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New Survey Highlights Pros and Cons of Teletherapy for Mental Health

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Key Takeaways

  • Online therapy, also known as telehealth or telemental health, has grown in popularity since the pandemic began.
  • Evidence shows telehealth can be effective for mental health treatment, but some therapists and patients prefer in-person sessions.
  • Certain factors may make teletherapy more beneficial for some people over others, like introverted tendencies and access to technology.

The use of online therapy, also known as telemental health or teletherapy, has increased as a result of COVID-19. It is praised as a way to increase access to mental health care, including medication and counseling—especially during the pandemic. But it's not right for everyone, since technology, insurance access, or simply a preference for in-person treatment can be barriers for entry. Only about a third of Americans are comfortable with online treatment, a recent survey finds.

United Way surveyed mental health care providers by state, as well as about 2,500 American adults, looking at attitudes about telemental health during COVID-19. The survey found 27.71% of Americans feel uncomfortable accessing telemental health resources compared to in-person care, while 45.63% say getting care online didn’t affect their comfort level. 

That said, teletherapy remains popular and widely advertised. According to a survey from the American Psychiatric Association, 63.6% of members/counselors didn’t do virtual sessions before the pandemic. But after the pandemic began, that fell to only 1.9%. Prior to the COVID-19 outbreak, 2.1% of providers said they used telehealth between 76% and 100% of the time; that figure soared to 84.7% during the COVID-19 outbreak.

G. Caleb Alexander, MD

Telemedicine may be an outstanding means for mental health counseling for some patients and may be extremely limited as a means of delivering care for others.

— G. Caleb Alexander, MD

Who’s Using Telehealth—And Where

The United Way study found a correlation between access to mental health care and comfort levels around seeking help. While they can't confidently say more access caused increased comfort levels around those receiving care, they found that when there were more providers available in an area, people reported more comfort.

The survey also looked at mental health care by state. Mental health care access was the worst in Alabama, Texas, and West Virginia, where there are as many as 990 state residents per a single mental healthcare provider. 

Even those who live in a state with ample providers still may not seek out mental health care. In Vermont, where there is a larger proportion of providers, about one-third of people aren’t comfortable accessing mental healthcare. Regardless of how many providers there are—or aren’t—people in Mississippi, Maine, and North Carolina are the least likely to seek mental health care via telehealth, the report finds.

Mental Telehealth Challenges

Stigma remains an issue in mental health overall, but telemental health carries its own set of obstacles.

Aside from technology access and insurance issues, parity remains a huge barrier for telemental health. Parity ensures providers get paid and receive the same amount for virtual visits as they would for in-person visits. Some states have passed parity laws for telemental health, but not all of them. Not all health plans have to follow federal parity laws.

"There are no national laws on insurance companies allowing their members to get reimbursement when they use telehealth," Roseann Capanna-Hodge, LPC, a counselor from Connecticut, tells Verywell.

When a state passes a telemedicine parity law, it means private insurance companies in that state must reimburse telehealth care in the same way they would for in-person care. That means with teletherapy, your virtual psychotherapy sessions would be covered in the same way that they would be as in-person sessions, she says.

"Just like any private pay insurance, telehealth reimbursement rates are dependent on the individual insurance companies and what individual employers have funded for their employees," she says.

What This Means For You

If you want to try online therapy or telehealth, look for providers covered by your insurance and licensed to practice in your state. Before scheduling an appointment, ask the provider what technology platform they use for their sessions to ensure you can access your care.

When Telehealth Isn’t Working

Telemental health is a challenge for people who don’t have access to technology, as well as those who have insurance-related issues.

There isn’t a one-size-fits-all approach. Telemedicine may be an outstanding means for mental health counseling for some patients and may be extremely limited as a means of delivering care for others,” Caleb Alexander, MD, a professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, tells Verywell. “In addition to technological barriers that may complicate the use of telehealth, some patients and clinicians simply should be engaging face-to-face."

There are all sorts of verbal and non-verbal cues that may be hard to glean from a phone or video call compared to a face-to-face visit, even when the telemedicine visit is based on a web-based video platform, which isn’t always a given, he notes.

You learn more about someone from being in a room with them than you do from interacting with them over a phone call or web-based browser, and in some settings where mental health or psychiatric counseling is being delivered, this may be especially important, Alexander explains.

“One of many settings where the face-to-face encounter may be especially helpful is for patients who are newly establishing care,” he says.

Getting Help

Thinking of seeking therapy online? It can be very helpful for many people.

When seeking out teletherapy, the American Psychological Association suggests you:

  • Look at your health insurance plan
  • Find out if a specific provider is licensed to practice in your state
  • Search what their specialty may be
  • Ask the provider what technology platform they use for sessions

That said, it’s not right for everyone. Kathleen McLean, a spokesperson for the Telebehavioral Health Institute, tells Verywell that telebehavioral health is not a good option if a therapist has not been trained with a reputable training organization that has a history of developing the evidence base in the field.

People who don’t have adequate or robust enough technology also aren’t good candidates for online appointments. Also, if the person doesn’t have the privacy to connect with a therapist online, it’s probably not going to work well, McLean says.

You may have some insight on whether online therapy will work for you based on your introverted or extroverted tendencies, Adolph Brown, PhD, a clinical psychologist based in Virginia, tells Verywell.

"Some people want to go to and be embraced in that environment. Extroverts, mostly, are the individuals who get their energy from others," he says. "On the other hand, if you do telehealth with an introvert, they claim to prefer it over in-person therapy. They state that it's not as draining and it gives them an opportunity to get their thoughts together."

Brown, who specializes in psychoanalytic psychotherapy, says telehealth can work against the therapeutic process. He prefers at least some in-person interaction instead of completely remote therapy.

"There'll be some things I don't know about you, there will be things that you can hide, there'll be things I don't see and may not be able to address," he says. "There's a lot that would be missing in that human exchange that therapy was built on."

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Article Sources
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  1. United Way of the National Capital Area. Mental health care access by state.

  2. American Psychiatric Association. 2020 APA telepsychiatry survey. Updated June 2020.

  3. National Alliance on Mental Illness. What is mental health parity?

  4. The Center for Connected Health Policy. State telehealth laws and reimbursement policies. Updated Spring 2020.

  5. American Psychological Association. What you need to know before choosing online therapy. Updated October 7, 2015.