Have Computer, Will Counsel: Taking Your Therapy Online


Through the magic of the World Wide Web, it’s now possible to find help cheating on your spouse and navigating through an Expedia purchase for the first time. It was only a matter of time before enterprising therapists thought of taking psychotherapy online.

From Pretty Padded Room to My Therapy Couch to Breakthrough.com, entrants to this new medium are proving there can be a sustainable business model built on providing digital therapy sessions. As the lines continue to blur between the “real world” and its virtual counterpart on the Web, in a few years people will likely think nothing of having a doctor’s appointment online. The time to establish a presence in the new environment is now, either by signing up with an online therapy network or offering e-visits on your own.

Why People Seek Help Online


Patients report opting for teletherapy for a number of different reasons. People who suffer from agoraphobia and have trouble leaving the house are obvious candidates for online therapy. Others say they’re able to use e-therapy to squeeze sessions into lulls in their otherwise busy day, and to arrange impromptu, emergency “mini-sessions” with their therapists. Others get on-board out of necessity, after moving far from their therapist of choice.

The savings from online therapy are not only in time. Without having to drive and park or take a bus, there are no transportation expenses to and from an office. There’s also the lower price of the sessions themselves. Online therapy appointments are generally quite a bit cheaper than face-to-face sessions.

There’s also the fact that the people who need therapy are often the very ones who have trouble seeking help in public. Teletherapy solves this problem by allowing patients to meet with a psychologist from the privacy of their own homes in comfortable surroundings, where there’s no chance of an embarrassing encounter with an acquaintance in the waiting room. Therapists also find that patients open up more online because they’re more relaxed and can focus on their feelings instead of processing a new environment.

Some of the cons of e-therapy are shortcomings practically all Internet businesses have to face. For one, it’s reliant on technology, which, for all its advances, can still fail now and again. A depressed or manic patient might not be able to cope with a malfunctioning site, or pick right up again where he left off after a power outage abruptly cuts off a connection with a therapist. Even some of the providers admit that teletherapy is probably not advisable for patients who need more than “casual therapy” for serious conditions like schizophrenia.

Despite thorough privacy policies and promises of security online, e-therapy providers face a challenge trying to ease public fears of the safety of taking extremely personal information and disclosures online. Public perception of the dependability of providers of online services has soured in the wake of recent privacy leaks by highly visited sites likeLinkedIn and Facebook.

And of course, teletherapy removes the feeling of connectedness patients get by being in the same room with their therapists. The patient-therapist relationship is heavily dependent on trust, which in turn is strongly affected by signals a therapist gives off like body language and tone that may be masked or invisible by being routed through the computer. It may take longer for that trust to develop, thus requiring patients to schedule more sessions , offsetting some of their savings from in-person therapy.

How Online Therapy Works


Although they differ in small details, in general, online therapy providers operate with a few set methods.

  • Email and/or chat: The most basic and arguably the most common type of therapy involves written communication between therapist and patient. For example, Online-Therapy.com makes use of worksheets that patients fill out and therapists respond to each day. It couples this with the ability to live chat with a therapist at any time Monday through Friday. MyTherapyCouch calls its system “email therapy,” while Pretty Padded Room offers a digital diary plan in which patients journal their thoughts and receive a response from a therapist with her comments in a day or two.
  • Video calling: Online video sessions are the next step up from written interaction and provide a virtual experience that’s the closest substitute for “the real thing.” Using either a computer’s webcam or a smartphone’s camera, patients can both see and hear their therapists by using a video chat service like Skype or FaceTime. Sessions typically last between 30 minutes to an hour and can be one-off events or scheduled on a weekly repeating basis.
  • Crowd-sourcing: One of the advantages the networks offer over individual therapists operating online are group therapy options. This often takes the form of free forums, although MyTherapyCouch offers a paid support group option, as well. Patients appreciate having a place where they can commiserate with other site members about similar problems without having to resort to more general forums where “trolls” often lurk.
  • Therapist choice: The majority of e-therapy networks allow patients to choose their own therapists (although some pair patients with therapists based on their responses to forms they fill out while registering). They help their customers make this decision by creating a web page dedicated to their roster of partnering psychologists, where each is able to list their academic and professional credentials, what areas they specialize in, and a little bit about themselves and their approach. Virtually all e-therapy networks let patients change therapists if they so desire.
  • Pricing: Fees typically range from $40-$110 per session, while monthly plans run from $100-$250, depending on the services included, which patients pay with a credit card or PayPal account. Registration or membership is typically free. In the past, insurance companies have not been willing to cover online therapy sessions, but that is beginning to change as the medium becomes more popular.

Why an Online Practice Might be Right for You

  • Expand your client base: Online therapy is still in its early stages, and the market is still largely untapped. Disabled people and homebound people now have the ability to have regular therapy sessions. E-therapy will also create a new group of people interested in therapy: those who have avoided it because of a perceived stigma. They will appreciate the secrecy online therapy provides.
    Finally, there’s the group of people who see therapists currently but would much prefer to do so online from the comfort of their own homes. For those with anxiety or agoraphobia, where the very nature of the problem hinders them from wanting to travel to seek help, online therapy will be exactly what they’ve been waiting for. All it takes is for the public to become comfortable with the concept of online medicine, which all signs point to as being soon, and the teletherapy field will take off.
  • Keep patients you would otherwise lose: In addition to expanding your reach to other states and even into other continents, online therapy allows you to maintain relationships with loyal clients you’ve treated for years if either you or they move away. Even the patients you lose to life changes that made scheduling appointments too difficult may now be able to find time to start being treated again.
  • Increase your flexibility: No matter what Marissa Mayer says, telecommuting is the wave of the future. The Internet allows you as a therapist to take your office with you wherever you go, and even keep it in your pocket. If you were lucky enough to shift your entire practice online, you wouldn’t need the overhead of an office or a staff. Even if you only use the Web to supplement your practice, the added flexibility can only be a good thing for your busy schedule.

Setting Up an Online Practice

  • Technical requirements: To take your practice online, obviously you’ll need a broadband Internet connection and a computer with either a built-in webcam
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    or an attachable webcam. You may also want to invest in a third-party microphone, as those that come either built-in or bundled with laptops often offer poor sound quality. The Samson Go Mic is an excellent choice for easy USB connectivity without the need for drivers and clear recording.
    You’ll also need a free Skype account, and a free (or paid) PayPal business account is advisable, as well. That way you can accept both PayPal and credit cards through your website. If you plan to do a lot of email therapy and/or chat, a Gmail account is the simplest and easiest answer for both.

  • Insurance and licensure: Although some insurers are beginning to cover health professionals who provide telehealth services, some still do not. The Telehealth Resource Center advises psychologists to get written approval from their liability insurer before moving a practice online. As for licensure, the subject is quite a bit cloudier. Rules governing out-of-state practice vary across the country, and only three states have laws outlining e-therapists’ legal obligations. The Center for Ethical Practice recommends checking with the state board of any patient outside your own jurisdiction before agreeing to treat them. The APA should soon have the results of a taskforce assembled to create a guide to telepsychology, so stay tuned for that release.
  • Set: You should also give some thought to the physical setting from which you’ll be hosting sessions; take it as seriously you took setting up your office space. The video chat experts at Skype recommend making sure the room is well-lit so that the webcam does not try to compensate, thereby lowering image quality. Just be sure there are no bright lights behind you hitting the camera and making your face look dark. The camera will also try to compensate for dark backgrounds, so make sure the area behind you is light-colored.
  • Online presence: You can create your own website, but unless you’re skilled in web design it’s probably more cost-effective to hire someone to set it up for you. Either way, a professional, calming look and easy navigation are musts. It should be easy for prospective patients to call up your professional credentials, your practice’s guiding philosophy, your areas of specialization, and information for new patients, including how to contact you. Do get SSL encryption and show the lock icon at the bottom of your site, but “guaranteed therapy” or money-back guarantee icons are tacky and unprofessional. Leave those off.You should also consider adding a social media element to your site. Starting a blog and creating a Twitter and/or Facebook account to link your blog posts with is a good way to give Web therapy searchers a feel for you and your therapy style. It also helps get your name out there as an e-therapy provider and draws people into the site.

Done right, online therapy can be every bit as effective as face-to-face therapy. While it is a new field and some questions remain unanswered, e-therapy is clearly the next frontier for health professionals. If you’re a psychologist who wants to be on the cutting-edge, don’t wait around. Hang your digital shingle and let the world know the doctor is … online.