Online Counseling.

Counseling for the 21st Century

I’m still surprised by the number of people who have outdated notions about counseling. Some have no expectations while others speak of couches, non-responsive therapists, and being forced to relive the past. These stereotypes stem from public perception of psychoanalysis, a type of therapy that was founded by Sigmund Freud. While psychoanalysts still practice today, their actual practice is a lot different from popular generalizations. Surprisingly, few people know that there are dozens of different schools of thought and practice types.

One of the weaknesses of modern counseling is that it must occur face-to-face in an office setting. This requires setting aside at least an hour each week for 8-12 weeks, plus driving time, plus time between sessions for processing and “homework”. This is difficult for many people to do. Life has to get pretty bad before most people are willing to disrupt their lives enough to accommodate therapy.

But what if it didn’t have to be this way? What if seeking therapy were as simple as chatting with friends online or using Skype to catch up with loved ones?  Guess what? It is!

Therapists are a conservative, risk-averse, techno-phobic bunch. We worry about privacy, confidentiality, security, liability, risk, and safety. But as the torch is passed to a new generation of counselors, use of technology to provide services is becoming a reality. Enough forward-thinking, adventurous people have ventured online through the use of secure, private, HIPAA-compliant platforms. These platforms allow therapists and clients to connect in ways that previous generations cautioned against because there was no reliable way to ensure client privacy was protected and personal safety maintained.

As with any other form of therapy, online counseling isn’t appropriate for everyone or all situations. If you are experiencing thoughts of harming yourself or others, are actively suicidal or manic, or have significant trauma you need to work through, then online therapy is probably not the best solution for you. It is also not appropriate when working with young children or engaging in play therapy.


  • Eliminates wasted time driving to an from an office
  • No concerns about running into people you know at an office
  • Therapy is not interrupted by illness or inclement weather
  • Remain in the comfort of your own home or office
  • Often more affordable than traditional in-office counseling
  • Generally more flexible scheduling hours


  • Must have access to Internet
  • Webcam required for Video Conferencing
  • Family members may overhear the conversation with your therapist
  • May have difficulty finding a therapist in your state who offers online services
  • Not all insurance companies will pay for online therapy. Be prepared to pay out-of-pocket
  • May be difficult to get immediate help in the event of an emergency

Questions to ask:

  • Do you use a HIPAA-compliant platform? FYI – Skype is NOT HIPAA-compliant.
  • What types of online access do you provide? Email? Chat? Video?
  • What do you charge per session?
  • Are there different fees for different services?
  • What about licensing? Some states restrict clients from accessing therapy from professionals not licensed in their home state (like California). Other states specifically allow interstate therapy (Massachusetts). You may not have any formal recourse to file a complaint should your therapist not have a license to practice in your home state. When in doubt, contact your state’s Behavioral Sciences regulatory board.