Online therapy is increasingly used as a medium to provide mental health support to people. With governments implementing stay-at-home orders due to the pandemic, online therapy has been the only option for people in need of mental care. Its usage has increased 38 times from the pre-COVID-19 baseline, despite both the pros and cons of online therapy.

COVID-19 made the shift to online therapy inevitable. This has been due to:

• social distancing leaving online therapy as the sole option
• the changing consumer and provider attitudes in favor of online therapy
• relaxing regulations permitting increased use of online therapy. For instance, the Centers for Medicare and Medicaid Services broadened the reimbursable telehealth codes for the 2021 physician fee schedule.

Mental health issues are becoming increasingly common across the world, with the pandemic making it worse. Over the years, international organizations and governments have accepted the critical part mental health plays in global development.

That is why WHO included ‘Ensuring Mental Health’ as one of the goals in its Sustainable Goals Agenda 2030. Despite advancements across the globe, depression is one of the major causes of disability today. In fact, the second major cause of death among people aged between 15 and 29 years is suicide.

Yet, 75% of people with mental health issues in low-income countries do not receive the required treatment. Online therapy has come to solve many issues like reaching out to more people in need of mental support at less cost. Likewise, online therapy has helped people overcome barriers like not seeking it due to the fear of visiting a mental health clinic.

Virtual therapy incorporates certain challenges despite so much good it can achieve for victims. Let’s understand what virtual therapy is and what are the pros and cons of online therapy.

What is Virtual Therapy?

Virtual Therapy is the therapy that is offered electronically or over the internet to people in need of mental support. Virtual therapy is known by various terms that are used interchangeably.

For instance, virtual therapy is also referred to as internet therapy, e-therapy, e-mental health, online counseling, cyber counseling, online therapy, or teletherapy. In fact, it comes under the term ‘Telepsychology’ in the American Psychological Association (APA)index of terminology.

APA has set up a Task Force on Telepsychology that defines Telepsychology as providing psychological services through telecommunication technologies. In other words, it includes preparing, transmitting, communicating, or processing information through electronic means.

These may include a number of technologies. For instance, videoconferencing, chat, text, email, the internet which includes self-help websites, blogs, social media, telephone, and mobile devices.

Benefits of Online Therapy

Using these technologies have made it really easy to extend mental care to individuals who were constrained by:

• Geographic location
• Medical illness
• Financial issues
• Other barriers like the stigma attached to mental illness.

There is no doubt that online or virtual therapy offers a good opportunity for mental health care providers. This is to increase patient access to psychological services. In fact, online or virtual therapy gives a boost to the traditional face-to-face counseling sessions given to people with mental health issues.

Also, the use of digital technology helps in providing psychological services through new methods. These include therapy given through interactive videoconferencing, online psychoeducation, etc.

But to direct mental health professionals in respect of their conduct and behavior, APA has come up with guidelines. These have been released to help professionals offer the best guidance as they adopt virtual therapy.

APA Guidelines

Some of these guidelines include:

• the competency of psychologists to use these technologies
• taking informed consent of the patients/clients
• maintaining the confidentiality of details related to clients
• ensuring that there are proper measures to protect client data
• being well-versed with and complying with laws when providing services to clients across jurisdictions

But despite these measures taken, there are both pros and cons of online therapy. Therefore, it is important to consider them before taking online therapy.

Pros of Online Therapy

The following are the pros of online therapy for patients/clients or mental health care seekers.

1. Accessing More People Needing Mental Care

You may not know that many people facing mental issues like anxiety and mood disorders never receive treatment. As per WHO, anxiety and depression cost the global economy US $1 trillion every year. Yet, 76% – 85% of people with mental health disorders receive no treatment.

There is a gap between the need or demand for treatment and its provision. And this gap is something that can be reduced with the help of virtual therapy. Thus, if you are one of the patients who haven’t received treatment for years, you can now be reached and given evidence-based psychological treatment via online therapy.

With online intervention, you are now able to seek therapy even if you reside in remote and rural areas. Online therapy is certainly an advantage if you haven’t been able to seek treatment because of various constraints. These limitations could be challenges of traveling, lack of transportation, physical or mental disabilities, etc.

With the increase in online counseling, more people can now receive telehealth services. This means you can receive mental health treatment, anytime, anywhere even if you’re bound by such constraints.

2. Meet Therapist Frequently and Through Many Ways

Virtual therapy allows you to meet your therapist anytime, anywhere, and multiple times in a day, week, or month. In cases of emergency, you can immediately fix up an online therapy session with a mental health professional, as per your need.

This means no hassle of going to the clinic, no waiting time of a week, and instant help to people who need help in an emergency.

Online therapy also is best for mental health care seekers who need frequent support. This is because telehealth enables you to connect to a mental health professional in a number of ways.

For instance, you can get in touch with your therapist over text, video call, audio call, etc. This gives you the flexibility to choose the way you feel convenient to have a therapy session with your therapist. Many people express themselves freely when on a video over text or audio call. Similarly, there are others who open up more freely when on an audio call or texting.

3. Increased Comfort and Flexibility of Receiving Treatment

The convenience of receiving mental treatment has increased more than ever with online therapy. Now, there could be a number of limitations on your end for not being able to visit a mental health professional’s clinic. For instance, you could have fear of you being identified by someone when sitting in a clinic, waiting for your turn. This could be due to the stigma attached to mental health or the culture you come from.

Similarly, you may have issues like traveling, time constraints, having no transportation facility, scheduling appointments, etc. This is where virtual therapy shines and comes to your rescue. You can take online therapy sessions from the comfort of your home, without the stress and anxiety that is usually caused due to the constraints mentioned above.

Also, you get a lot of flexibility in terms of having an online therapy session as per your comfort. For instance, you can schedule a session while you’re traveling, during work breaks, or when you’re free over the weekends.

4. Help Meet the Shortage of Mental Health Professionals

As per the latest WHO statistics, the USA had 10.54 psychiatrists per 100,000 people IN 2016. This shows that the gap between the number of people who need mental health care and the number of mental health care providers is huge.

However, this gap can be filled with the help of virtual therapy. This is because mental health professionals can reach clients/ patients in any part of the world.

All the patients and the professionals need is a stable internet connection, a mobile phone, laptop, or a tablet through which they can connect having a good quality camera. With connecting over the internet being that simple, virtual therapy helps professionals reach out to more people needing mental healthcare.

For instance, mental health professionals can reach out to people in remote or rural areas. This wasn’t possible earlier as rural areas could not get the resources and care of medical health professionals.

5. Cost-Effective Relative to Traditional Therapy

Well, at times online therapy can be cost-effective relative to traditional therapy. This is because online mental health care providers may provide you unlimited access to mental health services at a weekly or a monthly fee. Likewise, you may find virtual therapy cost-effective in comparison to in-office visits.

But you need to be careful here when comparing the cost of online therapy vs traditional therapy. This is because many online therapy websites and applications do not come under your insurance cover. Many insurance companies cover mental health treatment that is taken in person.

However, as per statistics, the traditional therapy costs betweeb $75 – $150 for a 45 – 60 minutes in-person session. These are rates after your insurance coverage. Thus, online therapy still turns out to be cheaper than in-person sessions. For instance, online therapy provider online-therapy.com charges between $30 – $65 per week.

6. Go for Online Therapy Instantly

One of the biggest advantages of virtual therapy is that you can go for it just a few hours after you schedule an appointment with your therapist. In some cases, it’s even faster than that.

However, you may take some time if the online therapy provider needs your health insurance. Still, the process is faster as compared to traditional therapy. If you’re signing up with an online therapist for the first time, searching for a relevant mental health professional also is not a big challenge.

This is because the algorithms are such that they ask you questions and track your search history. And this is what helps them in connecting you to the right professional within no time. But, in cases where professionals are not a part of the affiliate programs of the online therapy network searching for and connecting with a relevant specialist may take some extra time.

Also, the benefit of taking online therapy, anytime, anywhere is certainly a boon.

Cons of Online Therapy

The following are the cons of online therapy or the disadvantages of online therapy for mental health care seekers.

1. Online Therapy May Not Be for You

There is no research on online counseling suggesting that online therapy alone or as the only therapy can apply to every case and situation. You have to see whether the application that offers online therapy applies to your case.

This is because there are many websites and online platforms that claim to provide online therapy for various mental health issues. But, its effectiveness totally depends on the type of mental issue you have, how severe the symptoms are, and whether these can be identified over a video, email, text, or audio call with a mental health professional.

For instance, if you have a severe psychiatric illness and need in-person intervention, online therapy as a standalone option may not work. In such a case, you need the direct involvement of the mental health professional and need to see him in person to seek treatment for your complex situation.

2. Your Insurance Plan May Not Cover Online Therapy

There are many insurance companies that provide cover for mental health treatment only if you seek it in person from a professional. Thus, if you visit your psychologist in his clinic and work with him on your mental issue, your insurance plan may cover a complete or some portion of the fee.

In this case, mental health professionals issue you an invoice against which you can get reimbursed by sharing the same with your insurance company.

But, virtual therapy is generally not covered by the majority of insurance providers.

Similarly, many online therapy providers do not accept insurance coverage as payment. So, if you are looking to use your cover, check with your insurance company and the online therapy provider.

If insurance coverage is not applicable, you will have to pay the treatment fee in full out of your pocket.

3. Lack of Confidentiality, Security, and Privacy

Psychotherapy has been effective in treating mental disorders as it provides a safe, private environment to the clients. This makes them share their personal issues and express their complex feelings to the mental health professional with ease.

Since you know you have a private space where no one is listening to you, you can come out with your fears and difficult feelings easily. You know that there is no one to judge you. What you say, do, come out with is going to stay between you and your mental health professional. Now, privacy and confidentiality may be at threat when it comes to online therapy. This is because the information being transmitted online is exposed to hacks or has odds of leaking.

Similarly, technological glitches may at times create issues and make the situation complex for you.

4. Inter-State Laws Restrict Therapy to State Licensed Professionals Only

No doubt virtual therapy allows you to take mental health treatment from anywhere, but there is a caveat here. Psychology licensing laws are not catching up with the changing dynamics in providing mental health care services to people who need support.

According to the telepsychology licensing laws, the therapists licensed in your state only can provide you with online therapy. This means for therapists to provide online therapy outside their licensed state, they need to own a license for the other state. This is apart from the state in which they are licensed to provide online therapy.

There are, however, exceptions to this. There exist many states that allow out-of-the-state psychologists to provide services to clients for a period of 30-60 days in a calendar year.

5. Lack of Direct Help in Period of Crisis

Virtual therapy can help to seek help in less time. However, it lacks when in-person or direct help is needed by a person in crisis. For instance, a person having a major panic attack or suicidal thoughts needs direct help from a mental health care provider.

In such a crisis situation, online therapy may not be able to successfully be of help to the person facing severe or complex situations like these.

6. Can’t Read Body Gestures

One of the other disadvantages of online therapy is that the mental health care provider is not able to read your body gestures. For instance, your facial expressions while you talk, the tone of your voice, your actions may be clear in video calling. But, therapy over text, email, and audio calls lack this facility.

Even online therapy over video calling may lack that personal touch and detail as is present in a face-to-face session. These signals are very important for therapists to take into account in order to clearly understand the severity of your issue.

7. Ethical Issues Like Is the Therapist Licensed

Licensing is out of the few dangers of online therapy. Having a licensed therapist providing you with mental health is critical. Basically, licensing gives you protection as words like psychotherapist and therapist are not legally backed in many states.

This means that anyone can say that he/she is a therapist and provide you with mental therapy. It is absolutely necessary for your psychotherapist or mental health professional to have a license in the state in which he is providing mental health care services.

Thus, licensing gives you that guarantee that only the person who is qualified and trained is providing you mental health care services.

Also, you can count on and go back to your therapist in case you have any issues in receiving your treatment. Therefore, before you register with any online therapy website, make sure that you do the necessary research. This is to find out that the network of therapists registered on the website is authentic and has a license.

You can check the state for which the therapist is a license holder. You can also check his license number from the state online directory.

Ethical Issues With Online Therapy

The following are some of the major ethical issues with online therapy.

1. Medical Professional’s Training and Competence

It is important for mental health care service providers to be competent in using technologies to provide online psychotherapy. Further, they also need to have clinical competencies that are appropriate to the online setup.

For instance, the medical professional would need to know the ethical guidelines and legal requirements for providing online therapy. It is important to note here that the in-person therapeutic skills of the medical professional would not mean that he’s competent to handle mental health care seekers online. One of the drawbacks or issues with online therapy is that guidelines for online therapy are not well defined. Also, there are fewer training and educational programs in respect of virtual therapy.

Therefore, the therapists would have to be well-versed with the international laws and legal requirements of their clients. This is in case they are providing therapy to people in remote areas.

2. Insufficient Research Showing Effectiveness of Online Therapy

One of the other ethical issues with online therapy is that there is not enough research that supports the effectiveness of online therapy. In other words, much still needs to be studied and researched about online therapy.

For instance, the efficacy of virtual therapy, its effectiveness, the long-term outcomes of online therapy relative to in-person therapy.

3. Informed Consent of the Patient

The therapists need a specific type of informed consent from the patients when it comes to online or informed consent difference lies in legal and technical requirements. It may be challenging to determine whether the patient sitting for online therapy is legally capable to give consent or take their mental health services.

4. Lacking Technological Know How

It is a possibility that the medical professional may not have the requisite technical competence to undertake online therapy. Similarly, both the patient and the mental health care provider may not be well aware of the technical skills they possess so that they can have the online therapy session uninterruptedly.

5. Incomplete Guidelines

As discussed earlier, there is a gap when it comes to guidelines in respect of virtual therapy. The much-needed guidelines and regulations are either incomplete or do not exist. Likewise, the regulatory bodies to do not provide any guidelines with regards to virtual therapy.

Similarly, there are many queries that are not dealt with regard to online therapy. This is because of the lack of guidelines or code of conduct with regard to virtual therapy.

Online Therapy Vs Traditional Therapy

Let’s now compare online therapy vs traditional therapy so as to get a clear picture of how the two are different from each other. This will help you to get a better understanding of which one is better for you.

Basis	Online Therapy	Traditional Therapy
Definition	Online therapy refers to providing mental health support electronically, anytime anywhere. It may be provided through various forms such as text, video conferencing, audio calls, and email. It is also called telepsychology, online therapy, or virtual therapy.	Traditional therapy, on the other hand, is providing mental health care support in-person, in a clinical setup. This is where both the therapist and the patient are present in person and have a 45-60 minute long therapy session.
Communication	Therapists are able to communicate via text, audio, or video calls. When it comes to text or audio calls, therapists can’t see non-verbal cues which are very important to consider for understanding mental health issues. The video call, however, may allow the therapist to see the patient. But it lacks the intimacy and intricacy of an in-person session.	The in-person session allows the therapist to read the body language, the tone of voice, the way patients express or emote. This helps in understanding the non-verbal cues which are important to consider to reach any conclusion in respect of the mental health issue the patient is going through.
Convenience	Online therapy offers the comfort of undertaking the session anytime, anywhere. All you need is a strong internet connection and a mobile device, desktop, or tablet. Many people can freely express themselves given the comfort of their home and no one judging them. But a technological glitch may put your privacy at risk. This is because it may lead to your information leaking or the website being hacked.	The traditional therapy sessions give patients a space away from home. The mental health professional’s clinic gives them the space away to talk about their worries and share their complex stories with the therapist. Again, patients feel comfortable expressing themselves. Also, there’s an added advantage of the therapist being able to extend direct support, clearly getting the non-verbal cues and going into much detail.
Access	Online therapy can be accessed very easily. All it takes is a simple sign up and you can choose to meet the specialist you want to. Plus, you don’t need to get into the stress of visiting the clinic of the therapist. Online therapy makes it really easy for people bound by lack of transport facilities, physical or mental disabilities, etc to have access to mental health support.	It may be a challenge for people sitting in rural or remote areas, lacking transport facilities, disabilities, or work to go for in-person therapy. Also, one needs to schedule an appointment at a good time before they want to go for a traditional therapy session.
Cost	Online therapy is cheaper than traditional therapy. However, many online therapy sessions are not covered by insurance plans. There are various online therapy providers. The pricing for some of them starts at $30 per week. And neither do many online therapy providers accept insurance cover. So, you may have to pay the entire fee from your own side.	Traditional therapy is relatively costly. Although, the rates for traditional therapy sessions vary from state to state. The average cost for a 45-60 minute traditional therapy session costs between $75 – $150.
Support	Although seeking instant support is not an issue here, it may not be suitable for many mental health issues. For instance, a person having suicidal thoughts needs the direct assistance of a therapist. This is not possible with online therapy.	This is good for a crisis situation when a person needs direct support from the therapist. Also, the personal touch in the in-person therapy session is what is needed in severe cases.

Online Therapy Controversy

As mentioned above, one of the dangers of online therapy is determining the authenticity of the online therapy websites.

It is difficult to determine whether the person registered as a therapist on the online therapy platform is a licensed therapist or not.

Few of the leading online therapy-providing websites came into question for their exploitative privacy policy and regulations.

In fact, some of the social media influencers claimed that these online therapy websites were sharing client data with big social media companies of the world.

Not only this, these platforms were also exploiting genuine therapists by underpaying them.

These online therapy websites were even questioned for undertaking paid partnerships with some of the big celebrities. All promoting these websites that had questionable guidelines, no clarity with the credentials of the therapists registered, and clients being paired to specialists not matching with their needs.

Research on Online Counseling

More researchers have been going through online websites and applications to check their effectiveness. As per research, these internet-based tools can be helpful when used together with in-person therapy.

For instance, both researchers and patients are finding therapy over text helpful. Likewise, online video-conferencing is helpful in providing therapy to people in remote areas.

Here are some of the research studies undertaken to check the effectiveness of online therapy.

Cognitive Behavior Therapy, 38(4), 196-205. http://www.ncbi.nlm.nih.gov/pubmed/20183695

Journal of Technology in Human Services, 26.2-4: 109-160. http://www.tandfonline.com/doi/abs/10.1080/15228830802094429#.VI8vaCvF_hs

The future of online therapy. Psychotherapy Networker Symposium, Washington, D.C. http://dx.doi.org/10.1037/e561872012-001

Patients and text messaging: A boundary issue. (2009). The American Journal of Psychiatry. 166(11), 1298-1299. http://dx.doi.org/10.1176/appi.ajp.2009.09071012