you filter your therapist choices by ethnicity.
Therapist diversity (15%)
- We ask survey respondents to rate their platforms on the diversity of the available therapists.
Culturally competent care (35%)
- We ask survey respondents if they feel their therapist is attentive to their specific identity when providing care.
Brand inclusivity signals (25%)
- If the platform has a published statement about anti-discrimination, diversity, and inclusivity.
- If the platform’s advertisements and website show diverse individuals.
How do we ensure online therapy brands hire qualified therapists?
We evaluate the online therapy brands we recommend to see how they ensure they hire qualified mental health professionals. We ask brands about their quality control and assessment practices for the therapists on their platform. While each brand has its own set of requirements, one common factor among the best brands is that they only hire licensed professionals.
BetterHelp, for example, requires applicants to provide their license and proof of identity, which BetterHelp then cross checks with the relevant state licensing board. Additionally, applicants must complete a case study that is graded by a licensed BetterHelp clinician. Therapists must then undergo a background report and BetterHelp conducts periodic checks through the National Provider Data Bank (NPDB). This is an online database operated by the Department of Health and Human Services that collects reports on health care practitioners so that licensing boards, hospitals, health plans, employers, and other organizations can learn if a provider is in good standing.
BetterHelp also told us that they have “dozens of QA and clinical quality control processes in place for providers on the platform.” This includes an “in-house clinical operations team” that “oversees these processes and our therapist community. The clinical operations team at BetterHelp is a team of licensed therapists and clinicians themselves.” According to BetterHelp, “The goal of the clinical operations team is to uphold high quality mental healthcare, so they do have measures in place to suspend and terminate therapists who are not meeting those requirements.”
You can review the hiring and training policies of any online therapy brand before you sign up. If this information is not easy to find on their website, you should ask their customer service to provide it to you.
Can online therapists practice across state lines?
We research current licensure requirements for teletherapy providers, specifically how providers can work with clients across state lines. While each state has its own licensing boards for mental health professionals, many states have laws, regulations, and exceptions that allow providers to offer services across state lines, especially for telehealth purposes.
Some states offer licensure reciprocity for neighboring states, which means that they recognize licenses granted in the other state and allow those professionals to provide services in their state. Others allow out-of-state professionals to practice telehealth in their state through telehealth registrations, which require the providers to meet various state requirements and register with the state’s licensing board.
Another way that states allow out-of-state providers to operate is through licensure compacts. These are agreements between multiple states that allow a professional licensed in one state to provide services in any other state that is part of the compact. For example, the Psychological Interjurisdictional Compact (PSYPACT) is an interstate agreement that allows professionals to offer telepsychology services across state lines for any state that is part of the agreement. 39 states are currently part of PSYPACT.
It’s important to learn your state’s policies and laws around telehealth and out-of-state licensing as they could impact how online therapy works for you.
Bottom line
Everyone should have affordable access to mental health care. Online therapy can be a convenient way to get help from a licensed therapist or psychiatrist from the convenience of your home, but whether it’s right for you will depend on your individual needs and preferences.
We consult with experts, gather real-user data, and test the top online therapy platforms to provide the most helpful information for our readers. We hope our insights empower you to make highly informed decisions about your mental health care.
- Mental Health America. (2022). Access to Care Data 2022. Link
- Centers for Disease Control and Prevention. (2023, April 25). About Mental Health. Link
- United States Census Bureau. (2023, December 18). State Population Totals and Components of Change: 2020-2023. Link
- Mental Health American (2022). Adult Data 2022. Link