Figuring out how to do what’s best for your mental health is about more than taking a bubble bath or downing some hot chocolate (although those things are also nice). You’ve tried therapy, but the whole leather couch thing was way less comfortable than, you know, being at home. When you need to call in some professional reinforcements to give your emotional wellness a tune-up, laying out a step-by-step approach to starting teletherapy for the first time can make the road ahead easier.
Even if you’re anticipating getting back into the IRL swing of things post-vaccination, checking out virtual therapy options may be a good idea. “Teletherapy is here to stay,” says Alice Shepard, Ph.D., a licensed clinical psychologist at the telehealth platform Sesame. “Therapists are giving up expensive office spaces in exchange for the convenience for both them and their clients to work remotely.” For you, that means you’ll save on the trek to your therapist’s office (and the requirement to wear pants during your session).
Sure, teletherapy isn’t for everyone — it’s OK to want that physical space outside of your home, face-to-face IRL with no screen between you. And even if you’re good with video-based teletherapy, it’s important to remember that some teletherapy services are oriented around unscheduled texting rather than talking or video calling. That can be super beneficial, but is by nature very different than pulling up a chair and chatting face-to-video-face.
If you think any of the various forms of teletherapy might be for you, here are the steps to starting teletherapy for the first time.
Step 1: Ask Yourself Questions Before Starting Teletherapy
The steps you take to start teletherapy aren’t much different from the steps you take to start IRL therapy. Fittingly, you’ll want to start with some self-reflection, Shepard tells Bustle. “What are the main areas of my life that I would like help addressing?” she suggests asking. “What type of interactions do I want to have with a therapist (structured, not structured, mixed)? Who would I most feel comfortable working with (gender, age, race/ethnicity, level of expertise, sexual orientation)?” Sketching out some answers for yourself can help narrow your search.
Step 2: How To Find Teletherapists
Before you settle on who you want to share all your secrets with, you can shop around. “Ask friends and family for suggestions for a therapist,” Shepard advises. “Read online reviews and look carefully at therapists' websites, bios, videos, blogs, and articles. Can you picture yourself interacting with them?” Of course, you’ll also want to make sure they’re licensed to practice in your state before moving forward.
“Doing a search on psychology directories has definitely been a go-to for many people over the last year,” says psychotherapist Lillyana Morales, L.M.H.C. A great place to look is Psychology Today, which lets you search by area code. If your workplace offers an Employee Assistance Program (EAP), you can connect with a therapist through there (and some of the sessions may be covered). Sites like TalkSpace (from $65 a week) and BetterHelp ($60 to $90 per week) will connect you with licensed teletherapists, with whom you can have sessions over video, phone, or via chat. You might also choose to look for a teletherapist through your insurance’s website or an identity-based therapist directory, like this one for queer BIPOC therapists.
Step 3: Interview Potential Therapists
Think of your search for a therapist like interviewing someone for a job: you want to make sure it’s a good fit before you send them a check every week. “Therapists have very different approaches based on their training,” licensed psychologist Charmain F. Jackman, Ph.D. says. “Having a conversation with a therapist ahead of time is a great way to find out how they practice and whether they are a good fit for you.” Double-check if the person charges for a consultation, and find out how long they’re expecting your first conversation to be.
“An important consideration is asking a therapist if they are social justice-oriented, culturally competent, trauma-informed, and affirming of the populations you identify with,” Morales says. “Some examples of this can be LGBTQIA-affirming, sex-positive, and/or kink-allied, to name a few. You want to be confident that the therapist you're working with is not only licensed but also can understand and accept who you are and provide a space for you to be your authentic self.”
Talk to two or three therapists, Shepard says. “Ask yourself: did you feel better after the meeting? Did you like their way of relating to you? Do you feel like they would be able to help you to grow?” She advises asking yourself these questions after each prospective consultation to help determine how you want to move forward.
During this process, check in about money. “If you are using health insurance to pay for the service, make sure that teletherapy is covered,” says Jackson. If the therapist you love doesn’t take insurance (and many don’t), see if they offer sliding-scale payments that you can afford out of pocket. You can sometimes use a flexible-spending account to pay for or get reimbursed for sessions — just check with your insurance provider.
Step Four: Set Up Your Telehealth Platform
“The logistics of beginning teletherapy are very simple,” Shepard tells Bustle. The platform should be HIPPA-compliant to protect your privacy, and you’ll want to make sure that there’s no fee associated with using the video service. Once your therapist sends you the session link, just download the platform if you don’t already have it and fill out your paperwork ahead of time — the same as you would for an IRL appointment.
Make sure your internet connection is solid, too, Jackman advises. It’s bad enough when your boss tells you your screen froze in the middle of a presentation; you want to avoid this as much as possible when spilling the emotional tea to your therapist about your ex.
Step Five: Prepare For Your First Teletherapy Session
For your first video teletherapy session, set up as you would for any other video chat: Grab a comfy seat, make sure you're not backlit, and hide your face on the screen if you find it distracting. Have a glass of water and tissues nearby, too.
Whether you’re on your own couch or your therapist’s, your first session might be a little intense. “Once you set your first appointment, you'll meet with your therapist for what is called an intake session,” Morales explains. “During the intake, your therapist will go over your presenting problem more in-depth as well as gather history to understand some of those past experiences.”
You can share as much or as little as you’re comfortable with at the moment, but it’s helpful to prep emotionally to be asked about difficult subjects. “Be prepared to talk about your history of trauma, actual use of alcohol, any form of self-harm, and your actual internal monologue — not the dressed-up version,” Shepard says.
Even if you’ve done in-person therapy before, don’t be surprised if virtual therapy gets real pretty fast. “With some of my patients, having the screen almost feels like a level of anonymity, where sometimes they feel more comfortable sharing,” Cairo tells Bustle. "They're just comfortable in their home as opposed to in a more sterile therapy. So sometimes that actually allows for more vulnerability.”
Step Six: Make Therapy A Part Of Your Life
While doing therapy from your couch instead of from your therapist’s is obviously different, therapist Dominique Apollon, M.Ed, LPC, says that it’s important to treat an at-home session just as you would an in-person session. “Be sure to come to the session with goals or points to discuss in order to get the most out of your time," Apollon tells Bustle. Speaking of your time, make sure you’ve got your regular session time in your calendar every week — and always let your therapist know ahead of time if you have to cancel or reschedule.
Physically, you’ll want to ensure you have regular access to a space (and time) where you won’t be bothered. “Let your employer know that you have a weekly doctor's appointment if you would like to attend daytime sessions,” Shepard advises. “Let family, relationship partners, and roomies know that you have therapy, and please not interrupt you,” Shepard adds.
Consider asking roommates to take a walk, if that’s an option, or even going for a walk yourself and conducting your sessions over the phone, suggests Elana Cairo, Ph.D., a licensed clinical psychologist with Alma. She also recommends creating a “therapy space” that’s separate from your day-to-day space, even if it’s more conceptual than physical — so doing therapy from a chair in your room, rather than on your bed, for example. Try creating routines for before and after your session, to help delineate "therapy time" from "regular time."
“Doing this prep will allow you to feel safe and relaxed,” Shepard says.
Alice Shepard, Ph.D., licensed clinical psychologist and medical advisor at Sesame
Charmain F. Jackman, Ph.D., licensed psychologist
Lillyana Morales, L.M.H.C., MA in Mental Health Counseling, psychotherapist
Elana Cairo, Ph.D., licensed clinical psychologist with Alma
Dominique Apollon, M.Ed, LPC