1 May 2020 by Samantha Brodsky
Therapy in the traditional sense is a proven way to help people work through mental illness, handle the stressors of everyday life, and cope with past struggles. But, therapy is evolving with the times — more therapists are offering their services online as opposed to in person. That being said, even if you're communicating with a therapist through a screen, it isn't necessarily considered teletherapy by the book.
The same rules apply to teletherapy as in-person services in terms of who can administer it: legally speaking, you can only receive teletherapy from a licenced professional in your state such as a social worker, a psychologist, or a licenced mental health or professional counselor. And, teletherapy sessions should be administered through a HIPAA-compliant platform, meaning a platform that protects your privacy under the Health Insurance Portability and Accountability Act of 1996. This includes Doxy, Zoom for Healthcare, Google Voice, and Updox as opposed to Skype or FaceTime that you're able to use during the national emergency declared amid the novel coronavirus pandemic.
If a therapist does not use HIPAA-compliant technologies, they could be in legal trouble. Alissa Smith, a partner at the international law firm Dorsey and Whitney who represents people in the healthcare industry, told POPSUGAR in a previous interview that mental health information is especially sensitive, so the stakes are higher. However, you can read up on exceptions amid our nation's current coronavirus pandemic here (basically, the laws are becoming less strict in terms of technology and they may permit cross-state therapy).
You can get online therapy through specific therapists' private practices; through your health plan or employee assistance program (wayForward and AbleTo, for example); and through mental health platforms or apps that you have the option of signing up for individually (Talkspace and BetterHelp, for example). Some of these services offer messageing via text, video, or audio in addition to real-time therapy through phone calls and video sessions — Talkspace offers an Unlimited Messageing Therapy program among other plans, for instance — but most mental health professionals POPSUGAR has spoken with do not classify teletherapy to be anything other than phone or video sessions.
It's encouraged that therapists are trained in teletherapy best practices. Training requirements for teletherapy could depend on what type of licence a therapist has and where they are licenced, so therapists should check in with their individual state's licencing board for more information (i.e. every state has its own licencing board for each type of professional licence).
It's important to note that you should be extra cognizant when agreeing to use third party or online platforms as opposed to therapists through private practices simply because you're providing your information when signing up online. The privacy policies should be fully accessible to you. Sure, there are a lot of intricacies you need to read up on before starting teletherapy, but it could very well be worth it (at least we think so) because of the benefits it offers.
Teletherapy Increases Access to Services
Psychologist Navya Singh, PsyD, adjunct faculty at Columbia University in the department of psychiatry, said increased access, especially in rural areas, is an important benefit of teletherapy. She is the founder of wayForward, an example of a digital mental health platform offered exclusively through benefits packages that, after thorough assessment, provides you with a range of services through an app. You can sign up for a self-guided program, text coaching, or live video sessions with a therapist based on that assessment, and wayForward can also be used to refer you to other levels of care in person if need be.
In rural areas, there is less access to mental health professionals and people might need to drive long hours to sessions, Dr. Singh told POPSUGAR. Or, you might be located near therapy offices, but you physically can't get to those appointments in person. Having teletherapy available helps in both scenarios and benefits both parties: therapists can help more people and those people can easily keep up with appointments. It's important, she said, to make everyone more aware of their options and that this care is out there for them.
In Some Cases, Teletherapy Is Less Expensive Than In-Person Therapy
Going to a therapist can cost up to hundreds of dollars per hour session out of pocket if you don't have insurance, or if you have out-of-network benefits and are paying up front before sending your claim forms to your insurance company for reimbursement. Natalie Jones, PsyD, LPCC, told POPSUGAR in a previous interview that she charges her clients the same amount of money for in-person therapy as therapy over the phone or on video calls. Talkspace services are less expensive; plans range from $65 to $100 per week, according to the Talkspace website. BetterHelp costs $40 to $70 per week, billed monthly. Connecticut resident Julia Dugas, 24, who's been doing video calls with her therapist since August 2019, said that she found her therapist through her insurance company via work and pays a minimal copay for sessions.
Whether or not teletherapy is covered by insurance — and how much is covered — depends on your insurance and state policy. In March of this year, Slate reported that 37 states have telehealth parity laws. This ensures that private insurance companies cover telehealth services the same way they'd cover in-person services. As for Medicaid, 21 states offer coverage for telehealth services as they would for in-person services. Telehealth generally hasn't been available for Medicare coverage unless seniors on the plan lived in a rural area, according to CNN. (Note: under this national emergency, Medicare is waiving that requirement and making it easier to get coverage for telehealth overall.)
As for teletherapy apps, some insurance companies will cover them and some won't, so be sure to check in with your provider. For instance, Amy Cirbus, PhD, LMHC, LPC, director of clinical content at Talkspace, told POPSUGAR that the insurance companies Talkspace specifically works with like Optum and Premera cover all Talkspace expenses, text services included (though Talkspace is not available through Medicaid or Medicare). It's the inexpensiveness of their services, she said, that encourage people to stick with therapy longer.
Plus, some insurance companies don't cover the cost of teletherapy if you receive it over the phone (Medicare and Medicaid, for example, reportedly require a video component). We explain this more in-depth here.
Even More Benefits of Online Therapy
Online therapy is effective. Studies show that teletherapy is just as effective if not more effective than in-person sessions. That being said, it definitely depends on the type of therapy you're receiving and the relationship you have with your therapist. Before Dr. Cirbus gave therapy through Talkspace, she had her own private practice. The work, she said, feels just as meaningful, and because barriers of scheduling problems or cost have been removed, she feels like she tends to achieve her goals with her clients more now.
Online therapy is more convenient if your schedule is busy. Dr. Cirbus said that she has clients who are stay-at-home parents, those who are juggling work and family life, young people in college, etc., and teletherapy helps them have more flexibility to make time for sessions. Dugas agreed, stating she was initially on board for teletherapy because she could schedule appointments to take place after work from the privacy of her own home.
Online therapy still offers a connection. Though some forms of therapy are better administered in person, you can still build a connection with your therapist. Dr. Cirbus said that for clients she speaks with through Talkspace's HIPAA-compliant video platform, some of them really open up. Others, though, are uncomfortable doing live sessions, so they benefit from having the option to message her on the app. Dugas said the one time she had a phone session with a therapist, it did feel a bit weird to not see the visual feedback. For that reason she personally prefers video calls.
Online therapy makes it easier to switch therapists. Finding the right mental health professional is crucial, and Dugas said that it's definitely a lot easier to try out therapists online since you don't have to drive to different offices.
Online therapy also makes it easier to stick with therapists you like. Teletherapy allows you to stay with a therapist once you've found the right one and can't get to them in person anymore. If you're moving out of state, though, even temporarily, it's best to make sure that the therapist is licenced in that state. Cross-state therapy rules do defer depending on individual states' licencing boards, and rules are relaxed now due to novel coronavirus. But, Dr. Jones told POPSUGAR that it's always best for a therapist to get advice from their licencing board and malpractice carrier since providing teletherapy to clients who have relocated across state borders is a grey area.
Advice For Setting Up an Environment For Online Therapy in Your Home
Dugas started going to in-person therapy in grad school, where mental health services were free. When she moved away and started her new job, she decided to enroll in therapy again due to anxiety, dealing with her parents' divorce, and deaths in the family, but she was drawn to teletherapy in particular. It was offered through her work benefits, and the convenience factor for her was a win-win.
In contrast, Samantha, 25, who did not want POPSUGAR to use her last name, has gone to therapy since she was 14 due to anxiety, and she told POPSUGAR that talking to a mental health professional makes that anxiety more manageable. She has stayed with her therapist because the woman knows her history and supported her during different phases of her life, such as when she lost her mother back in college. "If I could choose, I would rather do in-person sessions, but if teletherapy is the best option, I definitely recommend it," Samantha said.
Samantha actually had her first video session with her therapist this month, stating that she preferred it to the phone sessions they'd been having ever since 2017 despite the strong relationship they maintained over the phone. "She was able to read my body language, and the conversation felt more natural because she could see me if I paused to think or got tense," Samantha explained.
Check out advice that Dugas and Samantha offered when it comes to starting teletherapy in your home:
Do your research on your therapist first to see their expertise and, if you want, be open to trying multiple therapists to find the right fit.
Have a designated private spot that you go to for your sessions. This way you separate "going" to therapy from being at home otherwise. Samantha likes to create a miniature therapy office for herself, take some deep breaths, and get water before she "goes in" to recreate what she's experienced with her therapist in person.
Adding to that, try not to take sessions in your bedroom if you can. "I was initially taking them in my bed, and I feel like it's too close to home there," Dugas said. Doing them in another room separates her "therapy space" from her personal space to sleep and relax.
If you don't live alone and if you're comfortable with doing so, tell roommates or family members when you have appointments in order to minimize noise and emphasise privacy. This way, you won't get interrupted.
Also for privacy, put on a fan or white noise machine. It's good background noise.
Eliminate distractions. Take off your Apple Watch or any other wearable technologies, and put your phone away if you're not using it for the session.
In speaking with many of the mental health professionals administering teletherapy, it was clear that this is a beneficial service that will continue to evolve. They also hope healthcare laws regulating online therapy and coverage will follow suit. It's convenient and effective, and Dr. Singh said she predicts a shift in openness to these digital means of care, especially since therapists have had to adopt teletherapy at this point in time.