When 23-year-old Yasmeen reached a point in her life where her anxiety and depression were, as she tells Bustle, “spiraling out of control,” she knew she needed help. She says she wanted to find a medical professional to speak to as soon as possible, but faced difficulties getting calls back from therapists’ offices to schedule an initial appointment. It was at that point she considered an alternative her friend had recommended: online therapy.
In recent years, websites and apps that offer remote access to trained therapists have risen in popularity. The convenience of communicating with a therapist via smartphone and the relatively low cost are some of the drivers behind why people use these services; even the American Psychological Association recognizes online therapy as a resource on its site. Well-known platforms include BetterHelp, which matches users with an online counselor they can communicate with live via text, phone, or video starting at $40 a week, and Talkspace, which allows the exchange of text, audio, and video messages with a therapist beginning at $49 a week. Other platforms include MyTherapist and telehealth services available through employee assistance programs (EAPs). While these apps and services aren't replacements for traditional face-to-face therapy, as the respective FAQs for BetterHelp, Talkspace, and MyTherapist note, these platforms can help users get more familiar with their mental health.
It’s easy to understand why these platforms have developed followings — almost one in five American adults live with mental illness, with less than half of those receiving treatment for their mental health in 2016, according to the National Institute of Mental Health. The cost of therapy, lack of access to mental health professionals, and fear of stigma are some common reasons that prevent many people from seeking help. In theory, apps and online therapy platforms diminish many of these hurdles. Since the field is relatively new, research on the effectiveness of online-based therapies in general, including online versions of cognitive behavioral therapy and mobile apps, is mixed. Anecdotally, it seems how effective online therapy is depends on the individual and what they’re hoping to get out of the experience.
For the past three months, Yasmeen has exchanged daily messages with a therapist on Talkspace to help cope with her anxiety and depression. She says her experience has been positive so far; she’s still using the app, and says her therapist helped her make “drastic changes” to her life.
Katherine, 32, tells Bustle that Talkspace has been a cost-effective way to get regular support for the past four years while she’s been traveling full-time. Katherine, who attended traditional therapy intermittently throughout her life, described her difficulties trying to find a regular therapist: “I remembered being so frustrated with trying to find a therapist that I liked and could afford, and it seemed so counter to the point that it was such a pain to get therapy when I was having a hard time.” Katherine isn’t diagnosed with a mental health condition that requires monitoring or treatment, and she says the app matched her with a likable therapist who fit her needs of wanting someone to have ”more philosophical conversations” with.
“I remembered being so frustrated with trying to find [an in-person] therapist that I liked and could afford."
However, not everyone has seen benefits. Cynthia, 28, who used Talkspace to deal with feelings of anxiety and stress, canceled her subscription after a couple of uses and an incident where she claims her assigned therapist stood her up during their chat time. (A representative for Talkspace tells Bustle, "We have policies in place with our therapists that prevent these types of incidents from happening, but given that our network is roughly 5,000 providers, unfortunately these outlying cases can happen from time to time.")
“I would not recommend it for anyone with any serious issues because it can actually create more frustration and anxiety,” Cynthia says. "I'm happy to say that I found an in-person therapist that I have started seeing which has been better for me.”
Therapist Ann Russo, MA.TH, LCSW, who runs her own virtual practice, says not everyone will benefit from online therapy. Russo says people most likely to benefit from online therapy, compared to more intensive traditional therapy, may include people with generalized anxiety disorder, panic disorder, or depressive disorders without suicidal ideation. They could also be people going through life changes that may need help with grief, loss, or coping skills.
“If someone is having anxiety symptoms or needs positive coping skills to deal with difficulties in life, or maybe someone just needs an hour or two of time to decompress, [online therapy] can be very helpful,” Russo tells Bustle. “Starting anywhere to see that mental health is not a scary thing and that there’s help out there for what you’re experiencing can be a good gateway, but [app-based therapy] doesn't necessarily represent what therapy is like ... Rather than thinking about it as therapy, I would call it learning coping skills.”
Aside from the issue of the efficacy of online therapy apps, some people have questions about how they handle patient privacy and safety. Writer Jessica Goodheart, in an article for Capital & Main that was co-published with Fast Company, raised the question of whether app users dealing with mental health issues would be considered "patients or consumers" by these companies. Other concerns include the security of discussing private health issues on an app platform. (Talkspace says its app is fully HIPAA compliant and communications are encrypted; BetterHelp also says its communications are encrypted, that users can seek care anonymously, and that messages can be deleted at any time.)
Despite these potential concerns, their relatively low costs remain a huge draw for users. “[Apps] can be an affordable way to help folks access therapy for low-level issues that might not require weekly therapy sessions,” Dr. Michael DeMarco, a New York relationship counselor in a private practice that offers webcam, phone, and office sessions, tells Bustle.
Lauren, 29, says she was drawn to using apps as a resource when she couldn’t afford in-person therapy. She tells Bustle she used Talkspace for roughly a year and a half after a difficult breakup and having bad anxiety at work. Lauren connected with her therapist daily via text, eventually transitioning to weekly video chats and alternating between the two mediums. While the experience was helpful, she says that it “sometimes felt like more work to text someone all the time and be reflective,” and that she preferred the video sessions.
Tamara*, 28, who used Talkspace for a month, echoed this sentiment. “Even though the therapy app didn't take a lot of time, I felt like I was returning to difficult issues more often and at a much more superficial level than I would have with traditional therapy, and just ended up feeling a bit down or agitated all the time,” Tamara tells Bustle. “I also found it to be rather impersonal — messaging with a person that I had never met about issues I was facing felt strange. I much prefer traditional therapy, and didn't find the app to be an effective alternative.”
Dr. DeMarco also raises concerns about how text communication can be more easily misunderstood than in-person communication, and how 24/7 access to a therapist may affect the quality of care. “A whole caseload of texts coming and going and we're supposed to keep clinical records, maintain confidentiality and do our ethical best to get you making some improvement?” An alternative he recommends is finding a therapist who charges on a sliding scale and understands technology enough to integrate webcam therapy sessions for convenience.
“Even though the therapy app didn't take a lot of time, I felt like I was returning to difficult issues more often ... than I would have with traditional therapy"
To minimize potentially ineffective experiences with online therapy, Russo says users should undergo a thorough assessment before engaging in online therapy to help ensure that it’s a good fit for them. “If people have more significant mental health issues going on, like suicidal ideation [or] psychosis, that would be appropriately addressed in person,” she says. “If there is a person out there who needs to unload a trauma or help process through a trauma, don’t go with apps.”
Lauren says that, based on her experience as a user, anyone looking into online therapy should gauge their self-awareness and be honest with themselves in terms of what they’re looking for from therapy, online or IRL. “If you don’t have a good sense of your own [emotional intelligence], it might be difficult to truly open up and get productive treatment without that personal connection,” Lauren says. “It might take longer to dig deep to find the root of whatever you’re dealing with.”
Russo also advises that users do their homework and understand their therapist’s credentials. If someone is dealing with a specific issue like substance use and is determined to use online therapies, for example, it’s crucial to find someone who specializes with what they’re seeking therapy for. “As a client you can ask your therapist whatever you need to ask — what is your license number, what did you specialize in, how much experience do you have? If they don't answer, then I would not see that person,” says Russo.
Online therapy may be beneficial for some people, but there are other ways to find financially accessible mental health care. The nonprofit Open Path Psychotherapy Collective allows people to search for therapists in their area who charge between $30 to $60 a session for life, after members pay a one-time fee of $49. If you live near a university or college, many training clinics offer more affordable rates for supervised sessions with graduate students studying to become therapists and psychologists. If your work has an employee assistance program, you might be eligible for a set number of free counseling sessions or other relevant resources.
If you're starting to figure out what you're looking for in terms of mental health care, online therapy can serve as a gateway tool to figure out what works for you. But it's important, as these stories show, to go in informed. “At the end of the day,” says Russo, “a therapist’s job is appropriate care, so make sure you know what you’re buying as a client.”
*Name has been changed.
If you or someone you know is experiencing suicidal thoughts, call the National Suicide Prevention Hotline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741. You can also reach out to the Trans Lifeline at 877-565-8860 or the TrevorLifeline at 1-866-488-7386, or to your local suicide crisis center.