Psychotherapy Online Therapy Working With a Therapist Guide Working With a Therapist Guide Overview Getting Started Pros and Cons Will My Insurance Cover It? Is Online Therapy Secure? Common Uses Depression Anxiety Stress Addiction Relationships Online Therapy for Depression By Sara Lindberg, M.Ed Sara Lindberg, M.Ed Sara Lindberg, M.Ed., is a freelance writer focusing on mental health, fitness, nutrition, and parenting. Learn about our editorial process Updated on May 11, 2020 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Table of Contents View All Table of Contents Types of Therapy Online vs. In-Person Tips and Strategies Limitations Next in Working With a Therapist Guide Online Therapy for Anxiety An estimated 17.3 million adults in the United States experienced at least one major depressive episode in 2017. This equates to 7.1% of all adults in the country, which makes major depression one of the most common mental health disorders in the United States—even prior to the COVID-19 pandemic, which may have worsened existing depression or caused new cases. Psychotherapy is a proven treatment for depression. Many therapists, psychologists, psychiatrists, and other mental health professionals shifted gears to provide remote or online therapy to new and existing clients during the pandemic, and have continued to use these platforms. Additionally, there are a number of app-based online therapy programs that can quickly connect you with credentialed therapists. Online therapy or “teletherapy,” as it is often called, operates much the same as traditional, in-person therapy, but with a twist. Rather than visiting a therapist’s office, you stay home and conduct a session via video on your computer, tablet, or phone with your therapist. If video is not an option, your therapist may offer a session on a conference call, a regular telephone call, email, or text messaging. Here, we cover the types of online therapy available for depression, how online differs from in-person therapy, tips for getting the most out of your online session, and limitations of online therapy for depression. Depression Therapies Available Online Cognitive-behavioral theory (CBT) and interpersonal therapy (IPT) are two of the most common evidence-based therapies for treating depression. With cognitive-behavioral therapy, a therapist will help you learn to better identify negative or unhelpful thinking that is leading to your depression and then work with you to change those beliefs and behaviors that are contributing to your symptoms. Interpersonal therapy addresses the interpersonal relationships you have and then helps you develop strategies to improve these relationships by expressing emotions and solving problems in a healthier way. It also helps with adapting to troubling life events and utilizing relationships in more supportive ways. Cognitive-behavioral therapy and interpersonal therapy are only two examples of therapies your counselor may use to treat depression. Your therapist may choose a different modality to deliver treatment, but ultimately, their goal is to work with you to create a treatment plan to address your needs. Online vs. In-Person Therapy As many people are discovering, the differences between online and in-person therapy may not be that significant. If you have an existing relationship with a counselor, you may find that the only adjustments are learning the technology and creating a space at home for regular sessions. If you’re new to counseling or working with a new therapist, you also have the issue of building rapport and trust, which may come easier for some people online. On the other hand, that can create problems for people who thrive on in-person contact. For example, when doing in-person therapy, Sean Paul, MD, a board-certified psychiatrist and owner of NowPsych.com, says you have the opportunity to look your therapist in their eyes and watch their body language. While this is still possible with live teletherapy sessions, it does not have the same effect as an office session. Also, Paul says you may be more likely to come out of the first session with a live therapist with a more robust feeling that you connected. Again, this can happen online, but in-person often creates a better connection for building initial rapport. That said, he points out that meeting your therapist virtually can significantly reduce the anxiety of physically leaving the comfort of your own home and going into a new place to meet a therapist. In some cases, people are also relieved not to risk seeing a co-worker or acquaintance at a therapist's office. Also, a patient who is oversensitive to eye contact and other non-verbal communication may react more positively to an online session. Getting the Most Out of Online Therapy Whether you’re transitioning from in-person therapy to online sessions or you’re seeking help for new symptoms, knowing how to prepare for your sessions can help you get the most out of your online therapy appointments. Designate a Space for Therapy Sessions To make the most out of online sessions, the first step is to find a place in your home strictly dedicated to therapy. Ideally, this should be a space you can close off and have to yourself. You want to be free of distractions such as family members, electronics, and other household noise. This also gives you privacy and keeps your sessions confidential. Do Your Homework If part of your treatment includes exercises outside of the therapy session such as journaling, mindfulness-training, or relaxation exercises, carve out time between sessions to work on these tasks. Then, come prepared to discuss what you worked on with your therapist. What Is Mindfulness-Based Cognitive Therapy (MBCT)? Prepare Yourself for Each Session Depending on what you’re doing right before seeing your therapist, Paul says you may want to do some breathing exercises to change your frame of mind prior to starting an online session. Treat the Session Just Like an Office Visit One way to set yourself up for success is to treat an online session just like an office visit. Ryan Soave, a trauma and mental health therapist and clinical director of telehealth services at APN Lodge, says to rise up out of bed, shower, and get dressed just like you would do on a normal day where you’re heading to an office. “Make a ritual around this and set an intention for your session,” he says. Soave also recommends carving out time before the session to get centered and prepare, and then allowing yourself some time after the session to process and reintegrate. Schedule a Time That Works Best for You Soave says it’s important to work with your therapist to find the best time of day during the week that will most support you. He also recommends discussing the frequency of sessions with your therapist. For example, maybe it would be better to have two half-hour sessions at different points in the week in lieu of a single one-hour session. Go Easy on Yourself Rachel O’Neill, PhD, LPCC-S, therapist, and director of clinical effectiveness for Talkspace, says there is no right or wrong way to approach online therapy. However, to the extent that you can, she says to try and stay consistent with your engagement. "If you’re using an app-based service, consider enabling push notifications so that you know when your therapist has messaged you, or set daily reminders in your phone to take time to interact with your therapist," O'Neill says. Be Honest With Your Therapist Being upfront and honest with your therapist is key during online sessions. Gail Saltz, MD, associate professor of psychiatry at the NY Presbyterian Hospital Weill-Cornell School of Medicine, says you need to commit to the process and know that it will be harder before it is easier. This may require more time than in-person sessions, so be patient and ask your therapist for help if you’re struggling with the process. Opt for Audio and Video When Possible “The closer the approximation to face-to-face, the better,” says Saltz. So, speaking is better than texting, and video chatting is better than speaking on the phone. But Saltz also reminds patients that something is better than nothing. Best No-Subscription Therapy Services Limitations of Online Therapy Although online therapy is generally an appropriate form of treatment for most mental health issues, O’Neill says it may not be the right approach for all. “Those with neurocognitive disorders, which are disorders that result in decreased mental function due to a medical disease (Alzheimer’s disease, traumatic brain injury, etc.), may not benefit as much from online therapy,” she says. Similarly, if you’re experiencing active psychosis, O’Neill says this may also require more intensive services than are able to be provided via distance-based counseling. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911 Online therapy is also not well suited for people who need a team of professionals, such as those with complicated issues like personality disorders, chemical dependency, and some eating disorders. Milder forms of some of these disorders may be amenable to online therapy, says Paul, but only if you have access to other local specialists such as substance abuse counselors, dietitians, and specialized group therapies such as dialectical behavioral therapy. And, if you are in crisis or immediate physical danger, Soave says you need to call 911 immediately. “Do not try to work through it yourself,” he says. If you’re not in immediate danger, then Soave says online therapy can help just like any other therapy. Paul stresses the importance of letting your therapist know your address and phone number in case they do ever need to call emergency services. “And remember, it will only be helpful if you're completely honest with your therapist—this is not any different than if you were sitting in their actual office,” he adds. Additionally, Paul says a large percentage of patients with depression have suicidal thoughts or present in some stage of a crisis. Because of this, your therapist may want to check in with a loved one to make sure you can call on someone outside of a session, especially if you're having an acute crisis. A Word From Verywell If you’re experiencing symptoms related to depression, being able to access mental health services is critical. If you’re currently receiving treatment for depression, work with your provider to coordinate online therapy. And if you’re new to counseling, talk with your doctor about referrals for online mental health services. Reaching out to a professional could be the key to managing the symptoms of depression. Online Therapy for Anxiety 3 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. National institute of Mental Health. Major depression. Bueno-Notivol J, Gracia-García P, Olaya B, Lasheras I, López-Antón R, Santabárbara J. Prevalence of depression during the COVID-19 outbreak: A meta-analysis of community-based studies. Int J Clin Health Psychol. 2021;21(1):100196. doi:10.1016/j.ijchp.2020.07.007 American Psychological Association. Overcoming depression: How psychologists help with depressive disorders. By Sara Lindberg, M.Ed Sara Lindberg, M.Ed., is a freelance writer focusing on mental health, fitness, nutrition, and parenting. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.