What Is Online Therapy?

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Online therapy, also known as e-therapy, e-counseling, teletherapy, or cyber-counseling, involves providing mental health services and support over the internet. This can occur through email, text messaging, video conferencing, online chat, messaging, or internet phone.

Online therapy can occur in real-time, such as in phone conversations and text messaging, or in a time-delayed format, such as through email messages. This type of therapy has limitations, but it is quickly becoming an important resource for a growing number of consumers. There are a number of reasons why a person might choose an online therapy option, including the convenience and accessibility that this delivery method provides.


What Is Online Therapy?

How It Works

Primary tools for communicating in online therapy include:

  • Email
  • Text messaging
  • Real-time chat
  • Internet phone
  • Videoconferencing
  • Mobile device apps

Such services may be accessed via a desktop computer or laptop, but mobile apps are also becoming an increasingly popular option.

History of Online Therapy

Distance communication between a therapist and client is not a new concept. Sigmund Freud utilized letters extensively to communicate with his clients. Self-help groups began emerging on the internet as early as 1982. Today, there are numerous sites offering mental health information as well as private e-therapy clinics.

The growth in online counseling and mental health services has led to the foundation of the International Society for Mental Health Online. This dramatic rise in the availability of online health care has led to a need for information and guidelines for customers interested in receiving mental health services via the internet.

In recent years, online sites and apps devoted to mental health services have become increasingly popular.

Options such as Talkspace and BetterHelp provide a range of options and price points, making these options appealing to those looking for affordable and convenient treatment options.

The prevalence of smartphones has led to a number of app-based options that are accessible and often quite affordable. Evidence also increasingly shows that such options may be an effective treatment option for some people.


While online therapy presents some challenges, it has received support from many patients who have utilized online mental health treatments. In a review of studies published in the journal World Journal of Psychiatry, patients receiving mental health treatment through video conferencing reported "high levels of satisfaction."??

online therapy
?Verywell / Alison Czinkota?

Research also suggests that online therapy may be effective in the treatment of a number of health issues. This is good news for many people, particularly those who live in rural areas where access to mental health services may be limited.

In one study, researchers found that online CBT combined with clinical care was effective in the treatment of depression, anxiety, and illness-related emotional distress. In some cases, the results indicated that some patients actually had better outcomes with online treatment than those who had traditional in-person CBT.??

Cognitive-behavioral therapy is one of the most well-studied forms of treatment and has been shown to be effective in the treatment of a range of mental conditions including depression, anxiety, PTSD, eating disorders, and substance abuse. CBT works to help people identify and change negative thoughts and behaviors.

A 2015 study found that internet-based cognitive-behavioral therapy was just as effective as traditional face-to-face CBT in the treatment of anxiety disorders.?? One 2017 review of studies also concluded that online CBT was an affordable and effective option for the treatment of mental health issues.??

Online therapy is not appropriate for everyone, but there are times when people might prefer this approach.

For example, those who feel uncomfortable attending traditional face-to-face support groups might benefit from internet-based options. Online psychotherapy services have some advantages and disadvantages that should be carefully considered.

Convenience is often cited as one of the greatest benefits while unreliable technology and lack of insurance coverage are potential downsides. Before you decide if online therapy is right for you, think about issues such as confidentiality, ethical and legal issues as well as the qualifications of online therapists.

Online Therapists

Just as therapists and counselors in "real-world" settings can have a range of qualifications and licenses, online therapists can also differ considerably in their training and credentials. While some sites may promise a quick and easy path to becoming an online therapist, the fact is that the educational and training requirements to become an online therapist are exactly the same as they are for a therapist or counselor practicing in a traditional face-to-face setting.

However, the actual practice of online therapy is very difficult to regulate since therapists can operate from anywhere in the world making it tough to enforce state laws regulating education, training, and scope of practice.

Online therapy is appealing to mental health consumers, who often view it as a convenient, economical and accessible alternative to traditional face-to-face therapy.

However, it also poses a number of unique concerns including questions about the confidentiality of client information the appropriateness of using online therapy as a treatment method for various psychological disorders. If you are interested in becoming an online therapist, then you should check the laws in your state to determine the requirements for becoming a licensed therapist or counselor.

The Online Therapy Institute also offers a good ethical framework for the use of technology in mental health. These guidelines suggest the minimum practices and standards required for ethical online therapy:??

  • Therapists should only work within the scope of their practice. In other words, online therapists should only offer services that they are trained to provide.
  • Online therapists should adhere to the laws and guidelines specified by their geographic location. For example, in the U.S., only individuals who have received specific training and have passed the required licensing process are legally allowed to call themselves psychologists.
  • Therapists should obtain knowledge, training, and supervision in online therapy practices and techniques. This includes formal training (college or university courses), informal training (workshops and conferences), and clinical supervision (either face-to-face or online).
  • Online therapists should have a solid understanding of technology. This includes how to use the tools required to deliver psychotherapy online and how to ensure that client information remains private and secure.

A Word From Verywell

While research increasingly suggests that online therapy can be an effective option, that does not mean that it is right for everyone. More serious forms of mental illness, including substance addiction and psychiatric conditions including severe depression and schizophrenia, require more than online treatment can provide. 

Consider talking to your doctor about your options to determine if an online option might work for your situation or as a supplement to more traditional treatment options. If you think that online therapy might be right for you, research some of the sites and apps that are available to determine which one is right for your needs and budget.

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Article Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Chakrabarti S. Usefulness of telepsychiatry: A critical evaluation of videoconferencing-based approaches. World J Psychiatry. 2015;5(3):286-304. doi:10.5498/wjp.v5.i3.286

  2. Gratzer D, Khalid-khan F. Internet-delivered cognitive behavioural therapy in the treatment of psychiatric illness. CMAJ. 2016;188(4):263-272. doi:10.1503/cmaj.150007

  3. Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2015;(3):CD011565. doi:10.1002/14651858.CD011565

  4. Kumar V, Sattar Y, Bseiso A, Khan S, Rutkofsky IH. The effectiveness of Internet-based cognitive behavioral therapy in treatment of psychiatric disorders. Cureus. 2017;9(8):e1626. doi:10.7759/cureus.1626

  5. Online Therapy Institute. Ethical framework for the use of technology in mental health. 2009.

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