How Does Online Therapy Work? Everything You Need to Know

Online therapy has long been a popular way to seek mental health support and has only gotten more in-demand since the pandemic. But, despite that, not everyone has engaged with online counseling before, and starting a digital therapeutic journey can be intimidating — especially if you don’t know where to start.

In this article, we’ll break down everything there is to know about online therapy, including what it is, how it works, what you can expect from the experience, and how to find the best therapist for you.

What is online therapy?

Unlike traditional therapy, which typically happens in person, online therapy refers to the practice of delivering mental health services over the internet — usually through video calls. 

Just like how traditional therapy usually covers a range of services and needs, online therapy can be varied, too, including:

• Individual therapy: One-on-one therapy between a client and a therapist, which is the most common form of online therapy and what we offer at Two Chairs.
  
  
• Couples therapy: Online couples therapy involves both partners participating in sessions with a therapist.
  
  
• Group therapy: Group therapy involves a therapist leading a session with multiple participants who share similar concerns or goals. Group sessions are conducted through video calls, allowing participants to interact with one another and the therapist.

Does online therapy work?

Many people who are new to mental health support wonder: Does virtual therapy work?

For those who are used to in-person, more traditional support, it’s hard to fathom that online therapy — through a screen — is just as effective. But, in truth, it is.

In fact,  studies have shown that online therapy, delivered via video, can be as effective as in-person therapy for a variety of mental health conditions. For example, research shows that online Cognitive Behavioral Therapy (CBT) can significantly reduce symptoms of anxiety and depression and provide effective treatment for conditions such as PTSD, OCD, and stress.

The accessibility and convenience of online therapy often play a role in its success, too. Think of it this way: When there are fewer barriers to receiving care, it is more likely that the care will be successful.

How does online counseling work?

Every provider and platform is different. But, most online counselors and platforms follow a similar cadence:  

1. Sign-up and setup

The first step to receiving online counseling is selecting an online platform or service.

After choosing a provider, you’ll need to register by providing basic information, such as your name, email, and sometimes a brief overview of your mental health needs. Some providers also ask for insurance details if applicable, too. 

2. Matching with a therapist

Some therapy providers, like Two Chairs, offer client-therapist matching to pair you with a licensed therapist who’s uniquely trained to offer you custom support for your individual needs. At Two Chairs, this looks like a 45-minute matching appointment with a licensed therapist who’s expertly trained in finding the right therapist for you based on your needs, preferences, and goals. .

3. Sessions

After you’ve been paired with a therapist, you’ll schedule sessions based on your mutual availability.  Your sessions will happen via video, where you'll discuss your concerns, progress, and strategies for managing mental health issues.

It’s important to note that therapists usually adapt traditional therapeutic techniques to fit the online format. For example, CBT is often conducted via video calls in addition to worksheets and exercises that the therapist either shares with you via email or through the platform.

From your first therapy session all the way through your last, your therapist will typically track your progress and adjust treatment plans as needed. 

7 things to be aware of before beginning online therapy sessions

Starting online therapy can be an adjustment — especially if you’re used to in-person therapy, or starting your therapy journey altogether.

That’s why it’s important that you consider a few things before getting started, so that you have the best experience possible.

Technology requirements

While probably not surprising, online therapy depends on technology. So, when starting your digital counseling journey, you'll want to make sure you have the right tools and setup, like the right:

• Internet connection: A poor connection can lead to interruptions, lagging, or dropped calls, which can disrupt the therapeutic process. Ensure your internet speed is sufficient to support video calls, especially if you’re using platforms like Zoom or Google Meet.
  
  
• Device: Ensure that your device has a functioning camera, microphone, and speakers. Using a device with a larger screen, like a computer or tablet, can enhance the experience by providing better visibility during video calls, too.
  
  
• Software: Before your first session, check that your device is compatible with the software or app your therapist uses. Download and test the required app or software (like Zoom, Microsoft Teams, or a specific therapy platform) to ensure everything works smoothly. 

If you want to learn more, check out these tips for a successful online therapy session we share with our clients. 

Privacy and security

Therapy can be a deeply vulnerable experience, and it’s important to know that the conversations and information you share with your therapist are confidential. 

To mitigate any concerns about privacy, be sure to choose a provider and platform that offers:

• Compliance: When selecting a therapy platform, it’s important to ensure that it complies with privacy laws, such as HIPAA, which is designed to protect your health information by adhering to strict security protocols. 

• Data storage and protection: Look for platforms that offer end-to-end encryption for video calls and messaging, as this ensures that your communications are secure. Additionally, review the platform’s privacy policy to see how long your data is stored and who has access to it.
  

Beyond the platform’s security, it’s important to consider where you’ll conduct your sessions, too. A private, confidential environment where you won’t be overheard or interrupted is usually ideal. 

Therapist credentials

Whether you’re engaging in online therapy or traditional in-person therapy, you’ll want to make sure that your counselor has the right experience and licensing to support you. 

Using online databases like the American Psychological Association (APA), National Board for Certified Counselors (NBCC), Association of Social Work Boards (ASWB), or the therapist’s own website, you'll want to assess the provider’s:

• Credentials: Before beginning online therapy, verify that your therapist is licensed to practice in your state or country. Licensing ensures that the therapist has met the necessary qualifications and adheres to professional standards.
  
  
• Specializations: Depending on your needs, you may want to find a therapist who specializes in certain areas, such as anxiety, depression, or trauma. Make sure the therapist has the relevant experience and training to address your specific concerns.

At Two Chairs, all of our therapists are licensed, and 98% of our clients find the right therapist for their needs on the first try.

Therapy costs and insurance

One of the biggest barriers that people face when starting therapy, whether online or in person, is the cost. That’s why understanding common expenses, including what your insurance does or does not cover, is important in deciding what kind of therapy is right for you.

Some common costs include:

• Copays: A copay is a fixed amount you pay for each session, which can vary depending on whether your therapist is in-network or out-of-network.
  
  
• Deductibles: Some insurance plans require you to meet a deductible before they start covering services. If your deductible is $1,000, for example, you must pay that amount out-of-pocket before your insurance starts paying for your therapy sessions.
  
  
• Other costs: Online therapy can vary in cost depending on the platform and therapist. Some platforms offer subscription-based pricing, while others charge per session. Likewise, there might be costs involved in cancellation or rescheduling appointments.

To check whether or not therapy is covered under your health insurance, be sure to check your policy documents for mental health coverage or behavioral health coverage. Or, call your provider directly to ask.

Setting expectations

Online therapy often comes with an adjustment period, especially for people who are used to in-person therapy. While much of the core content is the same, there are some differences to be aware of. 

Unlike in-person therapy, online therapy often requires a bit more intentionality around:

• Participation: Online therapy requires active participation. Be prepared to engage fully in your sessions, whether through verbal communication, completing assignments between sessions, or practicing new coping strategies.
  
  
• Building a relationship: In traditional settings, a therapist can read body language and cues, and a connection might happen more easily. With online therapy and communicating through video, however, it might take a few more sessions or some time for you to build a relationship with your therapist. 

Emergency protocols

Like with in-person therapy, online therapists usually have emergency protocols as well, which help both the provider and client prepare for potential crisis situations.

Typically, the process includes:

• Planning: At the start of therapy, the therapist will typically gather essential information, including emergency contacts, the client’s location during sessions, and details about local emergency services. The therapist may also ask about any history of crises or suicidal thoughts to assess the client’s risk level.
  
  
• Protocols: Usually, the therapist will discuss specific emergency procedures with the client during the first session. This may include instructions on what to do if the client feels they are in crisis during or between sessions.
  
  
• Evaluation: If a client expresses suicidal thoughts or severe distress during a session, the therapist will assess the level of risk. This includes asking direct questions about the client’s safety, current state of mind, and any plans or means they might have for self-harm.

• Action: Based on the assessment, the therapist may guide the client to contact emergency services themselves or, if the client is unable, the therapist might do so on their behalf using the information provided at the start of therapy.

Personal comfort and fit

Regardless of the type of therapy you’re engaging in, its effectiveness hinges on your ability to feel at ease and establish a strong therapeutic relationship. In order to make the most out of the experience in terms of comfort and fit, be sure to assess your:

• Tools: While any technology might come with a learning curve, you need to feel comfortable using the tools involved in your care. Be sure to access a free demo, if available, or play around with the platform to ensure you’re confident in navigating them before your sessions start.
  
  
• Environment: It's important to create an environment that is conducive to therapy. This means finding a quiet, private space where you won’t be interrupted and where you feel safe and comfortable to open up.
  
  
• Therapist: The therapeutic relationship is a key component of successful therapy. During your initial sessions, pay attention to how you feel with the therapist. Do you feel heard, respected, and understood? 

It’s normal to feel a bit uneasy during the first few sessions, whether due to the newness of online therapy or because you’re opening up to a new person. Give yourself time to adjust, and remember that comfort often grows as you become more familiar with both the format and the therapist.

How can you determine you're choosing the right online counseling option?

When choosing an online therapy platform or therapist, you’ll want to ensure that the service aligns with your needs and preferences. To do this, be sure to: 

• Read platform reviews and testimonials: Look for feedback on the platform's ease of use, the quality of therapy services, customer support, and any technical issues encountered.
  
  
• Read therapist reviews and testimonials: Look for reviews specific to individual therapists, if available. Feedback from other clients can provide valuable insights into a therapist's communication style, effectiveness, and overall approach.
  
  
• Check the platform out yourself: Consider the platform's user-friendliness. It should be intuitive, easy to navigate, and have clear instructions for accessing sessions, messaging therapists, and managing appointments.
  
  
• Look for any additional support: Some online therapy services, like Two Chairs, offer custom client-therapist matching, quality assurance of therapists, affordable pricing, care coordination and navigation, and other added perks that can help make the online therapy experience as successful as possible.
  
  

• View therapist profiles: Some platforms provide detailed profiles of their therapists, including qualifications, specializations, and years of experience. Read these carefully to assess whether a therapist’s expertise aligns with your needs.
  
  

• Ask questions: Before committing to a therapist, most people have an initial consultation to assess the fit if they haven’t been matched by a provider like Two Chairs. When in your first meeting, you might ask questions like:
  
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  • What is your style as a therapist?
  • What identities do you bring to the therapy room?
  • What does a typical therapy session look like with you?
  • How do you typically treat someone with *insert mental health struggle here*?
  • What is your therapeutic approach?
  • What is your cancellation policy and reschedule policy?
  • How does insurance and payment work?
  • How often will we meet? Who decides that? Can we change the cadence of how often we meet?

Begin your online therapy journey with Two Chairs

Starting your online therapy journey can be intimidating at first. But, with the right platform and the right therapist, it’s possible to find the exact support you need — right from your computer or phone. 

With our matching process — which considers your needs, goals, symptoms, and preferences — matches you to a therapist who has the right background and expertise, so you get the exact help that you need.