By Rebecca Stone, LMHC-QS of Stone Counseling & Consulting Services, LLC

Clinician Guide to Online Therapy: Benefits, Challenges, and Is It Right for Clients?

In recent years, online therapy has emerged as a practical and convenient alternative to traditional in-person therapy. With the advancement of technology and the increasing demand for accessible mental health services, online therapy platforms have gained popularity worldwide. But with this surge in popularity comes critical questions: How effective is online therapy? How do providers effectively offer telehealth services?

What is Online Therapy?

Online therapy, also known as teletherapy or telehealth, involves receiving mental health support remotely through digital platforms. Remote services can include video calls, phone calls, messaging, or email exchanges with licensed therapists. Typically, however, telehealth services are delivered synchronously through HIPAA-compliant real-time audio and visual video call services, such as Zoom, Microsoft Teams, Google Meet, and EHR systems with integrated telehealth services. Online therapy helps to reduce barriers in accessing care by making mental health support more available to those who might otherwise struggle to access it.

Is Virtual Therapy Effective?

Determining the effectiveness of any form of therapy involves considering several factors, including client satisfaction, symptom reduction, therapeutic alliance, and long-term outcomes. While traditional face-to-face therapy has a long history of research supporting its efficacy, online therapy is a relatively newer phenomenon, leading to questions about its effectiveness in comparison.

Numerous studies have sought to evaluate the effectiveness of online therapy across various mental health conditions, including depression, anxiety, PTSD, and more. Overall, the findings suggest that online therapy can be just as effective as in-person therapy for many individuals. For example, a 2018 study published in the Journal of Psychological Disorders found that internet-based cognitive-behavioral therapy (CBT) was as effective as face-to-face CBT in treating depression.

Advantages of Telehealth Counseling

There are many advantages for clients to access telehealth, such as:

1. Accessibility: Online therapy eliminates the need to travel to a therapist's office, making it particularly beneficial for individuals living in remote areas, those with mobility issues, those with busy schedules, and more.

2. Flexibility: Online therapy offers greater flexibility in scheduling sessions, allowing clients to fit therapy into their busy lives more easily.

3. Comfort: Some individuals may feel more comfortable opening up about their feelings and experiences in an online setting, where they can remain in a familiar and comfortable environment, such as their home.

4. Convenience: Say goodbye to the hassle of commuting to and from therapy appointments. With online therapy, clients can schedule sessions at a time and place that works best for them, whether it's from their home, office, or parked vehicle.

Challenges and Considerations with Online Therapy

While online therapy offers numerous benefits, it's not without its challenges and considerations such as: 

1. Technological Issues: Poor internet connection or technical glitches can disrupt sessions, affecting the therapeutic process.

2. Lack of Nonverbal Cues: Communicating through screens, where we typically only see head and shoulders, may diminish the richness of seeing full-body nonverbal cues which potentially impact assessment efforts, the therapeutic alliance, or the client’s progress.

3. Security and Privacy Concerns: Ensuring the confidentiality of online therapy sessions is paramount. Therapists must offer services through HIPAA-compliant secure platforms, and both the client and therapist must ensure they have confidential spaces where they can each respectively have their sessions.

4. Safe Behaviors: Having convenience can open up behaviors which may not be typical in an in-office session, such as clients who want to drive during sessions, are out in public during sessions, or engaging in behaviors (such as substance use, using the restroom, etc.) that would otherwise not happen in an office setting. Being clear about safety considerations and appropriate therapeutic behavior is key.

5. Treatment Plan & Progress: Having the most appropriate care delivered through the most appropriate method is key to therapeutic progress. While many conditions and treatment modalities are as effective via telehealth as they are in-person, not all mental health conditions or treatments are best suited to be delivered via telehealth.

How to Offer Telehealth Services

Offering telehealth is a great option for therapists, so long as they're prepared in advance. Below are some suggestions to help you get started.

1. Be Compliant: Make sure you're aware of telehealth laws, rules, and regulations and ensure you're working with HIPAA-compliant services within your licensure jurisdiction/scope of practice. Explore whether your insurance policy covers telehealth/cyber coverage; if not, consider adding it on to ensure your practice is covered. Seek professional training or consultation as appropriate and stay up-to-date on telehealth regulations.

2. Get Consent: Ensure you have appropriate consents for telehealth services in place before offering telehealth services. There are unique risks and benefits related to telehealth and clients need to understand and consent to this beforehand.

3. Plan for Tech Issues: Have backup systems, such as secure hotspot, battery backup, headphones/microphone, and alternate telehealth platforms, that you can quickly transition over to and avoid delays or appointment cancellations. Be sure to create a plan, and share the plans with your clients, for how you will both handle any technological issues that arise during your sessions. Knowing how you’ll both handle it is essential in ensuring you can reconnect as soon as possible.

4. Create a Comfortable and Professional Space: Designate a quiet, soundproof, private, and professional space where you can fully engage in your therapy sessions without distractions.

5. Assess Appropriateness for Telehealth: Assess clients regularly to ensure their needs are best supported via telehealth. If you assess them to be moderate to high risk of harm to self or others, they are not responding to nor engaged with telehealth, or otherwise are not benefitting from telehealth services, have a discussion with them about this and refer to more appropriate services or levels of care. 

Conclusion

Online therapy has demonstrated its effectiveness in treating a wide range of mental health conditions and offers accessibility, flexibility, and convenience to those seeking support. While it may not be suitable for all clients, conditions, or treatment methods, overall, telehealth serves as a valuable option for therapy and has the potential to expand access to mental health care. Be sure you follow professional laws, rules, and guidance, and ensure you're taking appropriate clinical steps to support clients seeking and engaging in telehealth services.

Need Help Getting Started with Offering Telehealth Services?

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About Rebecca Stone, LMHC-QS

Rebecca Stone, LMHC-QS, is a Licensed Mental Health Counselor, Qualified Supervisor, and owner of Stone Counseling & Consulting Services, LLC, a private practice based in Florida. With over a decade of experience in clinical therapy and a strong background in business and office management, Rebecca blends compassionate care with operational expertise. She is passionate about supporting individuals on their mental health journey—and empowering fellow professionals through supervision, consultation, training and education, and practical tools to grow thriving practices.