Is online therapy legit? What you need to know

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If you’re seeking relief from work demands, family concerns or general everyday stress, a licensed mental health professional’s office is a good place to seek counsel. But with demanding schedules and commitments, squeezing in one more appointment outside the home could be the excuse you were looking for to avoid therapy.

If that’s the case, it’s time to ditch the excuses and explore the world of online therapy.

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Also called “telepsychology,” “tele-mental health,” and occasionally “cyber counseling,” “e-counseling” or “e-therapy,” online therapy has been around for over 20 years. But with improved technology, online therapy has become easier to use and a more accepted practice amongst clinicians and patients today.

“Tele-mental health is wonderful because you can cross boundaries and remove a lot of barriers,” Dr. Mary Karapetian Alvord, a psychologist and the director of Maryland-based psychotherapy practice Alvord, Baker & Associates, LLC, told Fox News. “The research shows that [tele-mental health] is not only effective, but people often have a high satisfaction rate with it.”

According to the Substance Abuse and Mental Health Services Administration (“SAMHSA”), in 2014, about 43 million, or one in five, American adults suffered from some mental illness. Yet only 40 percent of Americans with mental illness report receiving treatment, and there is one mental health care provider for every 790 individuals.

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But telemedicine, which encompasses online therapy, may improve those rates, experts say. Recent estimates from a 2016 50-State Survey of Telemental/Telebehavioral Health from Epstein, Baker, and Green suggest about 6 percent of all mobile health applications developed worldwide focus on mental health, while 11 percent are devoted to offering stress management services.

“One reason many of us have been enthusiastic about online therapy is the geographic disparity in terms of availability of mental health professionals,” Elias Aboujaoude, MD, Stanford psychiatrist and the author of ‘Virtually You: The Dangerous Powers of the e-Personality,’ told Fox News. “The idea or the hope is that online therapy can help democratize access to mental health care.”

American Well, one of the companies involved in telemedicine, serves about 140 million patients and collaborates with major commercial insurance plans. The company allows users to book mental health services through its app, Amwell.

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However, navigating the world of online therapy can be tricky if you’ve never done it before. Not to mention, it’s not for everybody.

“We are not at a point yet where we can say that the online therapy services that are available for the time are equal in their quality to a traditional face to face, in-person therapy,” Aboujaoude said.

Fox News talked to Alvord and Aboujaoude to get the lowdown on what you need to know before considering this mode of mental health care.

How to pick a service

As is the case with in-person therapy, with online therapy, you’ll often need a referral from your doctor to ensure your insurance covers mental health costs. Telemedicine can be used for assessment, as a supplement to in-person treatment, for ongoing treatment, or used occasionally as needed, Alvord said.

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Look for a licensed mental health practitioner, such as a psychiatrists, psychologists, or a licensed social worker. Do some digging to make sure they have credentials and aren’t just calling themselves “therapists,” which can be an ambiguous term, Alvord said.

Another phrase to dig deeper into is “coaching,” Aboujaoude suggested. Inquire about the coach’s credentials and what their level of training is.

Alvord recommended asking if the provider is licensed to practice in your state. If the therapist is located and licensed to practice in Texas but you’re in Minnesota, you could run into trouble if there’s a legal issue down the line.

If you’re a veteran, the U.S. Department of Veterans Affairs (VA) has different telehealth federal laws and may allow VA-employed licensed providers to practice cross-state.

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Regardless, you also need to get informed consent forms signed before doing online therapy, Alvord said.

“The patient and provider need to discuss the confidentiality agreements. Informed consent also means there's a back-up plan,” Alvord said. “What if I'm on a video with you and you start telling me you have thoughts of suicide? If I assess that it's not just thoughts, you actually have a plan, and that you might be in imminent danger, as a provider, I need to have numbers to contact.”

Who can benefit

Online therapy can address the following problems: family issues, divorce, marriage counseling, someone who’s suffering from an injury or a disability, someone with language barriers, or those suffering from anxiety or depression.

“I often tell my patients that if you're in an area where access to traditional therapy is limited, then online therapy may be a reasonable source of treatment for you,” Aboujaoude said. “However, I also tell them that the best studies for online therapy have been in patients with mild to moderate symptoms. If it's somebody that had severe symptoms, be it of anxiety, depression, other conditions, then these are patients for whom I would really strongly recommend traditional therapy.”

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Psychosis is one of the conditions where there's the least amount of support for online therapy services, he said.

“Within depression [and] suicidality, there is very little in terms of studies that show that online therapy is appropriate for somebody who is highly depressed,” Aboujaoude said. “That is not someone who I would feel comfortable recommending online therapy for at this stage.”

If you have an ongoing substance abuse problem, this type of therapy may also not be the best, Alvord said.

“As a practitioner, I can't smell them, I can't see their eyes as clearly, what their gait is like, you miss non-verbal sometimes,” Alvord said. “I rely on those non-verbal cues to provide important information that helps assess the individuals condition each session.”

Dr. Zereana Jess-Huff, vice president of behavioral health at American Well, told Fox News the company serves patients with bipolar disorder through video conferencing, but it’s usually as a follow-up visit and referral from their regular therapist. She noted this service might not be best for a patient with schizophrenia or bipolar disorder.

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If your online therapist or psychiatrist thinks you need medication, he or she can usually refer you to a local psychiatrist who will do an evaluation to see if prescription medications would be beneficial.

Is it covered by insurance?

“What is now approved in terms of insurance reimbursement for many insurance companies in Maryland means online therapy is a real-time service that includes audio and video,” Alvord said.

“The way insurers have embraced this service delivery method has been an interesting development,” Jess-Huff said. “I think a lot of that is because their backs are up against the wall when it comes to accessibility. This service is an answer for that. For individuals who need to pay for online therapy out of pocket, we’ve also introduced rates that are competitive with what you would pay in a brick-and-mortar setting. If you are seeing a Ph.D. level therapist through Amwell, it’s $95, and if you are seeing a masters-level therapist it’s $79.”

At Dr. Alvord’s practice, the initial 60-minute intake session costs $280. Individual 45-minute sessions are between $195 and $210 for a session. When patients use Dr. Alvord’s services, they may do 20-minute or 30-minute sessions twice a week as opposed to a 45 minute session or a one-hour session, she said.

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Get in the right environment

Before you log on, make sure you have sufficient internet bandwidth for video to avoid disrupted service, Alvord said. She recommended using a private, quiet and well-lit room for sessions.  Be aware of your background as the provider will see what’s behind you.  Audio has improved dramatically, thus, many systems do not require use of headphones with a mic, but ask the provider if using a headset with a mic is preferred.  It is also a good idea to have a phone nearby should you need to switch to audio off-line, Alvord suggested.

The basics on getting started

If this article sends you on a Google search for “online therapy” or “tele-mental health services,” make sure the service provider offers HIPAA (Health Insurance Portability and Accountability Act)-protected technology. Ask if the online therapy services are HIPAA secured. It’s best to ask your insurance company first if they have a telehealth service they use as a starting point for your search, she said.

“I see people advertising that they’ll Skype with you wherever you are or use Facetime to connect with a patient,” Alvord said. “There are major problems with that because those services are not HIPAA secure. It's incumbent upon the provider to make sure that the video service they’re using is secure.”

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You should feel empowered to ask the potential provider a lot of questions before starting therapy, Aboujaoude suggested. “Check out who the providers are, what their levels of training are, what types of therapy they are skilled in, and how much the experience they have dealing with the particular diagnosis or the particular symptom that the patient is wanting help with.”

If your lack of technology skills makes you feel reluctant to try this type of therapy, consider using Skype or Facetime with family members first so you get a feel for video discussions until you’re more comfortable, Alvord said.