Best Online Therapy
Based on In-Depth Reviews

Online Therapy: A Viable Alternative

The mental health care industry is constantly evolving to increase access to care. Out of these attempts to make treatment accessible for more people, a new alternative to face-to-face therapy has grown.

Through mobile apps and websites, online therapy connects users and patients to licensed therapists and trained specialists. Treatment can take different forms, from providing various levels of therapeutic care, being a supportive listener who can help through hard times, or simply therapist-designed tools which serve as aids in overcoming difficult situations.

Telemedicine

Telemedicine or telehealth, refers to the use of digital data and telecommunications technology to carry out long-distance clinical healthcare, via videoconferencing, the internet, and media streaming. Remote patient monitoring with connected electronic tools, health info through mobile devices, and store-and-forward teleconferencing are also considered telehealth. While sometimes used interchangeably, telemedicine refers specifically to clinical services offered remotely, whereas telehealth covers a much wider spectrum. This distinction is important for regulatory and legal purposes, since some states may have telemedicine laws, but not telehealth ones.

Many telemedicine apps such as Amwell, Doctor on Demand, and MDLive, offer psychiatric and psychological services. Patients can schedule an appointment with the specialist of their choice via the app or website. In a video call, the specialist will diagnose the patient if necessary and can even prescribe medication, in the case of a psychiatrist. The cost of each session scheduled through these apps is comparable to that of a face-to-face appointment, between $75 and $200. Most apps accept insurance, so those who are covered by their health plan will only need to pay their copay. This solution is ideal for those who cannot leave their home to attend an in-person session or who live in areas without specialists.

Online Therapy Apps

When people talk about online therapy, they are often thinking about apps and websites that let you speak to a counselor or therapist via text message, web chat, voice message, or video call. Specialists who provide services through an online app can’t prescribe medication, but they can provide therapy that may include cognitive behavioral therapy or mindfulness, among other approaches. The cost for these services varies but it ranges between $49 and $79 dollars per week for the four companies we reviewed, usually charged monthly. This comes out to a monthly cost of around $250, which may startle some patients.

However, breaking down the services included in these subscriptions, such as unlimited text messages to your assigned therapist with daily text replies, as well as weekly or biweekly video sessions, puts the price tag in perspective. For patients who only visit a therapist once a month, a subscription to an online therapy app might not be worth it. But for people who want constant communication with a therapist or counselor, but can’t afford to pay for three or four in-person sessions every month, an online therapy subscription might make the most sense.

Peer-to-Peer Services

Further down on the range of expertise are peer-to-peer services and peer specialists. In other words, people like you who live with a mental illness but with special training to help other people. These services are often free, as in the case of 7 Cups. People who chat with peers often can’t afford any other therapy option or are just looking for someone to vent their frustrations with. Although it doesn’t meet the definition of therapy, it is included in larger conversations about mental health because it often provides a benefit to people who have no other alternatives.

Of course, it should also be noted that, as we mentioned above, listeners or peers receive very little training when compared to a licensed therapist, are often unsupervised and unregulated, and can provide contradictory or inflammatory feedback. Consumers who choose to use peer-to-peer services should follow their intuition and common sense when speaking with a peer and terminate and report the conversation if it takes a turn towards the inappropriate or dangerous.

There’s an App for Everything

Finally, the broader category of online therapy apps sometimes includes self-care apps like Headspace, Calm, and Pacifica, which offer free and subscription content that focuses on helping users reduce anxiety, track their moods, and improve their sleep habits. These apps may also include built-in communities where users can talk about their struggles and support each other, and they may include a therapist directory where the user can look for someone near them. While these apps do not offer therapy services (which is why we didn’t include them in our list or our testing process), their self-care tools, often created and vetted by mental health professionals, can truly help.

Why Choose Online Therapy

In this guide, we have decided to focus on the second category of online therapy. As with social texting, there are some limitations associated with online therapy. Dr. Terry Rabinowitz, a psychiatrist with the University of Vermont Medical Center, mentions “the inability to see a patient’s face, their affect, [and] that it’s impossible to write all of your thoughts and feelings or for a therapist to respond quickly in kind” as some of the things that can limit patient/therapist interactions. While face-to-face therapy in a clinician’s office may make these exchanges more effective, there is no denying that online therapy apps make mental healthcare more affordable and accessible.

As with any new technology, there are still concerns and misinformation out there regarding online therapy apps.

Online Therapy Can Be Effective

Though research into telebehavioral therapy is still in its infancy, some promising studies have already shown that certain types of remote therapy can be very effective in treating some conditions. A study published in the Journal of Psychoactive Drugs in 2015 showed that text messaging-based treatment has the potential to improve the rates of abstinence in people recovering from tobacco, drug, and alcohol addiction.

Another study from 2015 looked at the effectiveness of in-person and internet-based therapy for treating teens with insomnia, and found no significant difference between either type of therapy. In fact, the researchers mention that receiving therapy over the internet can help teenagers get over their apprehension about therapy while also giving them a greater sense of control over their treatment.

Some scientists and professionals are still hesitant about supporting online therapy. Dr. Todd Essig, a clinical psychologist and contributor for Forbes magazine, has been an outspoken critic of online therapy apps. When asked if online therapy can be as useful as in-person therapy, Dr. Essig said, “Absolutely not. It can be useful, but it is not a functionally equivalent replacement.”

Dr. Essig’s main reservation seems to be that some mental illnesses, like depression or eating disorders, may be serious enough —and perhaps even life-threatening— that speaking to someone over the phone or by text message may not ensure safe and effective treatment.

However, while online therapy may not be a perfect equivalent to face-to-face therapy, there are still benefits to be gained from exploring it. For some patients, says Dr. Rabinowitz, “remote therapy can be every bit as useful as face-to-face therapy”.

While he admits that some issues could exist when, for example, a psychologist prescribes medication to a patient they’ve only spoken with online, Dr. Rabinowitz explains that “there may be times when texting someone without knowing them face-to-face turns out to be important. It might even be life-saving.”

It’s all a matter of tempering expectations. There are clear limitations when it comes to text-based therapy, such as the patient not being able to see the therapist’s facial expressions or the possibility of the therapist misinterpreting the tone of a patient’s message. Said Dr. Rabinowitz, “if you accept that there’s some limitations and you agree with the patient early on that there will be limitations, it still might have great efficacy.”

Even Dr. Essig is forced to admit that, while text-based therapy often cannot replace face-to-face therapy, “it’s a better-than-nothing option, and it can be useful as a stepping stone towards a more traditional, in-person mode of psychotherapy.”

Online Therapy Can Be HIPAA-Compliant

Like other mental health care providers, therapists that treat patients over the internet and other platforms must adhere to the guidelines established by the Health Insurance Portability and Accountability Act (HIPAA), just as much as in-person therapists and clinics.

The HIPAA Privacy Rule regulates how patient records may be used and what the care provider needs to keep private. A provider can’t share your protected health information (also known as PHI), which includes the details of your condition, how treatment was given, and how you paid for it and identifies you as the patient.

This information cannot be sold or distributed outside of the covered healthcare provider unless it’s de-identified. That means any information that could identify you as the patient is erased — your name, address, phone number, photograph, and any other identifying characteristics.

An online therapy app may very well meet these standards. However, as Dr. Rabinowitz explained, it’s not the only thing you should be looking for.

“HIPAA is only one piece of what you have to consider when you’re thinking about a text-messaging approach. In some cases, text-messaging might be very protective of patients’ personal health information but that doesn’t mean it’s an appropriate or lawful use of telemedicine.”

Online therapy platforms should also de-identify your information, as well as have safeguards in place to prevent and stop unlawful access to your information that is stored on their servers. This includes, but isn’t limited to, transmitting information over HTTPS, which encrypts, for example, the communication between the user and the server.

When searching for an online therapy service, read through each company’s privacy policy and terms of service. Be sure you understand what kind of information they will collect from you and how they will use it. Mental health service providers, for example, are required to share patient information with law enforcement if the provider believes the patient may be in danger or a risk to others. This is true of both online therapy and in-person therapy, but if you don’t feel comfortable with this possibility, then therapy may not be for you.

Online Therapy Can Be Provided by Real Therapists

Online therapy can be provided by people with varying levels of expertise. Depending on the type of service you choose, you may receive counseling from a psychologist, a clinical social worker, or a professional counselor. Each type of mental health professional has varying levels of training and education, and these may provide different types of therapy. Some professionals, for instance, cannot make diagnoses. It’s important to understand the differences between the types of experts so you understand, for example, their obligations regarding HIPAA or the type of counseling you can expect to receive.

The following are just some of the different possible mental health credentials your online therapist may have. We recommend always asking your therapist for their credentials before beginning treatment and researching what they mean to make sure you’re happy with your counselor’s level of professional training.

• Licensed psychologists (PhD / PsyD): Doctor of Philosophy in Psychology (PhD) and Doctor of Psychology (PsyD) are the two doctorate degrees a psychologist can pursue. The former focuses primarily on research, and a large number of PhD-holders end up in teaching positions, while the latter primarily prepares students for clinical practice--seeing and treating patients. On average, PsyD degrees require fewer courses in statistics and research. Each state determines how many supervised clinical hours an aspiring psychologist must complete to get their license, but the American Psychological Association says the number ranges from 3,000 to 6,000 hours.

• Professional counselors: To practice, a professional counselor must have a license from the state regulatory board. Each state determines the requirements a counselor must meet to receive a license, but they are generally similar: a master’s degree from a counseling, psychology, or related accredited program and a minimum number of hours of supervised clinical practice. The number can be as low as 2,000 hours (Minnesota) or as high as 7,000 (Nebraska) and depends on the type of license for which the counselor is applying. License titles vary, but the most common are Licensed Professional Counselor (LPC), Licensed Mental Health Counselor (LMHC), Licensed Clinical Professional Counselor (LCPC), and Licensed Professional Clinical Counselor (LPCC).

• Marriage and family therapists: Though not as common as psychologists or professional counselors, family therapists can provide valuable counseling. Their practice tends to focus on family relationships, and they are specially trained to deal with marital or couples issues, but they can also offer individual therapy. To be a Licensed Marriage/Marital Family Therapist (LMFT), most states require therapists to have a master’s degree from an approved marital and family therapy or another related program, as well as a certain number of practice hours that vary by state but are comparable to the required counseling hours mentioned above.

• Clinical social workers: Social workers perform a variety of roles, like counseling children in school or supporting patients during emotionally taxing medical procedures. Clinical social workers focus on mental health treatment and see clients in a clinical setting. To be a Licensed Clinical Social Worker (LCSW), they typically must have a master’s degree in social work from an accredited institution and have logged a number of supervised clinical experience hours.

• National Certified Counselor (NCC): To be certified by the National Board of Certified Counselors, therapists must have a master’s degree in counseling from an accredited university, have 100 hours of supervised clinical work after graduation, and either a professional counselor state license or a minimum of 3,000 hours of independent clinical experience, among other requirements. Applicants need to pass an examination and meet ethical guidelines as well. 

When Online Therapy Can Help

Online therapy is often less expensive than in-person therapy, especially for people without health insurance or whose health insurance doesn’t cover mental health services. When you compare the cost between multiple in-person sessions every month with the cost of online sessions with a therapist, plus the ability to text with a therapist at any time, you may find subscribing to an online therapy site makes more sense for you.

One of the main objections to online therapy is the digital barrier that keeps therapists and patients from getting to know each other in person. For Dr. Rabinowitz, however, the relative anonymity and distance provided by online therapy can be a good thing.

“Shy or avoidant patients may actually appreciate the feeling of distance the telemedicine approach gives them versus a face-to-face approach,” says Dr. Rabinowitz. “And actually, it may help many of these folks avail themselves of psychotherapy that they wouldn’t avail themselves of otherwise.”

In addition to shyness or reluctance to treatment, online therapy can help many people avoid discrimination and judgment in their communities. The ability to restrict all therapeutic conversations to a mobile device or computer enables vulnerable people to keep their mental health status private, since they don’t have to find the time to physically attend appointments where they may be recognized.

In the course of our research, we were also surprised to find that one of the situations when online therapy can be most useful is when it comes to relationships. Couples with busy or conflicting schedules may find it impossible to receive therapy in person. Though commonly known as marital counseling, this type of therapy is not restricted to married couples and can be enjoyed by all kinds of people in romantic relationships. Online therapy provides an opportunity to meet in a neutral, virtual therapy room where they can talk about their relationship. Writing things down may also help people who may be too shy or scared to speak their problems out loud. Online therapy is also a great alternative for people in long-distance relationships.

Online Therapy Isn’t for Everyone

Despite online therapy’s convenience and affordability when compared to in-person therapy, it simply isn’t the right choice for some people. Many online therapy sites will refuse to treat you if you present signs of a more serious condition that requires immediate intervention or a level of care that an online therapist will have difficulty providing.

If you are having thoughts of harming yourself and others, or if you’ve been diagnosed with a serious mental illness and have been advised by a professional to seek intensive treatment, as may be the case with an eating disorder, you probably shouldn’t try online therapy.

The fact is there are physical barriers to getting you the immediate help you need if you’re in a crisis. Your online therapist may not know exactly where you are located in order to send you help (whereas an in-person therapist would be in the same place as you). Additionally, chatting online doesn’t allow a therapist to view your body language or facial expressions, which may be a key factor to recognizing the signs of a crisis in some people.

If you are currently thinking about hurting yourself or others, or if you’re in immediate danger, online therapy is not for you. Getting immediate help could save your life or that of the people around you. An online therapist is not able to provide this for you. The helplines below, on the other hand, can provide help when you urgently need it. 

Mental Health Resources

National Suicide Prevention Lifeline: 800-273-8255

LGBT National Hotline: 1-888-843-4564

Trevor Project Lifeline (for LGBTQ+ teens and young adults): 866-488-7386

Crisis Textline: Text HOME to 741741

Additional resources are on the American Foundation for Suicide Prevention website, including help for self-harm, eating disorders, and other conditions.

Abuse

Abuse can take many shapes and forms, from the emotional and verbal to the physical and sexual. It can happen during childhood or adulthood, and have wide-ranging effects far into the future. According to the Office on Women’s Health, experiencing abuse or trauma can lead to mental health conditions such as anxiety disorders, depression, post-traumatic stress disorder (PTSD), borderline personality disorder, or the misuse of drugs and alcohol. It can also result in eating disorders, self-injury, and severe stress or fear.

Still, it can be hard to figure out if and how you’re being affected by prior or current negative experiences. Sometimes the symptoms take many months or years to surface, manifesting as anxiety, trouble sleeping, changes in mood or appetite, anger and depression, or the abuse of drugs or alcohol.

If you are currently in a physically or mentally abusive situation, it can be hard or near impossible to get out of the house and receive the help you need. While online therapy may seem like an accessible alternative, it’s crucial to understand that it can only help to a certain extent. There are physical barriers to getting you immediate help should you need it. Your online therapist will likely not know your exact physical location and, therefore, cannot send qualified personnel should it become necessary. Additionally, online therapy usually has a time delay between patient and counselor, which can take hours, if not days. This also makes it ill-suited to emergency situations.

If you are not ready to take the steps necessary to get yourself out of an abusive situation, online therapy can definitely provide a helpful first step, but it should not be treated as anything more than that. In many cases, domestic violence and other types of abuse are life and death situations.

If you or someone you know is a victim of abuse, the National Domestic Violence Hotline has some helpful info on determining what constitutes abuse. Online chat with trained specialists is available in English and Spanish, as well as a 24/7 advocate helpline for hearing and Deaf callers. 

The National Coalition Against Domestic Violence also has a list of excellent resources for survivors of abuse in many communities (indigenous, LGBT, differently abled, and immigrants, among others).

National Domestic Violence Hotline: 1-800-799-7233 (SAFE)

TTY: 1-800-787-3224

Substance Abuse

If you’re struggling with addiction, it might be tempting to seek an online counselor – after all, it’s private, often anonymous, and easily accessible. However, your plan for recovery should include more intensive help than an online counselor can provide.

Addiction is often measured on a spectrum, which can range from mild to severe. If you’re only just becoming aware that you may have an addiction, online therapy may be a good place to start. A licensed counselor with experience in substance abuse issues – whether online or in-person – should be qualified to help you determine if you do, in fact, have a problem and figure out next steps you can take.

However, if you already know you have a serious substance abuse problem that may be life-threatening, the best thing you can do is seek out help in your area. Speaking to a therapist or physician in person can give you the consistent support you need in order to get sober and healthy. There are also support groups like Alcoholics Anonymous and Narcotics Anonymous, with millions of members worldwide, where you can find people like you to help you achieve your sobriety goals. Recovery is a hard road, but you don’t have to travel it alone.

The Substance Abuse and Mental Health Services Administration (SAMHSA) has an online directory of approved drug and alcohol treatment facilities in all fifty states, as well as the U.S. Virgin Islands, Puerto Rico, Guam, the Northern Mariana Islands, and Micronesia. They also have a National Helpline for people facing mental illness and drug abuse.

The National Drug Helpline has professional advisors available 24/7 to help you access additional resources, as does the National Council on Alcoholism and Drug Dependence (NCADD). You can also check out the National Institute on Drug Abuse (NIDA) website for more helpful information.

SAMHSA National Helpline: 1-800-662-HELP (4357)

NCADD Hope Line: 800-622-2255

Post-Traumatic Stress Disorder

If you have been diagnosed with post-traumatic stress disorder (PTSD) – or suspect you have it – therapy is a necessary step. And, if you have already gone through therapy before and your symptoms are manageable, an online counselor might serve as a helpful support system.

However, if you’re having frequent flashbacks, struggling with depression, or having problems in your relationships or job due to your symptoms, this might be a sign that you need more than what an online therapy site can provide. Additionally, if you have recently had thoughts of harming yourself or others, however fleeting, it’s time to seek in-person help.

While there are online therapists that are able to deal with PTSD, therapy can jog your memory and trigger symptoms in unexpected ways. It’s best to engage with a therapist that is available to handle crises immediately and effectively, and who can physically be there for you when you most need it.

If you are a military veteran, you can contact the Department of Veteran Affairs’ Veterans Crisis Line, by phone (support for Deaf veterans is available), chat, or text. There is also the PTSD Foundation of America, which funds the Camp Hope initiative to provide interim housing and one-on-one mentoring to combat veterans suffering from PTSD.

Survivors of sexual violence can contact the Rape, Abuse & Incest National Network (RAINN), which has resources available in English and Spanish, as well as a phone and live chat hotline.

SAMHSA National Helpline: 1-800-662-HELP (4357)

Veterans Crisis Line: 1-800-273-8255

PTSD Foundation of America: 877-717-PTSD (7873)

RAINN National Sexual Assault Hotline: 800-656-HOPE (4673)

America’s Mental Health Crisis

Much has been written about the lack of access to mental healthcare, one of the most pressing problems of contemporary American society. The National Institute of Mental Health estimates that one in five Americans suffers from a chronic mental illness in varying degrees of severity. Yet, every year, millions of Americans go without care. 

The statistics are staggering. According to Mental Health America, an advocacy non-profit, 24 million adults with mental illnesses don’t receive any treatment. In some states, such as Hawaii, the rate is as high as 65%.

What’s worse, incidences for major depression and serious psychological distress are rising among teens, according to the latest National Survey on Drug Use and Health from 2016. Suicide rates have also jumped for teens and young adults, as well as emergency-room admissions for self-harm, and hospital admissions for suicidal thoughts or attempts. The CDC reports suicide is the third leading cause of death among youths between 10 and 24 years old, a heartbreaking statistic.

However, despite the high prevalence of mental health issues in contemporary American society and the high visibility of the problem — with press and academia both covering and studying it extensively — too many are suffering and not getting help. It’s hard to find any other comparable health crisis that’s treated as cavalierly — most people, for instance, would find it unacceptable if only one in ten cancer patients was able to get professional help.

The big question is, why is it so hard to get mental health treatment?

It’s Too Expensive and My Insurance Won’t Cover It

Maybe your insurance severely limits coverage for mental health services or doesn’t cover it at all. Maybe you simply don’t have health insurance. Considering that a single hour of private therapy can run anywhere from $75 to $200, depending on the patient’s location and the type of mental health professional they are visiting, it’s clear that out-of-pocket costs are a huge obstacle to getting adequate access to mental health care.

In fact, the National Council for Behavioral Health (NCBH) found in 2018 that 42 percent of Americans cited cost and insufficient insurance coverage as the major barriers to seeking therapy, with one in four having to choose between daily needs and treatment.

Even if you have insurance, there’s no guarantee you’ll be covered. A 2014 study in JAMA Psychiatry, which analyzed a national survey of office-based physicians, found psychiatrists had considerably lower insurance acceptance rates for all types of insurance than for other specialties, with rates steadily dropping since 2005. In 2009-2010, almost half of private practice psychiatrists didn’t accept fee-for-service insurance, and more than half didn’t take Medicare or Medicaid.

Exacerbating the issue is that many insurance companies only cover customers for a certain number of therapy sessions, after which they may require that therapists present a case to a review board to explain and justify whether further treatment is needed.

I Can’t Find a Therapist Near Me

Many point to insurers’ low reimbursement rates as the main reason for non-acceptance, but there’s also the issue of a dwindling psychiatrist population.

In a reflection of a serious shortage of mental health care providers, physician search firm Merrill Hawkins reports, for the third year in a row, that psychiatrists rank second on the list of positions most requested by recruiting organizations. While there has been a slight uptick in the number of new psychiatry residents, according to the American Association of Medical Colleges, data from 2015 shows that 60% of existing psychiatrists are over 55 and aging out of the profession.

Access to care — measured by nonprofit Mental Health America by counting the size of the workforce, access to health insurance, and access to mental health treatment — can vary wildly according to geographic location. According to MHA, Mississippi, Texas, and South Carolina have the least access to mental health care, while Massachusetts, Vermont, and Minnesota have the most. Income level also plays a part in geographic access, with people living in economically disadvantaged and rural areas finding it considerably more difficult to find help.

The problem is so acute that the NCBH study determined that 96 million Americans seeking face-to-face services have to wait over a week to gain access to treatment. Almost half the population either know of someone or speak from personal experience about having to drive over an hour round-trip for an appointment.

Some states, considered mental healthcare deserts, have as few as one mental health professional —  such as psychologists, psychiatrists, social workers, counselors, and psychiatric nurses — per one thousand residents.

Mental Health and your Job

Many people struggling with mental health issues also worry about the consequences seeking treatment may have on their job security. In some instances, this fear is a reality. For instance, an official diagnosis could disqualify you from seeking employment in certain law enforcement agencies, such as the CIA, which requires candidates to pass a thorough psychological evaluation. 

In the overwhelming majority of cases, whoever, being diagnosed has little to no effect on your job. For one thing, it’s likely there is no obligation for you to disclose your mental health to your employer, and your healthcare provider can’t tell your employer for you without your consent.

HIPAA, which equally applies to online and in-person therapy, prohibits health care providers from sharing your personal health information with anyone else, and this includes your employer. You might need to provide your employer information about your care if you’re seeking reasonable accommodation or requesting a medical leave of absence. Otherwise, your therapist cannot disclose your treatment status, you are not obligated to tell your employer that you’re seeking therapy, and your employer cannot ask you.

There may be an exception if the computer you’re using is owned by your employer or if you talk to your therapist during work hours. Although the issue of employee privacy is still up for debate, generally, what you do on a work computer can be easily and legally tracked by an employer. This means that any conversations you have with your therapist on a work computer could be discovered as well.

Otherwise, there is virtually no reason for your employer to find out you have a mental illness or are receiving therapy.

If you do decide to be open with your employer about a condition, there are laws that limit how your employer can use that information. In the first place, employers are required to treat any health information with confidentiality, and it’s a human resources violation to disclose it.

Additionally, it is illegal to discriminate against you and withhold opportunities just because you go to therapy or have been diagnosed with a mental health condition. If it’s a chronic condition, and limits what the Americans with Disabilities Act (ADA) call “major life activities”, it could qualify as a disability, which implies additional protections under the law. Even if your condition isn’t continuous, but has flare-ups, you would still qualify for some protections, as long as it’s a long-term problem.

The bottom line is that, in most job situations, seeking treatment for a mental health condition should not affect you in any way.

The Stigma of Therapy

Aside from employment considerations, another major barrier to getting treatment is the social stigma involved with seeking help. Data published in 2015 by SAMHSA revealed that the fear of prejudice and discrimination is one of the most cited reasons for not seeking mental health services.

This apprehension is worse in certain populations. According to the same study, black, Hispanic, and Asian adults are less likely than other groups to seek treatment. Being afraid of being judged by relatives, neighbors, employers, and colleagues makes many people decide not to seek treatment at all.

It is unfortunately true that mental health conditions are often wrapped in prejudice, stereotypes, and discrimination which may harm social opportunities. Research indicates that people with concealable stigmas often hide them by not seeking help in order to avoid being labeled.

However, there have also been studies that correlate positive attitudes from family members with a greater willingness to seek help. Slowly, social attitudes towards pro-actively seeking mental health are changing. A 2012 study by the Center for Disease Control (CDC) evaluating the effectiveness of SAMHSA’s “What a Difference a Friend Makes” campaign to help destigmatize mental illness found that 80% of Americans across states surveyed believe that treatment can be effective and help people lead normal lives.

Increasing awareness matters because the stigma attached to the issue is significantly reduced in countries where there is greater access to information about how to deal with mental health and higher treatment rates.

What To Watch Out For When Using Online Therapy

The purpose of this guide is not to tell you which company to use — it’s to teach you the basics of online therapy so you can figure out whether it’s right for you and find the company that best fits your needs.

That means there are still a few things you need to do to be as informed as possible.

You and Your Therapist

Therapy is only as good as the therapist you are seeing, so it’s very important to make sure you’re talking to the best possible pick for you.

Authenticating Your Therapist

In the process of creating this guide, we came upon two companies that did not appear to fully vet the therapists on their site. In light of this discovery, we believe consumers should take a more active role in authenticating their therapist’s credentials and licenses.

Therapists should clearly display license numbers and any relevant certifications and diplomas on their profile page. If you can’t find them, don’t be afraid to ask. An in-person psychologist is legally required to display their diplomas and certifications in their office so their patients are sure they’re dealing with an authorized therapist. Asking an online therapist for this information shouldn’t raise any eyebrows. In fact, therapists should be glad to show you their qualifications because it shows you care about receiving the best treatment. If they’re not, we consider it a major red flag.

Refer to our guide to therapist certifications above to know what the acronyms mean. Then, search for your state’s counselor or psychologist license database. The American Counseling Association has a list of all professional counselor licensure boards in the United States and its territories. Feel free to call the board itself and ask for help if their database isn’t online or if you can’t find it.

This may seem like a lot of extra work, but it’s important to make sure your mental health is in trained, competent hands. Just as self-diagnoses can be dangerous, so can trusting your healthcare to an inexperienced or unqualified therapist.

If your therapist lives in a different state than you, ask if they are allowed to treat you. It’s possible the therapist is required to have a license to practice in your state in order to treat you. Your therapist should be aware of these regulations or could inform you about where to find out.

Many jurisdictions don’t limit interstate therapeutic relationships, so there may not be anything keeping your therapist from treating you. However, while receiving care from someone outside your state (or country) may not impact the quality of your treatment, there is a risk it could be regulated in the future. If a law is passed in your jurisdiction prohibiting out-of-state therapists from treating state residents without a state license, you may find yourself in the unwelcome situation of having to give up your therapist, with whom you may already have bonded.

This is not to say you shouldn’t receive treatment from an out-of-state therapist; only that you should be aware of the regulatory uncertainty and the possible risks.

Switching Therapists

If you feel your therapist isn’t a good match, it’s okay to seek out a new one! All the online therapy services on this list let you change your therapist if you feel you haven’t made a connection with them, if you think they demand too much or too little of your time, or for any other reason. Most services won’t place a limit on how many times you can do this change, but they will encourage you to give each therapist enough time to get to know you and try to build a relationship.

Reporting Your Therapist

Though most therapists are professionals who understand the responsibility they have to their patients and the profession, it may be that you get matched with a bad apple.

If you think your online therapist has committed an ethical or legal fault, contact the company immediately. Many companies have a direct method to file a complaint, but you may have to go through customer support. Provide as many details as you can, including screenshots of any correspondence between you and the therapist, if possible.

It’s a good idea to familiarize yourself with the ethical standards applicable to your therapist, such as the Code of Ethics of the American Counseling Association (ACA) or the Code of Conduct of the American Psychological Association (APA).

For example, a counselor is not allowed to be friends with current patients on social media, to establish a romantic or sexual relationship with a patient, or to terminate the therapeutic relationship without making arrangements for continuation of service.

Counselors are also obligated to be respectful of their patients’ diversity, meaning they can’t use discriminatory language against you, and they have to respect your privacy unless it’s possible that you or someone else could be seriously harmed.

If you find yourself in a situation with an unprofessional and unethical therapist, don’t be discouraged from seeking out therapy. It is not your responsibility to make the therapist behave adequately. Try again. It can be hard to allow yourself to trust someone again if you’ve been hurt, but it’s most likely the next person you find will be better.

You and the Company

Remember, you’re not only establishing a therapeutic relationship with a counselor, but you’re also entering into a contractual relationship with the company that hosts the service.

Reviewing the Terms and Policies

The Terms of Service or Terms and Conditions of an online therapy app or website establish the rules for using the platform and the counselor or therapist’s responsibilities when treating you. It’s important to read and understand these terms before starting the service so you know what to expect.

For one, the distinction between therapy (also known as psychotherapy and talk therapy) and counseling is important to note. Though sometimes used interchangeably, the term “counseling” is generally used to refer to a shorter-term relationship aimed at resolving or managing a specific problem. On the other hand, therapy is usually long-term and covers a wide range of issues, such as learning how to manage a chronic mental illness. Some online therapy sites, like BetterHelp, clarify in their terms of service that they connect customers to counselors who provide counselor services, while others use the terms as synonyms.

It’s also important to read the terms of service so you understand how billing works. Most of the companies on this list are subscription-based, usually on a monthly basis, and the subscription renews automatically every month. If you’re not happy with the service or simply want to cancel it, you must remember to cancel before the automatic renewal goes through.

Another reason to be clear on billing is because most online therapy services don’t offer refunds. Once you subscribe and submit a payment, it’s unlikely the company will agree to a refund, except in extenuating circumstances.

Make sure you understand these conditions before signing up for the service so you can avoid unpleasant surprises later.