Does Online Therapy Work?

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You've probably seen commercials with Olympic swimmer Michael Phelps talking about how therapy has helped him. The advertisement is for Talkspace, an app that allows you to exchange messages with a therapist on your smartphone.

There are many other online therapy sites and apps. Some of them offer subscription plans where you can schedule regular video appointments with your therapist while others offer unlimited email communication.

And while many people have found relief by accessing treatment from the comfort of their own homes, others raise concerns about whether online treatment might be too risky.

What the Science Says

One of the biggest concerns about online therapy is that therapists don't have an opportunity to observe the patient—something that is usually integral to an assessment and diagnosis. The tone of voice, body language, and overall demeanor provide insight into an individual's well-being.

A major component of effective therapy involves the relationship between the therapist and the patient. As online therapy is impersonal (often, it's completely anonymous), many people have raised concerns about whether digital communication can provide skills, tools, and healing power to individuals staring at a screen.

Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:

• A 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
• A 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, "effective, acceptable, and practical health care." The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
• A 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.

The Potential Benefits of Online Treatment

Online therapy offers some benefits over traditional face-to-face treatment:

• People in rural areas or those with transportation difficulties may have easier access.
• Many online therapy sites allow users to sign up with "nicknames" which can entice people who are embarrassed about getting services under their real names.
• Most online therapy services cost less than face-to-face treatment.
• Scheduling is more convenient for many people.
• Studies show online therapy requires 7.8 times less of a therapist's time than face-to-face treatment—meaning therapists can often treat more people online than they can in-person.
• Clients don't have to worry about seeing people they know in the waiting room.
• It can be easier for some people to reveal private information when they're sharing it online.
• Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.

The Potential Drawbacks

Online therapy isn't for everyone. Here are some potential risks and drawbacks:

• Online therapy isn't meant for people with certain problems or conditions (such as suicidal intent or psychosis).
• Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
• Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren't conducive to treatment.
• Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.
• Sites that aren't reputable may not keep client information safe.
• It can be difficult to form a therapeutic alliance with someone when meetings aren't face-to-face.
• It can be difficult for therapists to intervene in the event of a crisis.

How to Find an Online Therapist

If you are interested in online therapy, there are many options to choose from. Think about what type of services you want most—phone therapy, video chats, live chats, audio messaging, or text messaging.

You may find a local therapist who offers online services, or you might find you prefer a large organization that offers a substantial directory of therapists to choose from.

But do your homework and shop around for the service and price plan that best suits your needs.

Check Psychology Today’s directory of therapists for a professional near you.