What you need to know if you’re thinking about trying online therapy
Special to the Daily
Service comparison cheat-sheet
A comparison of three online therapy service providers:
Cost: $128-$276 per month
Insurance: Does not accept health insurance, Medicare or Medicaid
Free trial: No
Mobile app: Yes
Technology type: Messaging, chat (only available with select therapists) and video (extra cost required)
Cost: $35-$65 per week
Insurance: Does not accept health insurance, Medicare or Medicaid
Free trial: Yes, for seven days
Mobile app: Yes
Technology type: Messaging, chat, phone and video
Cost: $145 per session on average
Insurance: Does accept health insurance, Medicare and Medicaid
Free trial: No
Mobile app: No
Technology type: Video
Source: E-Counseling.com “Top Online Therapy Services – February 2017”
it’s not hyperbole to say the internet changed the way people communicate with one another.
From the early days of chat rooms and AOL Instant Messenger to the social media and video conferencing platforms we know and use with fervor today, it’s quite possible to have a relationship with another human and rarely — sometimes never — interact with them in person.
And now, with a growing number of mental health services available online, the same could become true for the relationship you have with your therapist.
Online therapy service websites offer individuals the opportunity to seek mental health therapy without ever stepping foot in a brick-and-mortar office. Even the therapists who run traditional practices in those offices are often also utilizing tools such as email and video conferencing to reach clients in remote locations — those with busy schedules or those for whom meeting face-to-face is cause for anxiety.
“The main advantages are convenience and easy access,” said Jill Squyres, who has a doctorate in clinical psychology, is a licensed psychologist in Colorado and Texas and offers online counseling and psychotherapy services to individuals in both states.
“It is also very private. No one sees you going into a therapist’s office. You don’t need to explain to anyone where you are going and you don’t need to worry about who you might bump into in the waiting room or parking lot.”
How it works
In addition to practices such as Squyres’, where she offers both online and traditional, in-person, services from her Eagle-based office, there are several websites offering services that are solely based online, such as TalkSpace, BetterHelp or Breakthrough.
While the process for each site is slightly different, you can expect to have an initial consultation, where you’ll fill out a questionnaire which asks basic questions about your gender, age and overall health, as well as more specific questions about your mental well-being and why you’re seeking therapy.
Squyres suggests taking every advantage during this consultation to both explain in detail what you’re looking for in a therapist and to ask questions about what to expect from the service.
“Good psychotherapy requires some assessment where the counselor learns about your background, personality and issues,” Squyres said. “A service should not be offering quick advice based on minimal interaction and information. When looking for online mental health services, you should look for all the same things as you would look for if you are going to see a therapist in their office.”
Once you’re matched with a therapist, depending on the site, then you can book an appointment for a video chat — according to Breakthrough’s website, you can usually get an appointment within 48 hours, or get started right away with a text conversation, which is the case on TalkSpace.
You should also expect to fill out consent forms, similar to those you’d fill out in a traditional therapist’s office. If the site you’re on doesn’t request this paperwork, then that might be a warning sign, Squyres says.
“You should have to sign a standard treatment consent form as well as a teletherapy consent form outlining the practice issues unique to online service delivery,” Squyres said. “If there is not a teletherapy consent form addressing these issues, you should be concerned.”
What it costs
Pricing structures for online therapy services vary. BetterHelp, for example, offers weekly membership plans starting at $35 per week. TalkSpace offers a monthly membership structure with plans starting at $128 per month. Breakthrough charges per session, with an average cost of $145 per session.
In comparison, traditional therapy can cost anywhere from $80 to $200 for one hour-long session, which has many touting cost as an advantage to choosing online therapy services before traditional. Squyres warns, though, to be wary of prices that are too low, in which case the quality of the therapy you receive might be similarly low.
“Good psychotherapy requires time and attention,” she said. “If the fees are too low (unless they are subsidized by an agency or grant), the service quality will be low, too. There is no way to provide good services if the therapist isn’t being compensated well enough to pay their bills, even if they don’t have much overhead.”
As for insurance coverage, neither TalkSpace nor BetterHelp accept health insurance, Medicare or Medicaid. In contrast, Breakthrough — the costlier of these three options — does accept a variety of health insurance plans. You can find a detailed list of exactly which plans are accepted and search for therapists based on insurance coverage on their website.
Know your therapist
In addition to taking into consideration things like cost and the logistics of how a given site works, it’s also important to research each site’s roster of therapists and their respective credentials before proceeding with online therapy, Squyres said.
“You are entrusting your counselor with sensitive personal information and you are spending time, money and effort to get help,” she said. “Make sure your trust is well-placed before you start talking to anyone. If little detailed information about the counselors is provided, I would consider that a red flag.”
BetterHelp features a profile for each therapist, with information about their specialties, licensing information and reviews from other users. Breakthrough has a similar system of profiles available, with added information about demographics served and the documents you will need to complete to receive treatment from the therapist.
Prescribing medication online
Another consideration to make is whether you need to speak to a psychologist or a psychiatrist. A psychiatrist has a medical degree and is authorized to prescribe medication, whereas a psychologist has a doctorate degree and treats patients by talking with them, but cannot prescribe medication.
TalkSpace and BetterHelp do not work with psychiatrists and their providers are unable to make any official diagnosis, either to fulfill any court order or to prescribe medication. Both sites state their therapists can make referrals or recommend a client to a general physician or a psychiatrist if they think the client needs medication.
Sites similar to Breakthrough and Amwell, on the other hand, do work with psychiatrists, though Breakthrough’s website states they “are not currently enabled for e-prescriptions.” And a statement on Amwell’s site clarifies that controlled substances and state-specific controlled substances cannot be prescribed via telehealth on Amwell.
“There has been some controversy in past years about physicians prescribing for people they’ve never met with in person, but that seems to be resolving in the direction of it’s OK if a physical exam isn’t needed,” Squyres said. “For psychiatric prescriptions, there is rarely any direct physical exam required.”
Squyres adds that online psychiatric services could be particularly helpful to those living in mountain communities.
“There is a nationwide shortage of psychiatrists, and we have a very small number of psychiatrists up here in the mountains, so online psychiatric service delivery is an option that people up here should really explore if they need to see a psychiatrist,” she said. “As with all health services online, the practitioner must be licensed in the state the patient is in to practice within the scope of their license.”
Privacy and confidentiality
“Regular email and text messaging is not usually HIPAA compliant, so clients should be careful about the sensitivity of the personal information they share with their therapists by text or email,” Squyres said. “Most therapists do have confidential email that is HIPAA compliant, but it is a hassle to use and most clients don’t want to have to deal with encryption keys to use email.”
You should be able to find confirmation somewhere on the online therapy service’s website that the technology they’re using is HIPAA compliant. For example, TalkSpace states this on their frequently asked questions page and adds that all chat data is encrypted on their servers.
A final item to take into consideration when deciding on an online therapy service is whether the provider has an emergency treatment plan in place.
“Many people in need of counseling will go through periods of crisis where their need for services is more intense or where steps need to be taken to ensure safety,” Squyres said. “Handling these situations from miles away is much more complicated than when they are down the street from your office.”
Ultimately, when it comes to finding the right therapy service for you, Squyres said, “if it sounds too good to be true, it usually is.”
“You don’t need an online mental health service to receive online services,” she said. “I would look around for independent practitioners who can provide in-office and online services as my first choice, and only choose a practitioner for online services who meets the same high standards and expectations you would have for someone you were meeting with in person. Also, most insurance companies, aside from Medicare, now cover online psychotherapy. So you don’t need to go to a low cost online subscription service when using your health insurance is an option you should explore.”
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