The COVID-19 pandemic has undoubtedly had an impact on mental health, with many people experiencing stress, anxiety, isolation and loss. Therapists quickly pivoted to an online model to continue caring for their patients, and now, over 76% of therapists offer their services online, according to a study conducted by the American Psychological Association (APA).
Teletherapy is similar to face-to-face therapy, and there are laws in place to protect patient privacy. It’s covered by most insurance policies — but it has its limitations.
How does teletherapy work?
Teletherapy is a form of telemedicine that allows therapists and their patients to communicate via video and phone calls, emails and text messages. Also known as telemental health, telepractice and telepsychology, it was first embraced by the military to treat veterans in rural and underserved areas.
Teletherapists deliver long-distance care in four major ways, according to the Center for Connected Health Policy (CCHP) — and video conferencing for live therapy sessions is the most popular.
|Live video||To conduct a real-time, two-way conversation between a therapist and their patient.||A patient has a session with their therapist over Zoom.|
|Remote patient monitoring (RPM)||To track the patient’s progress virtually.||A patient wears a blood pressure monitor and reports the reading to their therapist, or a therapist sends an email asking how the patient is doing.|
|Store-and-forward||To collect and transfer medical data using a secure electronic platform.||A family care doctor sends a patient’s medical records to a therapist for review.|
|Mobile health||To access health information and programs via a smartphone, tablet or laptop.||A therapist texts their patient to let them know their next session is coming up, or a patient signs up to a mental health app to access therapy.|
Find a teletherapist using these services
What happens in a virtual therapy session?
Online teletherapy sessions work in the same way as traditional therapy sessions — except the therapist and patient aren’t in the same room.
You’ll schedule a session at a time that suits you, and then log into a secure video platform to interact with your therapist in real-time. Your therapist will use the same strategies and activities as a face-to-face session, according to Positive Psychology. This might include asking you questions, developing coping techniques, practicing cognitive behavioural therapy and mapping out plans on a whiteboard.
Who can provide teletherapy?
Only licensed mental health professionals can offer teletherapy. While state licensing laws vary, therapists typically must hold a license in the state where their patient lives, according to Medical News Today. So, a therapist certified in California may not be allowed to see a patient who’s based in New York. You can get teletherapy services from:
- Clinical social workers
- Marriage and family therapists
Can I book a group teletherapy session?
Yes. Family, marriage and group therapists can conduct sessions with more than one person using video conferencing software.
How much does teletherapy cost?
Most teletherapists charge $1.75 to $4.99 a minute, according to PsychCentral. So if you’re paying out of pocket, you can expect a one-hour session to cost between $105 and $300. That’s around the cost of an in-person session, which is typically between $100 to $200 for a one-hour session.
Which mental health conditions can teletherapy help with?
Similar to face-to-face therapy, teletherapy treats patients with a range of mental health conditions. You can seek treatment for:
- Bipolar disorder
- Grief and loss
- Obsessive-compulsive disorder (OCD)
- Panic attacks
- Postpartum depression
- Post-traumatic stress disorder (PTSD)
- Relationship issues
- Stress and isolation
What is teletherapy not suitable for?
Teletherapy may not be the best solution in these situations:
- Mental health emergencies, such as a patient considering self-harm or suicide
- Some aspects of phobia treatment, like virtual reality (VR) and exposure therapy
- Play therapy for children
- Patients who feel unsafe or don’t have privacy at home
The benefits of teletherapy
Teletherapy has been around for over 20 years, and research suggests it can be just as effective as face-to-face therapy, according to the American Psychiatric Association.
Along with being a convenient way to get care, the main benefits of teletherapy are that it:
- Makes therapy accessible to more people, like those living in rural communities or with a disability that makes it difficult to travel.
- Allows patients to continue attending therapy while social distancing guidelines are in place.
- Opens up appointment times, including those outside traditional office hours.
- Eliminates the anxiety associated with waiting rooms.
- Boosts patients’ comfort, since they’re in a familiar setting.
- Enables patients to book sessions with specialized therapists who don’t practice nearby.
- Helps therapists and patients communicate between sessions.
The drawbacks of teletherapy
While teletherapy has its perks, the format also presents a few challenges. Some of its limitations include:
- Online sessions may slow progress for individuals who have trouble with social interaction and forming relationships.
- Patients may be unable to find a completely quiet or private space.
- Patients may struggle to maintain eye contact or offer other, nonverbal cues.
- Patients may be distracted by partners, children or roommates.
- Therapists and patients may experience technical difficulties that make the session feel stressful or less personal, like slow WiFi or communication delays.
- Phone calls, emails and text messages don’t convey subtle cues like body language.
- Teletherapy also raises privacy concerns. Before committing to a session, ask your therapist to confirm your information and sessions are encrypted, and make sure your Internet connection is secure.
Does health insurance cover teletherapy?
In many cases, yes. But private health insurance companies, Medicare and Medicaid have their own guidelines around telehealth, so it’s important to look at each individually.
The information below is general. For the most accurate answer, call your insurer’s benefits department and ask about your policy’s telehealth reimbursement policies.
|Private health insurance||Most major health insurance companies cover telehealth, and many have expanded their networks during the COVID-19 pandemic, according to APA.|
Many employers include telehealth as part of their health insurance packages. If yours does, you’ll be able to sign up for teletherapy services at cheaper rates.
|Medicare||You should be able to access teletherapy under most Medicare plans. Medicare has increased its teletherapy services and waived many restrictions during the COVID-19 health crisis.|
Depending on your plan and where you live, you’ll likely pay Medicare rates — which typically total 20% of the session cost.
|Medicaid||Each state has its own Medicaid program, and rules and regulations about teletherapy vary. For example, patients are authorized to receive teletherapy at home in only 19 states — so depending on where you live, it may be difficult to get help if shelter-in-place orders are effective.|
Here’s a general outline of Medicaid reimbursement, according to the CCHP:
- All states reimburse live video sessions to some extent.
- 23 states reimburse remote patient monitoring.
- 16 states reimburse store-and-forward services.
How to find a teletherapist
The best way to find a teletherapist is to ask for a referral from your doctor or trusted people in your life.
Otherwise, you can independently search for one online using platforms like ZocDoc, Teledoc or Doctor on Demand, or your health insurance company’s online portal. If you have insurance, filter the results by the policy you have so only in-network providers appear.
You can also look into online therapy services. Prices and subscription models vary, but some of these services accept insurance. Some popular service include:
- AmWell to set up a video call with a therapist.
- BetterHelp to connect to a therapist via live chat, or phone or video calls.
- Breakthrough (or MD Live) to communicate with a therapist by video.
- Lantern to work through online modules and speak to a therapist over the phone.
- TalkSpace to connect to a therapist with online chats, voice messages or video calls.
How secure is an online therapy session?
Teletherapists are ethically and legally bound by privacy laws and ethics under the Health Insurance Portability and Accountability Act (HIPAA). All teletherapy sessions have to comply with HIPAA standards. This means:
- The Internet connection must be secure.
- The therapist must be in a private room.
- The therapist must prevent third parties from viewing the session or session notes, unless they have the patient’s explicit consent.
- The therapist must protect patient confidentiality.
- The therapist and client must log onto a secure, encrypted platform to conduct sessions, schedule appointments, send treatment plans and collect payment.
These are the most popular HIPAA-approved platforms:
- Google Meet
- Zoom Healthcare, a separate plan that costs mental health professionals $200/month
FaceTime and Skype are not HIPAA-compliant.
How to prepare for a teletherapy session
For effective teletherapy counseling, prep your space beforehand.
- Choose a quiet space where you won’t be disturbed or overheard, like a bedroom, home office or even your car. If you’re worried about others listening, place a fan, speaker or white noise machine outside the door.
- Ask roommates or family members not to disturb you during your session.
- Charge your computer, tablet or smartphone and check that the camera and mic are working.
- Test your Internet connection.
- Consider using headphones to improve the sound quality or privacy.
- Speak clearly and try to make eye contact with your therapist during the session.
- Avoid doing any other tasks during the session, like folding laundry.
Ask an expert: In your clinical experience, do you think teletherapy is as effective as in-person therapy?
In my experience, teletherapy is very effective for my clients — and I consider it just as effective as in-per- son therapy for many individuals.
I was first introduced to teletherapy about 7 years ago when several of my colleagues in the community began offering their clients telephone sessions in addition to traditional in-person therapy sessions. At the time, this service was chosen primarily by individuals who were “on the road” for work, and wanting or needing support between our regularly scheduled sessions. Since this time, the term teletherapy has come to encompass therapy done virtually.
Personally and professionally, it has been incredibly meaningful to be part of the growing teletherapy trend. During the COVID-19 pandemic, teletherapy allows my clients and I to safely and responsibly continue our therapeutic work together. Live-stream teletherapy allows my clients and I to interact much like we would in-person. I am able to see my clients expressions, respond to them, and be present with them throughout the session. I believe these pieces to be particularly important in creating a strong therapeutic alliance with my clients, and them finding the therapeutic work we do together to be effective and beneficial.
How can teletherapy help patients struggling with mental health?
Many of my clients report that teletherapy with me has helped them deal with feelings of stress, sadness, loneliness, overwhelm, grief, relationship conflict, and parenting concerns.
Who is and isn’t a good candidate for teletherapy?
I believe teletherapy is a great option for individuals who are working from home, don’t have transportation, live in rural communities, have very busy schedules, are sick, choosing to stay at home due to the COVID19 pandemic, or simply prefer to meet with their therapist over video.
I do not recommend teletherapy for individuals who are suicidal, are unable to create a private space in their home for their session, do not feel safe doing sessions from home, or who have an unreliable internet connection.
Are mental health apps the same as teletherapy?
No, though some do offer online therapy sessions. While mental health apps can’t always replace teletherapy sessions, they can help you to manage any situations or feelings you’re experiencing. They’re also an affordable and accessible way to get help with your mental health, and a great ways to stay on track between or after in-person therapy sessions.
Explore these popular apps:
- Depression CBT Self-Help Guide
- Mood Kit
- Self-Help for Anxiety Management
- What’s Up
If you’re really struggling, consider seeing a therapist who can professionally evaluate and treat you so you can start feeling better sooner.
Mental health resources available during COVID-19
Thanks to telehealth, it’s easier to communicate with a therapist online and get the help and guidance you need. Virtual sessions have become standard during the pandemic, and they’re proven to be as effective as face-to-face therapy — but they’re not suitable for everybody
Teletherapy is covered by most insurance plans, at least while the US is in a state of emergency.