Virtual therapy for mental health: The Optum Store Guide

Therapy, also called psychotherapy or talk therapy, involves meeting with a psychologist, psychiatrist, licensed professional counselor or licensed social worker to talk about anything that’s causing you distress. Therapists are professionals who are trained to help you manage your feelings. Since they’re not emotionally involved in your life, therapists are well-suited to help you process your emotions and find ways to cope.

Things you might talk about include:

• Depression
• Anxiety
• A past trauma
• The death or illness of a loved one
• A strained relationship with your partner or work colleague
• Coping with a tough diagnosis such as cancer

People often go to therapy to feel more confident in who they are or to improve their relationships.

The reason for going to therapy is very personal. The therapist is there to provide an outside perspective, support you and help you find relief from whatever concerns brought you there. A lot of people find therapy life-changing. One possible reason? It’s a safe space to talk about your emotions without fear of judgment. And for some people, it could be the first time they’ve ever experienced that kind of freedom.

Therapy is an umbrella term for many different methods and treatment types. Those include individual therapy, family therapy, couples/marriage therapy or group therapy. The best method for you depends on why you’re seeking help.

If you’re suffering from depression, for example, individual therapy is probably best. If you want help managing your life as a parent or to improve relationships with your kids, you may choose family counseling. Group therapy or support groups can be valuable for meeting other people who are going through the same challenges as you. These issues could include substance abuse or eating disorders.

There are many types of treatment used in therapy. Some of the most common include:

Cognitive behavioral therapy (CBT): This popular therapy treatment helps you recognize unhelpful patterns of thinking and teaches you how to challenge and eventually change them. A review of more than 100 studies published in the journal Cognitive Therapy and Research found that CBT can help ease anxiety, stress, depression, eating disorders and more.

Dialectical behavior therapy (DBT): This treatment helps people learn to accept uncomfortable thoughts and moods, and to better manage their emotions. It’s helpful for people who have trouble handling distress or who have a hard-to-control temper. DBT is often used to help people who experience borderline personality disorder, eating disorders, substance abuse disorders or who have thoughts of suicide or self-harm.

Interpersonal therapy (IPT): This works on improving your personal relationships to help you heal from mental health issues, mainly depression. Similar to CBT, the therapist will help you recognize negative behavior patterns, such as social isolation or expressing frustration or aggression toward others. Then they teach you how to change those behaviors.

Acceptance and commitment therapy (ACT): With ACT, you learn to accept your thoughts and emotions as they come, without judgment. For example, the thought “nobody cares about me” becomes “I’m having the thought that nobody cares about me.” This helps you pause and decide how much (if any) truth there is to your negative thoughts. ACT can help with a variety of mental health issues, including social anxiety, depression or obsessive-compulsive disorder. It’s also been used to help treat medical conditions such as chronic pain and diabetes.

A therapist may specialize in one or many of these treatment types. If they offer multiple options, you can talk about which type of therapy is right for you based on what you want help with. For instance, if you’re dealing with an anxiety disorder, CBT is often recommended.

Learn what to expect during your first therapy session here. 

No big surprise here: The main difference is that virtual therapy is done remotely through your computer, tablet or other device. Virtual therapy can be a great option when:

• You live in a rural or remote area and don’t have access to a mental health practice.
• Your schedule isn’t very flexible.
• You’re having trouble finding a therapist you like. (Video appointments mean you can search beyond your immediate geographic area.)

Plus, if you’re new to therapy, a virtual session may be less daunting. You can get comfortable in your own home during an appointment.

Some therapists also offer a hybrid approach. Most sessions are done virtually, and then there’s a monthly — or occasional — in-person visit (assuming you’re both local).

Otherwise, the type of work you do while in session is very much the same whether you’re online or face-to-face.

Beyond convenience, virtual therapy also eliminates the need to search for a new therapist if you move to a new city. That’s incredibly valuable. It takes time to establish a trusting relationship with someone and for them to get to know your story and all the key people in your life. With virtual therapy, you can continue to move forward in your healing with the same person — no need to start over.

However, if you move to a different state, your therapist may need to be licensed in both their home state and yours. The rules vary by state, so ask your provider to confirm.

Virtual therapy also offers accessibility to people who are disabled or unable to leave their home for various reasons, such as physical illness or a potential COVID-19 exposure.

Overall, virtual therapy makes mental health care available to more people. And that’s a great thing.

The short answer is yes, it can be for many people, depending on what support is needed. Research published in the journal Psychotherapy Research shows that virtual therapy may be just as effective as in-person therapy for various mental health conditions. And there are many more promising studies. For example:

• A 2018 research review published in the Journal of Anxiety Disorders found that virtual CBT was equally effective as in-person treatment for generalized anxiety disorder, panic disorder, social anxiety disorder and depression.
• A 2020 review of 17 studies published in The Lancet found that online CBT for depression may be more effective than face-to-face therapy.
• A 2018 report from the Canadian Agency for Drugs and Technology in Health, which examined data from more than a dozen studies, found that online therapy can ease symptoms of post-traumatic stress disorder (PTSD). Plus, patients who got online therapy were just as satisfied with their experience and equally likely to stick with it as those who got in-person treatment.

In general, in-person therapy can often seamlessly translate to virtual. After all, you and your therapist spend most of your time together talking, so there’s little to be done that can’t carry over.

Virtual therapy does have limits to consider. For example, when your therapist can see you only from the chest up, it’s harder to know whether you’re taking care of yourself (with good hygiene). It’s also more difficult to see signs of any physical self-harm or extreme weight loss.

It’s also a little trickier to interpret body language, depending on your video frame. These nonverbal clues tell your therapist a lot about how you’re doing and what you might be struggling with — even if you’re not yet talking about it.

Therapy is incredibly personal. Just because many people respond well to virtual therapy doesn’t mean it’s right for everyone.

And in certain situations, virtual therapy may not be appropriate. This may be especially true when someone is processing trauma for the first time (sexual assault, physical assault or the sudden death of loved one, for example). Talking about especially emotional topics or anything that makes you feel unsafe is best done in person.

Once the session is over, the benefit of in-person therapy is that you can leave the therapist’s office — and all those distressing emotions — behind. Think of it as a way to compartmentalize in a healthy way. At home, it might be harder to separate yourself from all the feelings conjured up in therapy. And that can lead to additional distress.

You also have to consider the logistics of virtual therapy. You may not have to drive to the therapist’s office, but you do need:

• A reliable internet connection
• A quiet space free of distraction and interruptions, private enough that you won’t worry about someone hearing your session
• A comfortable seat so that you’re not fidgeting

The bottom line: If it’s hard to find time to be alone in your home or your Wi-Fi connection is spotty, you might find virtual therapy frustrating. Leaving the house for an in-person appointment may feel more sacred and productive.

Depending on where you live, virtual therapy may cost slightly less per session. But it’s generally similar in cost to traditional therapy.

When it comes to paying for virtual therapy, the more important questions are:

• Does your insurance policy cover virtual therapy?
• Does the therapist you want to see accept your insurance?

Insurance plans purchased on the Affordable Care Act marketplace must offer mental health benefits, including therapy. But specific rules vary by state. Virtual therapy isn’t always included. Your best bet is to call the number on the back of your insurance card to confirm what’s available to you.

If you have insurance through work, it might include an employee assistance program (EAP). This typically covers a limited number of therapy sessions, but you’ll want to confirm that virtual therapy is included. To find out if you have an EAP (and what’s covered), call the insurance company or ask someone in your human resources department.

If you’re paying out of pocket, you have options. First, ask the therapist for help in making it fit your budget. Instead of weekly appointments, they may suggest every other week. They may end each session by talking about what you can do on your own. That can include journaling, mindfulness exercises or using an app for meditation.

Here are a few more budget-conscious options to explore:

Local universities: Many universities with mental health training programs offer low- or no-cost therapy from their students. Try calling a nearby school to ask about options for virtual therapy — chances are they started offering it during the pandemic, if they weren’t already.

Online support groups: Many outlets offer free and low-cost online support groups, including the Anxiety & Depression Association of America, Mental Health America and The Tribe Wellness Community.

Any virtual therapy platform you use should follow HIPPA privacy guidelines. Those federal guidelines ensure that all health information stays between you and your doctor. Look for third-party verification displayed on the platform, such as a credential from URAC. That organization establishes quality standards for the entire health care industry. If you’re unsure, don’t hesitate to ask your therapist.

We’ve said it before, but it’s worth repeating: Therapy is very personal. Think about what you want out of it. Do you value quick, frequent connections with a therapist? You might look for a virtual therapy platform that allows for 24/7 access and includes emailing or text messaging as an option.

On the other hand, consider that your relationship with your therapist is the foundation of your whole therapy experience. A lot of trust is built from having conversations where you can see each other’s facial expressions and body language. You don’t get that when communicating via text.

Therapy requires a commitment to showing up for yourself and doing the work to heal. That’s true no matter how you connect with your provider. 

Ultimately, your relationship with a therapist and the services they provide matter much more than the platform you use. You want to work with a therapist who specializes in what you need help with (anxiety, postpartum depression, PTSD or marriage counseling). And you also want someone you feel comfortable around and trust. That’s how you’ll be able to fully open up and get the most out of therapy. 

Caroline Brown, LMSW
Senior associate therapist, Gateway to Solutions
New York City

Nicole Bentley, LCSW
Licensed therapist and senior director of intake services and clinical operations, Cityscape Counseling
Chicago

Michelle Hunt, MHC-LP
Licensed mental health counselor with Empower Your Mind Therapy
New York City

CBT can help ease anxiety, stress, depression and eating disorders: Cognitive Therapy and Research (2012). “The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses”

Virtual CBT was equally effective as in-person treatment: Journal of Anxiety Disorders (2018). “Computer Therapy for the Anxiety and Depression Disorders Is Effective, Acceptable and Practical Health Care: An Updated Meta-analysis”

Virtual therapy may be just as effective as in-person therapy: Psychotherapy Research (2020). “Treatment Engagement and Effectiveness of an Internet-delivered Cognitive Behavioral Therapy Program at a University Counseling Center”

Online CBT for depression may be more effective than face-to-face therapy: The Lancet (2020). “A Comparison of Electronically-delivered and Face to Face Cognitive Behavioural Therapies in Depressive Disorders: A Systematic Review and Meta-analysis”

Online therapy patients were just as satisfied as in-person patients with their experience: Canadian Journal of Health Technologies (2018). “Internet-Delivered Cognitive Behavioral Therapy for Post-Traumatic Stress Disorder: A Review of Clinical Effectiveness”