Is Online Therapy Worth the Money?

Excuse me, I'm on hold with my shrink.

Posted Feb 10, 2018

GaudiLab/Shutterstock
Source: GaudiLab/Shutterstock

With the proliferation of professional therapists moving—or even starting—their practices online on Skype, questioning what you get by engaging an online therapist, coach, psychologist, or other “telemental health” professional and whether it’s as effective as conventional face to face counseling is worth considering. (Caveat here—I conduct most of my practice by phone and email.)

Almost all clinicians in private practice—the ones with the ergonomic chair behind the desk, the carefully framed diplomas and certificates above it, and the Kleenex box close at hand—occasionally treat patients and clients over the phone. Even psychoanalysts with very strict rules about keeping regular appointments, and paying for those you might otherwise miss, understand when an unanticipated event or illness makes it impossible to stick to a schedule.

But there’s a difference between hearing and seeing a client every session. Clues like affect and body language are missing. Nuance in email communication is difficult to create or discern.

There’s not a lot of evidence-based proof that mental health care offered by variously credentialed experts is as good as that provided in person by someone with the same credentials—or lack of them. And there’s a mixed bag of data about how well any of the so-called talking therapies works—compared to, say, a prescription for Prozac.

In either environment—on Skype or in-person—what matters most in terms of outcome is the fit between the client and the provider. Is the professional you’re engaging to help you solve your problems (or at least listen attentively to them) offering advice, direction, interpretation, analysis, tools and techniques, referrals, and/or emotional support? Do you clam up on the phone, or is it easier for you to be open and honest with someone you haven’t met? Does he or she seem accessible and friendly, or detached and reserved, and which do you prefer? And what qualifies him or her to offer what you’re looking for?

The provider’s approach, like the fit between the two of you, is important in terms of what you want to accomplish—change, insight, self-knowledge, or personal or professional development. Only in novels about the '50s and Woody Allen movies do we hear many references to the kinds of shrinks who demand four or five days a week of 50-minute sessions to recap all the trauma of early childhood and painful adolescence. It’s too expensive, too time-consuming, and too vague in the promise of self-knowledge, which is why many of its practitioners have adapted to that change, deployed their skills differently, or retired from practice.

As a social psychologist with training in psychotherapy and boundary management, I’m less interested in the past than in the here and now, and frankly, I don’t have the time to wait for a client to understand why he keeps putting roadblocks in his way when I already do—yes, like that aggravating kid in fifth grade who kept waving her hand in front of the teacher—I know, I know! 

This is why I’m a coach and not a shrink. I marvel at the patience and compassion those providers display to their clients, especially when they hear the same complaints from the same clients over and over, and I know I don’t have it.

Change is a different goal from self-knowledge and regulation of emotions, which is why it’s more amenable to certain kinds of therapy that focus on changing habits, thought patterns, attributions. These are cognitive interventions, most useful for those who already understand that they’re the ones responsible for making change happen in themselves, not others—although often when we change how we interact with them, they may change too, which is what I tell the parents of grown kids who want to change them, not how they relate to them.

Coaches are more likely to hold you accountable for your goals than conventional therapists may be. Usually, coaches, even those with credentials, can’t be paid by insurance companies, nor do most of them carry malpractice insurance.

As in every case of finding the best person for any job you need done, check with the obvious sources—other professionals, people in your network, providers’ web sites, and references. Then see if they offer a free or low-cost initial phone call.

Ask good questions, like: How does the process usually work? Is there a timeline? What does it cost? What kind of follow-up, referral, or other services do you offer? Have you dealt with issues like mine before? How do you think you can be most helpful to me?

In the end, it’s your call. Caveat emptor.