What is Teletherapy? Everything You Need To Know.

published:	15 Oct 2019
updated:	9 Apr 2021

Do you want to receive mental health treatment that’s more flexible, convenient, and cost-effective? Or are you a practitioner looking to grow your practice, cut your wait times, and reach more patients with technology?

Teletherapy, or telepsychology, is a growing field of psychological services that allows patients and practitioners to interact in real-time, without the need to meet in person. Read on to learn about the research on teletherapy, learn about its benefits and drawbacks, and discover whether it’s right for you.

Before you continue, we recommend trying out Quenza for $1 a month. With powerful, intuitive tools for delivering teletherapy solutions online, this customizable software will take your practice digital and help you reach even more clients today.

What is Teletherapy?

Teletherapy is quite simply: [1]

The provision of psychological services using telecommunication technologies.

Essentially, it is an alternative way for practitioners to deliver (and patients to receive) the same counseling or mental health services as one would expect from professional face-to-face treatment.

The same high service quality and ethical considerations apply to both – in other words, practitioners are bound by privacy laws such as HIPAA to protect patients’ confidentiality. Despite there being no nationwide legal framework for the regulation of these practices as yet, many states have introduced their own laws to ensure their enforcement.

Let’s compare the two side-by-side for a few examples of their similarities and differences:

Aspect	Face-to-Face Therapy	Teletherapy
Interaction	In-person treatment	Live video, Voice Over Internet Protocol (VOIP), e.g. Skype, Zoom, FaceTime
Flexibility	Depends on therapist and client arrangements	Involves no travel, typically flexible timing
Timing	Synchronous, live interactions	Can be synchronous (e.g. video conferencing, live chat), or asynchronous (e.g. email-based e-therapy)
Cost	Depending on provider Can average between $150 – $300 per 45 min/1 hour session	Depending on provider/therapist Can range from free (peer-counseling) to $300+ monthly for more comprehensive treatment
Insurance/State Coverage	More frequently included in coverage plans	Less widely covered by providers, between states

Applications

Teletherapy can be thought of as a key approach within the much larger blended care family, which covers a range of telepsychiatry, telehealth, and telepsychology treatments.

In this respect, many validated, established treatments such as Internet-Based Cognitive Behavioral Therapy (iCBT), psychoeducational therapies, and behavioral therapies can be implemented over video conferencing tech in a similarly structured way, minus the personal interface. Already, teletherapy is being widely used by practitioners to help patients with [2]:

Anxiety disorders
Depression
Speech-language challenges
PTSD
Smoking cessation
Physical Therapy
Occupational Therapy
Body image issues, and more.

As increasingly more research emerges on its practice, growing evidence suggests teletherapy can be an acceptable – even an equally effective, more engaging alternative – to in-person sessions [3].

Let’s have a look.

Is It Effective?

In general, teletherapy seems to hold some significant promise for the treatment of specific illnesses, as well as being a source of social support for those who seek out peer-counseling platforms.

Here, a few more studies and meta-analytic data suggest that professional, therapist-guided teletherapy may be an effective way to treat depression, anxiety, and stress, among other conditions.[4][5].

Depression

Participants who undertook teletherapy showed large, significant decreases in depressive symptoms in comparison to control group (wait-listed) individuals.[6]

Further, comparing traditional-only therapy patients with a group who received teletherapy (iCBT) and traditional treatment, studies found greater improvement in the latter group several months later[7].

Anxiety

Paxling et al.[8] studied wait-listed (control group) participants with those undergoing an 8-week, therapist-guided iCBT. The teletherapy group patients showed significant notable improvements in anxiety symptoms such as persistent worry and irritability compared to the control group.

Stress

Looking at PTSD and other stress effects in a meta-analytic review, Barak et al.[2] found various forms of teletherapy can be particularly effective for treating stress-effects, concluding that it can be as effective, on average, as in-person interventions.

Many professionals are quick to advise against the use of teletherapy as a treatment for severe psychiatric or mental illnesses – as more serious issues, these almost always warrant a direct and close level of supervision that virtual care cannot provide[9]. However, telepsychiatry can and is an effective means of treating certain conditions.

Teletherapy seems to hold some significant promise for the treatment of specific illnesses

Benefits of Teletherapy

In today’s world, where VOIP and video protocols are almost ubiquitous, teletherapy opens up a whole host of new blended care possibilities for conventional treatments such as CBT, Applied Behavior Analysis, ACT, and more. And this field of real-time, licensed treatment options brings with it an array of distinct benefits for both therapists and patients.

Let’s take a look.

Patient Benefits

Practitioner Benefits

Accessibility. Medical conditions, chronic illness, mobility impairments, and distance often prevent many potential patients from attending in-person therapy with a licensed professional. Telepsychology – particularly mobile apps – provides a convenient alternative for those who can’t afford the time, money, or resources to see a practitioner face-to-face as often as they’d like.[10][11]
Availability. Long wait times can be common with conventional therapy sessions, especially for patients who cannot afford private mental health care. In some instances, this can contribute to poorer health outcomes.[12] Many teletherapy providers avoid this by pairing patients with an initial therapist immediately after they have created an account, thus reducing cancellations as patients forget or change their minds.
Privacy. Some practitioners and clients may feel online psychotherapy offers more privacy than in-person sessions, which can bring patients together in waiting rooms or on surgery premises. Because sessions can take place from the comfort of a patient’s home there is no need for individuals to share that they are seeking professional help. It’s important to note that patients should ensure they are in a private setting for sessions to preserve their confidentiality.
Overcoming social stigma. Many people choose not to seek therapy for fear of judgment, despite experiencing very real mental, physical, or emotional difficulties. Because it offers privacy and removes the need for face-to-face interactions, many practitioners believe teletherapy is a more appealing alternative to patients who are concerned about being seen as ‘mentally ill’.

Higher client retention. Statistics show that early withdrawal from treatment is a top concern for therapists, with roughly 20% of clients discontinuing their program before reaching an acceptable level of recovery.[13][14] By expediting client intake and removing deterrents like perceived stigma, teletherapy may help practitioners retain patients for longer periods to receive more necessary help.
Safety. According to an industry task force report, 35-40% of practicing clinical psychologists are at risk of behavioral emergencies such as patient assault at some point throughout their careers.[15][16] While such assaults are generally not physically serious, they can be emotionally damaging for the practitioner; removing the element of physical proximity can create a more secure environment for safe practice.
Marketing and Employment Opportunities. With a professional virtual presence, therapists can increase their visibility to potential clients, expanding their reach to clients whose search is otherwise limited by distance, time zones, or perceived stigma. Free initial consultations become much easier, and teletherapists can share their philosophy, credentials, and additional services or products to attract a greater range of appropriate clients, helping them grow their practice.[17] As well as this, many teletherapy platforms now offer client management software and features, providing additional marketing help.
Efficiency. Whether part or all of the treatment is delivered virtually, digital tools help practitioners with preparation, planning, and implementation. A growing market of specialized tools, e.g. iCBT and ABA software programs, offer templates and note-taking features to give professionals more time with patients.

Disadvantages of Teletherapy

Teletherapy has plenty of potential for practitioners looking to grow their practice, as well as for potential patients who are restricted from conventional treatment due to financial, medical, or other concerns. As with any treatment option, however, teletherapy has limitations to note if you’re trying to decide whether it’s right for you.

Limitations For Patients

Limitations For Practitioners

Insurance and Coverage. As with the privacy laws that govern its practice, insurance coverage for teletherapy can vary. Some state and private insurance providers do not cover e-therapy, which can make treatment an expensive option.[18]
Requires Internet Access. While still more readily accessible than traditional therapy for a lot of potential patients, teletherapy requires stable and reliable internet access in a private setting. Those with less computer proficiency may also find it difficult to use.[19]
Confidentiality. Teletherapy providers are required by law to protect patient confidentiality, however accidental data leakage and software malfunctions remain a risk factor with any type of digital technology.
Limited Applicability. Serious or complex psychiatric or mental illnesses that require direct, intense treatment cannot be addressed properly with virtual therapies. Severe addictions, psychoses, and other more serious medical concerns call for a level of close supervision and support that teletherapy providers are unable – by definition – to enforce.[20]

Miscommunications. Some therapists may find it difficult to build trust, engagement, and rapport without important cues from face-to-face interactions. Body language, olfactory cues, and subtle nuances can be lost in transmission with internet protocols, which practitioners often rely on to develop meaningful, effective therapeutic relationships.[18]. However, other studies suggest some clients may find online interactions less stressful in general, potentially leading to fewer inhibitions[21]
Responsiveness in Emergencies. Patience-therapist distance prevents practitioners from responding quickly or providing aid in emergencies, such as suicidal threats or serious withdrawal symptoms.[20][22]
Boundary Issues. Without clear limits such as predetermined session times in conventional treatment, some experts argue that certain forms of teletherapy can blue professional boundaries. Research suggests some client-practitioner relationships can suffer from harassment or over-messaging.
Interstate Practice. Many state licensing laws do not allow out-of-state psychologists to deliver teletherapy, requiring practitioners to hold a license in their own state as well as their clients’ state. Practitioners wishing to practice e-therapy should regularly check the legal status of interstate practice with their state licensing board and malpractice insurance providers.[23]

Is Telepsychology Right For Me?

As a patient, you don’t need to be all-in or out – teletherapy can easily form one part of a broader blended care program. If your current therapist is located a while away, or if you’ve got a busy schedule, it can be a good way to continue your treatment between in-person sessions.

Additionally, with the huge range of different teletherapy options – from videoconferencing to email, VOIP, and even avatar therapy – there’s a good chance you’ll find something appropriate and effective for your specific needs.

Essentially, the most important considerations you’ll need to make come down to a few things:

Cost – Does your insurance cover teletherapy? Are you prepared to pay out of pocket expenses if state funding is insufficient or non-existent?
Effectiveness – Is there research supporting its efficacy for your particular issue? Do you feel like you might benefit from a therapeutic relationship via instant chat, videoconferencing, or phone calls?
Convenience – Are you willing to hold yourself accountable for doing any exercises assigned, or turning up to scheduled virtual sessions? Is teletherapy available from a licensed practitioner in your state or area? Do you have the technology and digital proficiency to benefit from a teletherapy platform? If you’re unsure right now, don’t worry. Many teletherapy providers give a detailed overview of their services, and even free trials.

Let’s consider a few examples below of the best-known and most popular teletherapy platforms for patients and practitioners.

9 Teletherapy Platforms For Patients

As we’ve seen, teletherapy platforms can be a quick, easy, and cost-effective way to get support if you’re looking for it. Many of the following platforms will connect you with licensed therapists, while some use peer-counseling models.

The latter may not be appropriate for certain mental health issues, though they may be a valuable source of social support. As the name suggests, peer-counseling platforms are more comparable to groups in which members can communicate, share experiences, and offer advice, but do not necessarily have any mental health licensing or expertise. Peers in such groups may not be trained in delivering therapies and, as such, the model is often considered a complement rather than an alternative to psychotherapy.

App	Details
	MDLive is a telehealth service provider that also focuses on mental health and counseling. They work with licensed therapists to help users who experience a variety of issues, from anxiety to depression, bipolar disorders, grief counseling, trauma, stress, or even PTSD. After you sign up for their services, you can choose the specialist you wish to see and contact them directly or schedule an appointment if an instant meeting isn’t available. MDLive Therapists may be licensed to issue prescriptions, and some insurance plans will cover these services.
Name	MDLive
Price	$99 Weekly
Good For	Phone, Video
Website	https://www.mdlive.com/

App	Details
	BetterHelp is exclusively designed for therapy and other psychiatric services. After sign-up, you will be matched with an available counselor who fits your health objective requirements, so you can begin the session right away. However, if you feel the counselor is not a good match for you, you also can request a different therapist to work with. All their therapists are credentialed, licensed, and vetted by the platform before allowing them to counsel through BetterHelp. You can opt to remain anonymous while receiving treatment.
Name	BetterHelp
Price	$40 – $70 weekly
Good For	Text Messaging, Chat, Phone, Video Therapy, Counseling
Website	https://www.betterhelp.com/

App	Details
	7 Cups of Tea is a peer-support, chat-based platform that connects you with “active listeners” when you need it most. It may be very beneficial for those looking to speak to someone, but who are reluctant to talk to a friend or family member. It’s anonymous, users can discuss any topic of their choosing, and available active listeners are trained in offering support. It’s possible to pay to speak to a licensed therapist or counselor, but they are not able to provide users with medical advice. All user-listener connections are on-demand, so using 7 Cups recurrently means it’s possible to talk to different Active Listeners every time. As noted, the peer-counseling model on which it’s based may not be appropriate for those struggling with severe mental or emotional conditions.
Name	7 Cups of Tea
Price	Free 24/7 Listener Chat – $150 Monthly for Counseling
Good For	Peer/Social Support, Instant Messaging, Chat Rooms, Forums
Website	https://www.7cups.com/

App	Details
	Larkr is a service that closely resembles traditional face-to-face therapy models, as users connect with therapists through video. Their algorithm analyzes your profile and matches you with a licensed therapist in their database, although you can request a new therapist if you wish. The Larkr app also offers an integrated mood tracker and activity calendar that can be a useful way to monitor your emotional health or follow a therapeutic plan created for you by your practitioner.
Name	Larkr
Price	$85 (50 min Therapy Session)
Good For	Video Chat, Professional Therapy
Website	https://larkr.com/

App	Details
	There are over 3000 therapists on TalkSpace – all licensed and vetted with rigorous background checks. On filling out a sign-up questionnaire, users are matched algorithmically with a practitioner that best suits their requirements. You can work with the same professional for the duration of your treatment by default or request to swap therapists. Your therapist will respond 5 days a week, and it’s possible to choose a more comprehensive plan for up to 4 30-minute live sessions per month. While arguably one of the best-known teletherapy platforms, it’s not covered by insurance.
Name	TalkSpace
Price	$260 – $396 Monthly
Good For	Text, Audio, Video Messaging, Counseling
Website	https://www.talkspace.com/

App	Details
	With the Amwell app, it’s possible to reach therapists and medical professionals 24/7. After signing up, you’ll indicate what service you’re looking for, then you’ll be invited to schedule a therapist consultation. Browse the full bios of each licensed professional before you choose one, including their credentials and photos, and choose a practitioner with the specialty and expertise you’re after. Some insurers and employers will cover Amwell consultations, while therapists provide counseling and care for a range of issues. Examples include panic attacks, depression, stress management, insomnia, life transitions, and OCD.
Name	Amwell
Price	$59 – $99 per consultation, depending on practitioner.
Good For	Video Calls, Phone, Therapy, Psychiatry, Medical Conditions
Website	https://business.amwell.com/

App	Details
	With Joyable, which is designed for employers, users fill out a brief 60-second introductory quiz to unlock digital therapy designed by a trained coach. You’ll get daily activities and science-based CBT solutions for common issues such as stress, depression, and anxiety, however, Joyable coaches are not licensed doctors or therapists. You can choose to have an introductory call with your coach, establish personalized goals, and contact them an unlimited amount via email or text message. It’s also possible to schedule check-in phone calls during your customized program if you wish.
Name	Joyable
Price	$99 Monthly
Good For	Text Messaging, Phone, Email, Coaching, CBT
Website	https://joyable.com/

App	Details
	Regain Counselors are all certified, licensed psychologists, professional counselors, marriage and family therapists, or clinical social workers with the 2000 hours of experience required for accreditation. Two users share one account on the platform and interact with the counselor together (you need to be in the same place for live video), although it’s also possible to schedule an individual chat with your therapist. You’re connected algorithmically with your therapist based on the information you provide, and you’re free to discuss anything that falls under the relationship counseling umbrella. Examples include conflict, communication, infidelity, intimacy, and more. It’s possible to leave text messages for your therapist at any time if you prefer asynchronous communications.
Name	ReGain
Price	$40 – $70 Weekly, Billed Monthly
Good For	Messaging, Video Chat, Live Chat, Couples Counseling
Website	https://www.regain.us/

App	Details
	iCounseling offers unlimited video conferencing therapy with an accredited, licensed counselor. It’s billed at a flat rate, though its services are not covered by most public or private insurance providers. HIPAA-compliant, secure, private, and anonymous, national and state laws protect everything that you share with your practitioner. iCounselors all have a minimum of 2000 hours of practical experience and operate independently through the platform, meaning you will work with them directly. You’re able to set appointments whenever it’s convenient, and you’re matched within 24 hours or fewer. You can choose to discuss a whole range of common topics with your professional, including anxiety, depression, addictions, trauma, conflicts, and self-esteem.
Name	iCounseling
Price	$40 – $70 Weekly, Billed Monthly
Good For	Live Chat Messages, Video Calls, Phone, Counseling
Website	https://www.icounseling.com/

6 Teletherapy Platforms for Practitioners

Many, if not all of the above platforms provide the HIPAA-compliant tech that practitioners need to start using teletherapy with clients. They’re also a good way to broaden your reach and help more people thanks to their established reputations. But what if you want to help your existing clients, or prefer to work independently?

If that’s the case, you’ll be looking for a multi-functional service that ticks more than one box. Here are a few examples:

App	Details
	Doxy.me supports Low- (LD), Standard- (SD), and High-Definition (HD) video calls, as well as audio. HIPPA-compliant and available in free or paid versions, it’s simple for patients to use with no need for any special downloads. Usable with iOS and Android, you’ll also find it comes with Waiting room and Patient queue features plus somewhere to view your Meeting history.
Name	Doxy.me
Price	Free – $50 (Monthly)
Good For	Videoconferencing, Text Chats, Audio
Website	https://doxy.me/

App	Details
	eVisit is a video chat platform not unlike Skype, which includes a host of features that make it easy to work with clients. Using your tablet or smartphone camera, you can have live meetings with clients and bill them afterward – you can also view relevant background information they’ve provided, their insurance, and their electronic medical records. It’s HIPAA-compliant and patients have access to their own portal so they can schedule appointments and register.
Name	eVisit
Price	$600 (Monthly)
Good For	Videoconferencing, Text Chats, Audio
Website	https://evisit.com/

App	Details
	Quenza is especially-designed for teletherapy and mental health coaching, with quick and simple tools for designing activities and interventions. Assessments, meditations, exercises, and learning content can all be professionally created and branded, then uploaded to a patient portal for digitally sharing with clients through the web or mobile-based apps. A library of science-based assessments and resources helps speed up treatment planning, while custom form creators help you create therapy progress notes, intake forms, informed consent documents, SOAP notes, BIRP notes, and more. Multimedia support makes video coaching and video therapy easy, while automation tools allow teletherapists to schedule and deliver entire programs or care pathways in a pre-determined sequence. As well as goal-setting and treatment tools, Quenza enables progress monitoring through reports, allowing you to make tweaks and amendments to boost engagement. HIPAA-compliant for telepsychiatrists, e-counselors, and psychotherapists, Quenza can be trialed for $1/month.
Name	Quenza
Price	$1+ monthly
Good For	Video Coaching, Instant Messaging
Website	https://quenza.com/

App	Details
	With Clocktree, teletherapists can have a certain number of HD video hours per month with an unlimited number of clients, and it features secure HIPPA-compliant messaging and storage. Keep your client notes in a dedicated space, use the scheduling feature to organize appointments, and get reminders for key events on any computer. There’s no cap on the number of providers you can have on your therapist account, and you can share documents, images, and more.
Name	Clocktree
Price	$29 – $89 Monthly
Good For	Video, Audio
Website	https://www.clocktree.com/

App	Details
	Teletherapists can use VSee to connect with clients through messages and video. Setup involves only an email and login, then you can invite clients with links and view them in a contact book. HIPAA-compliant, the platform allows file sharing, screen sharing, annotation, and more to help you communicate. Compatible with Mac, iOS, Windows, and Android, it’s fairly easy to use.
Name	VSee
Price	Free – $49 Monthly. Includes enterprise plans at quoted prices.
Good For	Instant Messaging, Video
Website	https://vsee.com/

App	Details
	Telemental health platform WeCounsel provides video and text-based communication functions that therapists can use to hold sessions, as well as document sharing, scheduling, billing, and assessment capabilities. It’s designed to be a scalable solution for private practitioners and includes eSign functionality for official documentation.
Name	WeCounsel
Price	Free – $99 Monthly
Good For	Instant Messaging, Video
Website	https://www.wecounsel.com/

Final Thoughts

Teletherapy is continuing to remove mental healthcare barriers such as distance, expense, and stigma for increasingly more people every day. As technology advances and more platforms become available to practitioners, we can expect this positive trend to continue.

Whether teletherapy is right for you is very much a matter of what you’re looking to achieve by seeking virtual treatment. For more serious issues such as mental health, psychiatric conditions, or similar, it’s always best to seek direct and close help from a licensed professional rather than looking online as the first port of call.

However, if you’re hoping for a convenient complement to an existing treatment or help for more common issues such as depression, anxiety, and stress, teletherapy as a field holds some serious promise.

Let us know your experiences as a practitioner or as a patient – have you tried counseling others, or receiving treatment using teletherapy? How did you find it?

We hope you enjoyed this article. To take your practice online, get started with our $1 Quenza trial, for a month of unlimited access to all its teletherapy features. Designed especially for online therapists and coaches, our tool has everything you need to create custom activities and automated care pathways, so you can engage patients more effectively for the best possible results.

References

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