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The Best Online Therapy Services of 2021

Online therapy services like BetterHelp, Talkspace, 7 Cups of Tea, and Pride Counseling make accessing mental health services more affordable than ever before.

By: Erik Rivera

Medically reviewed by: Dr. Gerardo Sison

Last Updated: April 8th, 2021

The increasing importance of mental health and the effort to destigmatize mental health disorders has led to an increased push to make therapy more accessible and affordable to everyone. More and more online therapy services have popped up in recent years and patients now have more options than ever to gain access to the services they need. 

We’ve rounded up the best online therapy services of 2021 to help you choose the right one for you.

What are the advantages of online therapy?

Online therapy is incredibly popular for many reasons, and its tremendous growth in recent years speaks to the ease of use of online services. Advantages of online therapy include the following.

Easily Accessible Regardless of Physical Abilities 

People with physical disabilities and those who are housebound have many challenges when it comes to accessing quality therapy. 

First, patients may not be able to leave their homes at all, which would prevent them from accessing in-person services. Other patients may rely on friends or family members for transportation and are therefore limited in the availability and times that they can attend appointments. 

However, accessibility can also play a role on the provider end. Some therapists provide services out of their home or out of a private office that may not be fully accessible for those with disabilities. In these cases, even patients who could physically get to the therapy location may not be able to enter the premises. I

n these cases, online therapy may be much more easily accessible on a regular basis than traditional in-person therapy.

Accessible for People in Remote Areas

While in-person therapy services may be widely accessible in urban and suburban areas, they are often much harder to come by in rural or remote areas. Because it is so critical that the patient-therapist relationship be compatible, limited availability of therapy services in rural or remote areas is particularly problematic for patients who want to seek therapy but are having difficulty finding a therapist that they click with nearby. 

Other patients may not have access to any therapists at all. Not only does the limited availability of therapists make things challenging, the long distance that patients have to travel to access mental health services in an emergency is also problematic. 

With online therapy services, patients are able to quickly connect with a therapist that can immediately help them work through any issues they might be experiencing, no matter the day or time. However, patients in rural or remote areas may not have access to reliable internet access, which can prevent them from accessing online therapy services.

Convenience

No matter where you live, online therapy services are extremely convenient. You no longer need to spend time getting ready, driving to your therapist’s office, sitting in the waiting room, and driving home. You’re no longer beholden to standard business hours for appointment times. 

Instead, you can access mental health services on your schedule based on your needs. 

Patients who previously could not take time away from work or who did not have childcare options are now able to have live sessions, audio messaging, and unlimited messaging through text right from their homes without needing to overcome either of these obstacles.

Affordability

Therapy is notoriously expensive and is rarely entirely covered by even the best health insurance plans. Online therapy has made everything more affordable, although insurance coverage lagged until several months into the COVID-19 pandemic, when new regulations were passed to expand coverage of telemedicine services. 

However, even without insurance coverage, Medicare, or Medicaid, online therapy is much more affordable. Many therapists, particularly those who operate privately, do not accept insurance and rely on patients to check with their own insurance companies about reimbursement. 

While many online therapy services do accept insurance, many are designed to be affordable even without coverage. Online therapy eliminates many of the costs associated with in-person therapy, such as renting an office space. These savings are then passed on in the prices of online insurance.

Reduced Stigma

For too long, there has been a stigma around mental health services, and this stigma has prevented many patients who needed help from seeking services. While it is common for people to discuss physical ailments with their friends, mental health issues are much less commonly discussed because people are afraid of being labeled as “weak” or “crazy.” 

The internet has made therapy more accessible to everyone by making it more private. Some people may also feel more comfortable and safe speaking to a therapist from the comfort of their own home rather than going to an office, particularly when dealing with issues like anxiety or trauma. 

People that are worried about seeing someone they know in the waiting room of their therapist’s office no longer have to worry about being seen. This not only makes patients more likely to seek services in the first place, it also keeps feelings of shame to a minimum and makes them more likely to return. 

Plus, patients are able to receive therapy in the way that works best for them, whether that’s over the phone, during a live video session, or via text message.

Many Applications

Online therapy isn’t just for people with diagnosed mental illnesses. Patients who are hoping to learn new coping mechanisms, deal with a temporary situation that is causing distress, receive couples counseling, and more can all benefit from online therapy services.

What are the disadvantages of online therapy?

Although online therapy has many advantages and is helpful for people in a variety of different situations, online therapy isn’t right for everyone, and there are some disadvantages associated with the practice.

Inconsistent Insurance Coverage

Although insurance coverage for online therapy services has greatly expanded, it is inconsistent and can vary from provider to provider, insurance company to insurance company, and state to state. Some states do not require coverage for online therapy services, and some forms of public insurance may not cover the treatment. 

While online therapy services are generally more affordable than in-person services even for people without health insurance, the out-of-pocket costs may still be prohibitive and out of reach for some people, preventing them from seeking treatment.

Provider Eligibility Issues

One of the biggest hurdles that online therapy providers must overcome is laws in many states that prevent therapists licensed in one state from treating patients that live in another. The laws vary from state to state, but many providers remain limited to working with patients only in their state of residence. 

That means that while some online therapy services may boast about having a large number of providers, the actual number of therapists available in your state may be considerably smaller. Because laws vary, some states do allow psychologists to provide mental health services to patients residing out of state for a set number of days per year. Typically, the maximum number of days per year is 10 to 30 days depending on your state. 

While that may work for some people, patients run the risk of building up a rapport with an out of state provider and then potentially not having access to their therapist when they need them the most.

Privacy Concerns

It’s critical to keep your health information private regardless of whether you’re talking about physical or mental health, but mental health is still so stigmatized that privacy is especially important. 

As a result, offering therapy services online creates potentially complex confidentiality concerns due to threats from internet hackers and people who know how to take advantage of online systems. 

That’s why it is critical that patients only agree to receive therapy services through secure, encrypted platforms that meet the requirements of HIPAA, rather than utilizing online platforms that are not secure and can be compromised, such as Zoom or Skype on your smartphone or tablet. Patients should only access online therapy through a secure system and should never use an open WiFi network, like the kind you might find at an airport or hotel, to receive services.

Technology Barrier

While the use of the internet makes online therapy more accessible than in person services for many people, it also creates a barrier for those who do not have access to the internet at all let alone an android or iOS device, including those in remote areas, the elderly, or some low income groups, as well as those who do not have a strong or reliable internet connection. A strong internet connection is required for video chat, so patients without the right technology may be limited in their access to online services.

Inability to Respond in a Crisis

One of the biggest issues associated with online therapy is the lack of availability for treatment in a crisis situation. Even if you are using a service that allows you to speak to the same therapist each time, your therapist may not be able to respond at the time you need them. 

They also are not able to help in-person, as may be required in some situations. Patients experiencing suicidal thoughts, having a mental breakdown, or who have just experienced a personal tragedy may find that they are not able to get a hold of their therapist when they need them most.

Not Appropriate for Serious Mental Health Disorders

Online therapy is a wonderful tool that can be used to treat many different common mental health issues, including depression and anxiety. However, patients with serious mental health disorders, including those that require close and direct supervision or in-person intervention, should not use online therapy services. This includes patients with mental health issues like schizophrenia, bipolar disorder, personality disorders, serious addictions, and other concerns. 

Patients with these disorders may be able to use online therapy sites as one component of their treatment plan with the approval of a local mental health care provider, but they should not rely on online therapy alone to manage their condition. Online therapy is often limited in scope and the length of the appointment time may not be long enough to address more significant mental health issues.

Difficulties Determining Body Language

Therapists rely on a number of different tools to interpret your moods, thoughts, and feelings in person, including reading your body language, listening for vocal cues, and examining facial expressions. While online therapists may have access to this information in a live video session, many online therapy platforms offer counseling through text message or phone instead.

Even when online video sessions are available, they may lack the depth and complexity of an in person appointment, which can make it challenging for a relationship to develop between the provider and patient. While people of younger generations often feel more comfortable undergoing therapy online, older people or those who crave a physical human connection may find that they don’t get as much out of online therapy as they do out of in person sessions, and some providers may feel that they are less effective in delivering therapy to their patients.

Other Concerns

Online therapy opens up therapy availability for patients around the world, which is great unless they connect with an unlicensed or unscrupulous provider. It is much more challenging to regulate the internet and it can be challenging for a patient to verify their patient’s identity, experience, and qualifications.

Further, many online therapy services do not meet the requirements for therapy that is mandated by court order or other official notice. If you have been ordered to undergo therapy, make sure you confirm that online therapy will meet these requirements.

BetterHelp

BetterHelp is one of the most well-known online therapy platforms out there, and it is also the largest. More than 12,000 licensed, accredited, and experienced counselors offer therapy services through BetterHelp, which means you’re virtually guaranteed to find a mental health professional that’s a great fit for your individual needs and preferences. 

The company employs mental health professionals like licensed psychologists, psychiatrists, social workers, marriage and family therapists, and other mental health providers and offers individual, couple, and teen counseling. 

It should be noted that BetterHelp does not offer psychiatric services, so patients who need prescription medications to manage their mental health will need to get their prescriptions elsewhere. 

BetterHelp offers therapy sessions in areas such as:

  • Anxiety
  • Depression
  • Life transitions
  • Relationships
  • Grief
  • Eating disorders
  • Parenting
  • Addiction
  • Religion
  • Psychiatry
  • Couples therapy
  • Cognitive behavioral therapy (CBT)

Patients can access therapy through BetterHelp by video conferencing, online live chat, text message, and phone sessions. The live video conferencing sessions are particularly popular and serve as a kind of middle ground for patients who want the convenience of online therapy but prefer a stronger connection with their therapist.

Setting up a profile with BetterHelp is easy. You’ll complete a short questionnaire and set up your account, at which point a computer algorithm will match you with a therapist in your state based on your needs and preferences. Patients have the option to change counselors at any time if they decide they do not like their counselor.

BetterHelp does not work with insurance companies, so patients pay out of pocket for the company’s services. Costs depend on the amount and type of therapy requested and range from 160 to 280 dollars per month, billed monthly. Patients who cannot afford therapy may be able to receive financial assistance.

Talkspace

Talkspace is a wildly popular online therapy service that has celebrity endorsements from the likes of Michael Phelps and Demi Lovato. 

Patients have access to over 3,000 licensed therapists that can assist with concerns that include:

Unlike BetterHelp, which does not offer psychiatric services, Talkspace does offer personalized psychiatric treatment and prescription management from licensed psychiatric providers. Psychiatric services are not included as part of Talkspace’s therapy subscription plans.

Signing up with Talkspace requires patients to complete a questionnaire and select a payment plan based on their anticipated usage and preferred means of delivery for therapy services (text messages, phone, or live video sessions). Patients are assigned a consultation therapist that will match the patients to several different therapists, and the patient is able to choose their therapist from this list. Patients typically have their first appointment with their chosen therapist just a few days after signing up.

As noted above, Talkspace has numerous subscription plans available based on your preferred means of receiving therapy and the frequency you desire. Pricing ranges from 65 to 99 dollars per week, and subscriptions are available for individual, couples, and teen counseling. A la carte live video sessions are also available for 65 dollars per session and can be added on to any plan.

Pride Counseling

Pride Counseling is specially designed to meet the mental health needs of the LGBTQ+ community, which is known to suffer from mental health issues at a disproportionate rate compared to the rest of the population. All of Pride Counseling’s therapists are specially trained to work with the LGBTQ community on a variety of mental health issues, with the goal of making therapy more accessible for everyone.

After signing up, patients are matched with a counselor who specializes in dealing with the types of issues the patient is experiencing and who meets their preferences. Although all of the therapists specialize in working with the LGBTQ community, each has a different area of focus and technique. 

Areas of expertise include:

  • Depression
  • Anxiety
  • Stress
  • Relationships
  • Religion
  • Trauma
  • Family conflicts
  • Eating disorders

All therapists are licensed and include accredited psychologists, licensed marriage and family therapists, licensed clinical social workers, or licensed professional counselors. 

Patients are able to access Pride’s therapy services via video conferencing, phone calls, chatting live, and exchanging messages. 

Costs range from 160 to 280 dollars per month and are usually not covered by health insurance. However, companies recommend that patients check with their insurance provider.

7 Cups of Tea

If the costs of online therapy still seem out of reach, 7 Cups of Tea likely represents the most affordable option. The company is designed with the goal of providing affordable and accessible therapy services to everyone. 

In addition to offering affordable online therapy, patients can also receive emotional support for free 24 hours per day, 7 days per week, and chat rooms with people experiencing similar issues are available.

Specialties and areas of expertise include:

  • Addiction
  • substance misuse
  • Anxiety
  • Depression
  • Family
  • Grief
  • Bipolar disorder
  • Parenting
  • Trauma

Online therapy services with 7 Cups of Tea’s licensed therapists and counselors costs 150 dollars per month, which is about half of the price of many other online therapy providers. Additionally, patients have the option of accessing emotional support and trained volunteers 24 hours a day, 7 days a week for free. This additional support can be valuable for people who want to connect to others who understand their feelings and circumstances outside of a therapy setting on a regular basis.

While simply receiving free support from trained volunteers may be enough for some patients, others may need more in-depth treatment. In these cases, it is recommended that patients purchase a subscription to receive access to a therapist. 

When creating an online profile, patients have the option to choose between free or paid services and can switch to the other subscription at any time. You will need to provide more information to sign up for the provider model, as the platform needs enough information to match you to the right therapist.

In general, services offered by 7 Cups of Tea are not covered by health insurance. However, patients should check with their insurance provider.

Summary

Online therapy providers make accessing mental health services more convenient, affordable, and accessible than ever before. 

Companies like BetterHelp, Talkspace, 7 Cups of Tea, Amwell, ReGain, and Pride Counseling offer online mental health services that are designed to cater to different groups of people and income levels. While there are many different advantages to using online therapy services, these platforms are not appropriate in all situations. 

Patients with severe mental health conditions like schizophrenia, bipolar disorder, and severe addiction should not use online therapy services alone to treat their conditions, but the therapy may be useful as part of a broader treatment plan.

Sources:

https://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml

https://www.healthline.com/nutrition/common-eating-disorders

https://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/symptoms-causes/syc-20355967