Is Online Therapy Right for Me?

The technology to support telehealth therapy has been available since the early 2000s but didn’t really take off until the pandemic. When the whole world shut down, we were told that being near other people was risky to our health and survival. Counselors, social workers, and psychologists around the world scrambled to quickly find ways to connect with clients. Most were just as unfamiliar with the technology as everyone else. So we all learned together, making the best of an impossible situation. Most mental health providers are risk-averse by nature and training and lack advanced technical skills. We connect with people, not machines. It literally took a worldwide pandemic to push us into this new technology!

Now that it’s widely available, you may be wondering if online therapy is right for you. A good online therapist will offer you a free consultation to assess if online therapy is appropriate before asking you to commit to therapy. They may also help you choose a therapist who is a good fit for your needs and personal preferences. Below, you will find some important things to think about when deciding between in-person and virtual therapy.

“Tell me what brings you to therapy.”

If you’ve ever had in-person mental health services, this is likely one of your new therapist’s first questions. How you answer this question helps us begin the screening process to see if we are a good fit for you and your concerns. Most of us specialize, so we want to make sure you’re in the right place to get the help that you need.

We are looking for things like…

• Are you struggling with urges to harm yourself or others?
• Are you having difficulty with cognitive decline?
• Are you hearing or seeing things that aren’t there?
• Are you engaging in risky behaviors you can’t stop?
• Is your problem something we’re trained to address?
• Are there any other resources you might need, like group therapy, a medication evaluation, medical care, social services, peer support, etc?

In an online setting, the answers to these questions are even more important as some problems are not well-suited to a virtual setting. In most cases, these issues are better addressed in person.

• Active suicidal thoughts and urges
• Active homicidal thoughts and urges
• Current self-harm behaviors
• Hallucinations
• Mania
• Dementia
• Active substance abuse with little or no sobriety
• Children – some therapists may refer children for in-person therapy

Problems that respond well to online therapy include:

• Depression
• Anxiety
• Grief
• Interpersonal conflicts
• Trauma & PTSD
• Workplace stressors
• Parenting concerns
• Midlife transition
• Behavioral modification

“What is your experience with mental health services?”

We ask this question to learn about your previous experiences and the impact they’ve had on your expectations for therapy. This allows us to help you understand what may or may not be different from your previous experiences. We can also assess which interventions might be most helpful to you.

If you’ve had previous experience with online therapy, then we’re likely to initiate a conversation about what worked and didn’t work for you. Some negative experiences can be prevented or mitigated if we know what happened previously.

If you’ve not experienced online therapy before, you might still be a good candidate. Most people have experience connecting with friends and family online. The technology is similar and your potential therapist will cover the differences.

Access to the right technology

GOOD                   phone or tablet with wireless internet access, camera, and sound

BETTER                 laptop or PC with wireless internet access, built-in camera, speakers, and microphone

BEST                      laptop or PC with network cable connected directly to an internet router, external webcam, and external speakers and microphone

Using the technology

All healthcare providers are required to use HIPPA-compliant video-conferencing technology. There are many available, so ask your therapist for a link to the one used during sessions. Most therapists are willing to arrange a brief appointment just to check that you can connect successfully.

Also, most of us have Client Portals that serve as electronic health records (EHR). Make sure you have an account and know how to use this portal. Often, you will communicate with your therapist through the portal as well as manage your appointments, keep track of invoices, download health records, or request information be shared with a third party.

Ask questions! If you’re not sure how something works, ask your therapist. Often he or she can connect you with tech support for the EHR being used.

Other considerations

A private space away from other people and noise is ideal for therapy. The room should be comfortable and well-lit. If there is a window or bright light, make sure you are facing the light source. A light behind you will result in a bright glare on the screen and make it difficult to see your face. Sometimes ceiling fans will produce strange effects. It’s ideal if you turn those off, too.

One big risk with online therapy is the limitation of confidentiality. Just because your therapist has access to HIPPA-compliant technology doesn’t mean your conversations are totally private. A number of factors on your side of the connection affect privacy, too.

• Are you in a public space? Even an empty office at work may or may not be totally private. We are so comfortable using technology in public that we often forget everyone else can see and hear us.
• Are you using an unsecured, public internet connection? That’s a big risk! Please make sure you are connected to a private network (i.e. username and password).
• Even at home, you will want to take precautions by connecting from a private room away from family activities. Make sure the door closes, too.

Parting Thoughts

Once we realize we need therapy, it can be tempting to schedule the first available appointment with almost anyone. That could set you up for bitter disappointment. You see, multiple studies have shown that the single most important predictor of therapy success is the connection between client and therapist. Getting that right is vital. Many therapists are starting to offer free, brief meetings before starting therapy. Take advantage of these offers!  Prepare for that meeting by writing down questions you want to ask. Making a list of the qualities you’re looking for (or want to avoid), too.