Online therapy and counselling: where to begin? by Giorgia Cristiani with illustrations by Cloudy Thurstag
Online therapy is relatively new, and it has been growing at a fast pace. With a quick google search it is now possible to access hundreds of therapy platforms and to be connected with thousands of professional counsellors and psychologists who are willing to work over Skype, phone calls, or even texts. The possibilities are (almost) endless, but before you sign up for these services, it is important to consider whether online therapy is the best option for you.
Pros of online therapy
Online therapy can be extremely beneficial in many cases when the access to in-person therapy is difficult or impossible. People who travel or move often, and are thus unable to see a specialist regularly, can keep the same online therapist and access counseling no matter where they are. As well, if you are a busy individual juggling a full-time job, a family, and other commitments that make it hard to stick to appointments, you could probably benefit greatly from the flexibility of e-therapy. This type of therapy is also good for those whose mental or physical health issues prevent them from seeing someone in person, or even leaving the house.
Financial accessibility remains one of the main obstacles to therapy. Many online therapy platforms offer competitive rates compared to regular therapy, therefore representing a valid option for those who cannot afford to shell $100+ for a single session. Finally, online therapy is definitely a great option if you prefer writing rather than talking, and/or are better at expressing your thoughts and feelings in the written form.
Cons of online therapy
The lack of in-person relationship is perhaps the biggest limit of online therapy. If you have a hard time communication over the phone or skype, and prefer face-to-face interactions with your therapist, this might not be a viable option for you. Also, keep in mind that responses are usually asynchronous, meaning therapists respond to messages when they login, which is usually once or twice a day, on business days. If you opt for text/email therapy, the lack of non-verbal cues can also have an impact on the conversation, resulting in miscommunication and frustration.
Online therapy is not recommended to those who are dealing with very serious mental illnesses. If you are struggling with addiction, paranoia, delusion, suicidal thoughts, etc., it is best if you seek help in person or call one of the prevention hotlines that are always available, such as the National Suicide Prevention Lifeline (1-800-273-8255), the national sexual assault hotline RAINN (1-800-656-4673), or 911 in case of emergency in America.
How to start
Let’s say you decide to give online therapy a try. The biggest question now is: how to start? The options available are so many, it can be overwhelming to scan through website after website looking for the perfect fit. Here is a small list of resources to guide you to the right direction.
Talkspace is a platform that connects you with more than 5000 therapist and can be used from any device. The information you share with them is kept safe and confidential through banking-grade encryption. You will start your journey by an assessment talk in which you will specify your needs and chose a payment plan. After this first step, you will be matched with a therapist and begin your therapy right away. Therapists respond 1-2 times a day. You will also have the option of scheduling video chat sessions.
LGBTQI: Talkspace has over 1000 therapists who specialize in helping individuals work through questions of gender, sexuality and identity, and they claim to be a 100% stigma-free platform.
Social Media Therapy: Talkspace offers therapy tailored around issues of social media dependency. Social networks help us staying connected to our loved ones, sharing our experiences, finding useful information, and much more. Unfortunately, social network use has also been linked to body image issues, depression, anxiety, and relationship problems. Talkspace has developed a 12-week program to help people deal with Social Media’s impact on their mental health.
Veterans: many of Talkspace therapists specialize in treating PTSD, trauma, severe depression, chronic anxiety, and different types of mental and physical abuse.
Talkspace offers three different types of membership, ranging from $69/week to $99/week for individual therapy. The cost for couple therapy is $99/week if billed monthly, $89/week if billed every 3 months.
BetterHelp is the largest online counseling platform worldwide. Through BetterHelp, you can communicate with your counselor in four ways: exchanging messages, chatting live, talking over the phone, and video-chatting.
In order to get matched with a therapist, you will have to fill in a questionnaire with questions about your age, gender, sexual orientation, physical and mental health, relationship status, your symptoms, and certain habits. After the questionnaire, you will have to enter your payment details and you will get matched to a therapist. Like Talkspace, you can message your therapist anytime, while also having the option to scheduling video calls.
You can check counsello’s profiles here. On their page, they indicate their areas of expertise and the service offered (messaging, live chat, phone talks, video calls). The cost of BetterHelp ranges from $40 to $70 per week.
3. 7 Cups
7 Cups is an on-demand emotional health service and online therapy provider. The difference between 7 Cups and other online therapy providers is that 7 Cups connects people and volunteering listeners, not necessarily certified therapists. Listeners are required to complete the Active Listening training program, an online course in advanced skills for compassionate communication. This is a great option for those who do not wish to commit to therapy, but simply feel like they need someone to talk to. However, if you prefer traditional therapy with licensed professionals, 7 Cups also provides that option.
7 Cup covers a broad variety of specific therapy topics, including body image issues and feeling fat, weight loss,disability, discrimination, LGBTQ, nonmonogamous relationships, racism, and much more. The rate accounts for less than $40 per week. 7 Cup does not offer instant messaging, but you can still write to your therapist anytime you choose, and as much as you would like. Therapists log in 1-2 times per day Monday through Friday and reply to your messages.
Pride Counseling works similarly to the other online therapy platforms: you share info about yourself, get matched to a therapist, and begin your journey through messages and/or phone and video calls. The difference between Pride Counseling and the other providers is that Pride Counseling is specifically tailored to meet the needs of the LGBTQI community. People of every gender, sexual orientation, and identity are welcome, and therapists working for Pride Counseling specialize in the support of LGBTQI individuals. Rates range from $40 to $70 per week.
The Body Image Therapist is a platform created by Ashlee Bennett, a registered art psychotherapist, counselor and coach. Ashlee uses cognitive behavioral approaches and focusing-oriented approaches to help people healing their experience in their body. Her approach complies with ASDAH (Health at Every Size), meaning clients are not subjected to discrimination against on the basis of their body size or current health behaviors.
The Body Image Therapist offers both in-person and online services. Online services are divided in online counselling, online coaching, and e-mail based support. As stated by Ashlee, coaching works best for individuals who are “currently working with a therapist and are after additional support specifically for body image, internalized fat phobia and mental health not steeped in diet culture”. The rate for online coaching and for online counselling is the same: $120 (AUD) for a 50-minute Skype session. The cost for e-mail support is $50 (AUD).
The Transgender Institute is a collaborative center that, with its partners, provides a full spectrum of therapeutic, psychological, psychiatric, medical, endocrinological, surgical and aesthetic care for the transgender person. Their team offers a variety of services, including therapy and coaching via Skype. Vocal feminization taught by a former singer and voice teacher is also available through Skype.
Unveiled Stories offers online and in-person counselling (based in Coffs Harbour, Australia) for “over-thinkers, perfectionists, introverts, broken hearts, atypical, survivors, and other people who just want to be free”. Counselling is provided by Nicole Hind, a psychotherapist who uses a narrative therapy approach, a method that recognizes that people have skills and expertise that can help guide change in their lives, and that uses the power of people’s own stories to help dealing with and overcoming difficult situations.
Some of the specific areas Nicole Hind offers support with are relationships (breakups, separation, divorce), women, and people with disability. In particular, her approach to disability is not one aimed at fitting into an able-bodied world: her narrative approach, aimed at making the person feel heard, has the goal of broadening the ability to seek the life imagined. In addition to video talks, this therapy uses email, drawing, chat, video-sharing, letters, music-sharing and any other creative idea the person might use to explore and understand their problems.
As for fees, the cost of video session is $120 (AUD) for a 55-minute session or $160 for 85 minutes, and a talk session is $100 for 55 mins or $135 for 85 mins. Instant messenger sessions are also available for $80 for 55 mins or $110 for 85 mins, while the cost of an email session is $70 per email exchange. Nicole also offers a list of options to help covering the cost of the sessions.
Does it work?
Many wonder if online therapy works, meaning if it is as good and effective as meeting your therapist in person. The good news is that there is evidence that cognitive behavioral therapy delivered face-to-face and via telemedicine were similarly effective in the case of treating eating disorders, and online therapy has proven to be effective to treat issues such depression, panic disorder, bipolar disorder, obsessive-compulsive disorder, and more. Indeed, the effectiveness of online therapy is usually the outcome of a combination of factors. Studies and trials have shown how online therapy reaches its maximum efficacy when (a) a proper diagnosis is made before the treatment starts, (b) a comprehensive treatment is provided, (c) the treatment is user friendly and not overly technically advanced, and (d) support and a clear deadline are provided for the duration of the treatment.
As in-person therapy, the crucial step with online therapy is to find the right therapist, both on a professional level (meaning they are licensed, have experience, and are qualified to treat your condition) and a personal one (you feel like you can trust them, and you are at ease with their methods).
Finally, you have to be comfortable with the medium you chose to communicate with your therapist. If you are a talker rather than a writer, Skype and phone calls are probably more effective than texting. Vice versa, if you feel uncomfortable speaking over the phone, or you think you express yourself better when writing, texting, live chat, and e-mails are most likely your best bet.
In the end, if you are considering online therapy, giving it a try won’t hurt. Most platforms are pretty flexible with their subscriptions and payments, so if you feel like it is not the best option for you, it is not hard to opt out and seek in-person assistance.