Traditional talk therapy is in-person and office-based. Read a balanced analysis of the advantages and drawbacks of online counseling (e-counseling).
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“Professional counseling is too expensive, too time-consuming, and it’s inconvenient. Besides, I don’t want anyone to know I’m getting therapy.”
These are some of the many reasons why less than half of those with a mental health disorder seek counseling, aka psychotherapy. (1)
But e-counseling overcomes these and other objections, making mental health therapy more accessible to everyone.
What Is E-Counseling?
Psychologists, and other mental health professionals, use psychotherapy (talk therapy) to help their clients recognize and change thought and behavior patterns that negatively impact their lives.
Psychologists commonly refer to therapy conducted via an electronic device, rather than face-to-face, as telepsychology.
E-counseling is simply a more common term for telepsychology.
Depending on your therapist’s set-up or the online counseling service you’re using, your therapy sessions can take place via phone call, webcam, online chat, email, or text.
Note: E-counseling goes by many other names, including online counseling, online therapy, e-therapy, teletherapy, cyber-counseling, web therapy, internet-based psychotherapy, distance therapy, and remote counseling.
Remote counseling is not new.
In fact, Sigmund Freud could be considered the original remote counselor since he frequently wrote letters to patients.
E-counseling, as we now know it, has been around in some form since the advent of the internet.
The International Society for Mental Health Online has been exploring and promoting mental health via digital means going back to 1997.
But online therapy has recently exploded in popularity due to the increase in smartphone use, the creation of online counseling services (like BetterHelp and TalkSpace), and acceptance by both the consumer public and mental health care professionals. (2)
Teletherapy has not been without controversy, and practitioner reluctance has been the biggest barrier to its use, but many therapists now acknowledge its value. (3)
They realize that e-counseling can be a positive step that makes therapy accessible to many people who would otherwise avoid professional care.
Online therapy sometimes transitions to traditional face-to-face therapy when the situation warrants.
Some counselors even offer blended counseling, a combination of both in-office therapy and e-therapy.
Research Confirms That E-Counseling Is Effective
Before we look at the advantages and drawbacks of e-counseling, let’s address the most important concern first.
Does e-counseling actually work?
E-counseling has been found to be effective for people of all ages, from children and adolescents to the elderly. (4)
- anxiety disorders
- dysfunctional thinking
- eating disorders
- general distress
- mental distress from physical diseases (cancer, diabetes, IBS)
- post-traumatic stress disorder
- quality of life issues
- stress management
One large review of studies that included nearly 10,000 clients found that e-counseling had outcomes “quite similar” to traditional, face-to-face therapy. (10)
Another large review that encompassed about 12,000 participants found that online therapy helped them make positive behavioral changes. (11)
E-counseling helped them eat healthier, exercise more, and maintain weight loss longer.
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The Major Advantages of E-Counseling
The evidence is clear that e-counseling is effective.
Here are some of the advantages that online counseling has over traditional, office-based counseling.
E-counseling allows you to make appointments that suit your schedule.
You can communicate with your therapist from the comfort of your own home or any other secure location you choose.
Your therapist may also give you the option to text or email 24/7.
In the US, the nationwide median rate for therapy is $120 per 45-minute session, but this can be more or less depending on where you live. (14)
This makes e-counseling an affordable option since appointments typically cost much less than paying out-of-pocket, or even paying co-payment amounts.
E-counseling helps to democratize mental health therapy, making it more accessible to everyone.
Online counseling is ideal for many people:
- employees who can’t take time off for appointments
- anyone lacking mobility or transportation
- underserved populations (rural, inner cities)
- the uninsured or underinsured
- stay-at-home parents
- college students
It’s not unusual to have to wait for weeks for your first appointment with an office-based counselor.
Online therapy services can generally get you access to a therapist fast.
Many people who could benefit from mental health counseling are ashamed or embarrassed, or afraid of being judged by employers, colleagues, or family.
Counterintuitively, e-counseling can be more private than traditional counseling.
You don’t have to take time off work or inform your insurance company.
No one is going to see you walking in or out of your therapist’s office.
With some e-counseling services, you can use a nickname so that you don’t have to reveal your real name to your therapist.
This anonymity can actually help some people be more forthcoming with their therapist — a therapeutic advantage.
It can be hard to locate the right therapist, or even any therapist, because the US has a severe shortage of mental health care professionals. (15)
E-counseling allows you to find a counselor outside the area where you live.
This makes it much more likely that you will find the therapist with the specific expertise you need.
E-counseling helps you assume control over your own mental health.
You get to choose where, when, and how you want to communicate with your therapist.
Every year millions of Americans move.
Previously, if either you or your therapist moved, you’d have to find a new therapist.
With e-counseling, you can always maintain the connection with your counselor.
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Drawbacks of Online Counseling
While there are numerous benefits to online counseling, there are also a few drawbacks that you should be aware of.
Diminished Nonverbal Communication
It’s widely accepted that a relatively small portion of the information of our personal communication is contained in the actual words we speak.
The rest of the information in personal communication comes from body language and tone. (16)
A good psychotherapist is adept at picking up on nonverbal communication, but this information can be missed when you and your therapist communicate remotely, rather than face-to-face.
This can be mitigated by using video chat, rather than text or email.
While there is concern that diminished nonverbal communication prevents clients and therapists from building a strong trusting bond, this fear may be unfounded.
Some research has shown that online clients and therapists rated their bonds as strong as those who met face-to-face. (17)
A few studies have found that asynchronous (non-simultaneous) messaging therapy (i.e., email and text) can be as effective as in-person therapy. (18)
Credentials and Security
Before you start working with a therapist you find online, the burden is on you to be sure that they have the experience and credentials claimed.
You also need to confirm that they are using secure communications.
It’s not simply a matter of talking on Skype or Zoom.
If your therapist is not using the right technology and software, your interactions may not be secure.
Therapy works best when you actually keep your appointments and follow through with the homework you are to do outside of your therapy sessions.
For example, you may be asked to practice stress management techniques, keep a journal, or take note of negative thought patterns or cognitive distortions.
Online therapy, compared to face-to-face therapy, has a low adherence rate. (19)
So if you lack the motivation to follow through in this way, e-counseling may not be the best option.
Not Right for Everyone
E-counseling is not suitable for people suffering from serious mental health problems, such as bipolar disorder, schizophrenia, or addictions.
According to the American Psychological Association, online counseling is not advised for anyone in extreme crisis, those who has suicidal tendencies, or anyone who is a danger to others. (20)
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How to Find a Reputable E-Counselor
First, see if you can get a referral from a health professional you trust, such as your primary care physician.
Or, your insurance plan may be able to give you a list of available providers.
If neither of these options is helpful, there are two main ways to find a therapist who offers remote services.
Locate an E-Counselor on Your Own
You can find an online counselor by searching in Google or by using a directory such as Psychology Today’s Online Counseling Directory.
But you must do some due diligence if you opt to find one on your own.
You’ll need to confirm that this person is a legitimate practitioner, i.e., that they have an academic degree and are licensed to work with patients in your area or state.
You can check a prospective therapist’s certification and credentials at the Association of State and Provincial Psychology Boards or the National Board for Certified Counselors.
Additionally, you must confirm that they will be conducting your sessions using software that is compliant with the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.
This assures that your sessions and other communications are safe, secure, and private.
Use an Online Counseling Service
The second way to find a reputable counselor is to use an online service.
Some popular online counseling services include:
- 7 Cups
Some, like Doctor on Demand and MDLive, offer all kinds of health care services, including online counseling.
Others specialize in certain demographics, such as ReGain (couples), Teen Counseling, and Pride Counseling (LGBTQ).
One benefit of using an online therapy service is that they almost certainly use HIPAA-compliant software to keep communications secure.
But not all of them have counselors with the same high level of expertise.
On one end of the spectrum, 7 Cups relies mostly on a group of “trained listeners” who are not mental health professionals.
On the other end of the expertise range is BetterHelp.
They have the world’s largest network of licensed, accredited, and experienced counselors.
These therapists must have a masters or doctorate degree and be certified by their state’s professional board.
BetterHelp also performs a rigorous background check on every therapist in their system.
So when BetterHelp’s algorithm matches you with one of their 12,000 therapists, you can feel confident that your therapist is well qualified.
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Getting the Most From Your E-Counseling Sessions
For online therapy to be successful, you need to have access to the required communications technology and feel comfortable using it.
If you feel nervous when using a webcam to meet with your counselor, for example, you will not have the most productive therapy sessions.
To keep your sessions private and secure on your end, it’s imperative that you have private and secure internet access.
This means that you should not conduct your therapy sessions while at work or at Starbucks!
Arrange to be at home or some other private space where you will not be interrupted.
Remove all potential distractions.
Your therapist should do the same.
Some e-counseling services let you be anonymous, i.e., you use a nickname rather than your actual name.
But you should be transparent in every other way.
You need to be completely honest about your struggles and your goals.
The foundation of productive therapy is your relationship with your therapist.
You need to establish a bond of trust to feel connected and safe.
If, for any reason, you don’t feel comfortable with your therapist, it’s your prerogative to end the relationship and find another counselor.
E-Counseling: Take the Next Step
E-counseling is a growing trend in the delivery of mental health counseling that offers many benefits to consumers.
Research has shown that online counseling usually works as well as traditional, face-to-face therapy.
E-counseling is also more convenient, accessible, and affordable, while giving you more control over your mental health therapy.
Online counseling services make finding a qualified therapist easier and ensure that your communications are private and secure.