Online Therapy for Depression

In This Article

Before the coronavirus (COVID-19) pandemic, an estimated 17.3 million adults in the United States, experienced at least one major depressive episode. 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.

But with the added stressors and unknowns due to COVID-19, those rates may climb. And while psychotherapy is a proven treatment for depression, many, if not most, in-office visits are prohibited during the stay-at-home orders enacted in many states. While we don’t know when widespread social distancing will end, it’s safe to say that virtual visits may become our new normal for some time.

To help fill this void and expand services, therapists, psychologists, psychiatrists, and other mental health professionals are shifting gears to provide remote or online therapy to new and existing clients. 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, via email, or text messaging.

Here, we cover the types of online therapy available for depression, how online differs from in-person, 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 trouling life events and better-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 Different 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 weekly sessions.

But 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 does point 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.

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 just a single one-hour session.

Go Easy on Yourself

Rachel O’Neill, Ph.D., 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," she says.

Be Honest With Your Therapist

Being upfront and honest with your therapist is key during online sessions. Dr. Gail Saltz, 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 face to face online is better than just speaking on the phone. But Saltz also reminds patients that something is better than nothing.

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 1-800-273-8255 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.

That said, he does stress 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 during this difficult time. In response to the growing need for support, many private therapists have transitioned to online platforms to continue offering psychotherapy to patients.

If you’re currently receiving treatment for depression, work with your provider to coordinate continued care. 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. 

Was this page helpful?
Article 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.
  1. National institute of Mental Health. Major Depression. 2019. 

  2. American Psychological Association. Overcoming Depression: How Psychologists Help With Depressive Disorders. 2016. 

Additional Reading
  • O’Neill, Rachel. Email interview. April 16, 2020. 

  • Paul, Sean. Email interview. April 15, 2020.

  • Saltz, Gail. Email interview. April 15, 2020. 

  • Soave, Ryan. Email interview. April 14, 2020.