Online therapy: video, phone & text
Therapy from your sofa, your car or your lunch break can work well. Here’s how to choose safely and make it work for you.
By the numbers
How many people use online therapy, and what research says.
United States
Research
Privacy
Kinds of online therapy
Video, phone, messaging, guided programs and groups.
Online therapy (also called telehealth or telemental health) means getting care from a licensed professional at a distance. NIMH lists video calls, phone calls, text messaging and email as ways it can happen.
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A live session with your therapist over a secure video link, usually weekly or every other week. This is the closest to in-person therapy.
Individual, couples, family and group therapy can all happen by video.
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Phone sessions need no camera or fast internet. Some people find it easier to talk when they aren’t being seen.
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In messaging therapy, you and your therapist exchange written (or voice) messages on an agreed schedule, rather than meeting at a set time.
Early trials for depression found messaging therapy worked about as well as weekly video therapy. These studies were small, and some were run with a messaging-therapy company, so more research is needed.
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Some services offer online courses based on CBT, with a therapist checking in and giving feedback. Therapist-supported online CBT has worked about as well as face-to-face CBT in many trials.
Apps and programs without any therapist are different. They can teach useful skills but aren’t the same as care from a professional. See “Levels of care & kinds of help” for how to check an app.
Does online therapy work?
For many people and many problems, yes.
NIMH says virtual care can be effective for anxiety, depression, PTSD, ADHD and bipolar disorder. Research comparing online and in-person therapy has found similar results for many conditions.
A 2023 review of 31 trials found therapist-supported online CBT and face-to-face CBT gave almost identical results. Half the trials were about depression or anxiety.
The bond with your therapist matters online too. The link between a strong alliance and good results was about the same in internet-based therapy as face to face. One review found the bond in video therapy may be a little weaker on average, but symptom improvement was no worse.
Is online therapy a good fit for you?
The upsides, the downsides, and when in-person may be better.
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- Appointments are easier to schedule, with more flexible hours
- Walking into an office feels intimidating
- You can’t drive, or live far from services
- Your schedule is busy or unpredictable
- You want a specialist who isn’t nearby
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- Internet or devices are unreliable
- People at home could overhear you
- You feel uneasy having your home on camera
- Screens already wear you out
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If online sessions aren’t working, counselors are expected to consider seeing you face to face, or help you find someone who can.
If you’re often in crisis, or need a higher level of care, talk with your provider about options. “Levels of care & kinds of help” explains outpatient, intensive and crisis care.
Choosing a service or therapist
Licensing, matching, costs and insurance.
You can find online therapy through a local therapist who offers video, your insurer, your doctor, your workplace EAP, or a dedicated online therapy company. Whichever route you take, the same basic checks apply.
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Online counselors can be subject to the laws of both their own location and the place where the client lives. They’re expected to tell you their credentials, where they practice, and any legal limits.
Some states have joined compacts that let professionals practice across member states. The Counseling Compact went live for licensees in ten states as of October 2026.
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- Can I read profiles and choose my therapist?
- Can I switch if it isn’t a good fit, and is there a cost?
- Will I see the same person each time?
- Do they have experience with what I’m going through?
Matching therapy to your preferences is linked with fewer people dropping out and better results.
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NIMH advises checking that your plan covers telehealth, because policies vary from state to state.
Medicare covers outpatient psychotherapy by telehealth. Through December 31, 2027, Medicare covers telehealth you can get from anywhere in the U.S., including your home. For most telehealth services, you pay the same as in person.
Ask before you sign up
- Is it per session or a monthly subscription?
- How do I cancel, and is there a minimum term?
- Do you take my insurance, or can you give me a receipt to claim?
- Is there a free first call?
Your privacy online
Who can see your information, and what to check.
NIMH advises choosing a secure platform that protects your privacy and confirms who you are. Counselors working online are expected to use current encryption and to explain the limits of privacy with technology.
Privacy promises aren’t always kept. In 2023, the U.S. Federal Trade Commission ordered an online counseling company to pay $7.8 million. The FTC said the company shared users’ email addresses and health questionnaire answers with social media and advertising companies.
Questions to ask any service
- Do you share any of my information with advertisers or social media companies?
- Who can read my messages or session notes?
- How long do you keep my information, and can I delete it?
- Is the video or chat encrypted?
Setting up your space
A quiet spot, working tech, and a back-up plan.
Before your first online session
- Test the link, camera, microphone and sound a day early
- Choose a private, quiet spot, and use headphones if you can
- Charge your device, and keep your phone nearby as a back-up
- Agree what happens if the call drops (who calls whom, and on what number)
- Share where you are, so your therapist can get help to you in an emergency
Online counselors are expected to talk through the chance of tech failure, how quickly they reply to messages, and what to do in an emergency when they aren’t available.
They may also check who you are at the start of sessions, for example with a code word. This protects your privacy.
Making online sessions work
Small habits that make screen therapy feel more real.
Helpful habits
- Treat it like an appointment: same time, same place, phone on silent
- Give yourself five minutes before and after, rather than jumping in from a work call
- Keep a notebook nearby for thoughts and homework
- Tell your therapist if something feels harder on screen
- Ask for a mix of video and in-person sessions if that’s possible
It can be harder to read body language on a screen. Saying out loud how you’re feeling, or that a comment didn’t land, helps your therapist understand. Talking through strains and repairing them is linked with better results.
Online therapy for children & teens
It can work well for young people, with a few extra checks.
In 2024, 13.1% of U.S. teens received mental health care by telehealth. A 2024 review found technology-assisted CBT, including video sessions, worked about as well as face-to-face CBT for anxiety and depression in young people.
Extra things for parents to check
- Is the therapist trained to work with this age group?
- How will parents be involved, and what stays private?
- Where can your child talk without siblings or others overhearing?
- What’s the plan if your child is upset after a session?
Counselors seek a young person’s agreement and include them in decisions, while respecting parents’ legal rights. Rules on consent for minors differ by state.
When and where to get help
Online therapy isn’t a crisis service. Here’s who to contact if you need help now.
Most online therapy, especially messaging, isn’t set up for emergencies. If you feel unsafe or are thinking about suicide, reach out to a crisis line or emergency services right away.
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Call or text 988, or chat at 988lifeline.org. It’s free, confidential and open 24/7. For Spanish, call 988 and press 2. Veterans can call 988 and press 1, or text 838255.
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Text HOME to 741741 to reach a trained crisis counselor, free and 24/7, in the U.S.
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Find A Helpline (findahelpline.com) lists free, confidential helplines in over 175 countries. If you use an online service from abroad, check that your therapist can legally see clients where you live.
📝 Worksheets for this guide
Fill these in privately in the app. Your answers stay on your phone.
Sources
- Substance Abuse and Mental Health Services Administration (SAMHSA) (2025). Key Substance Use and Mental Health Indicators in the United States: Results from the 2024 National Survey on Drug Use and Health
- National Institute of Mental Health (NIMH). What Is Telemental Health?
- National Institute of Mental Health (NIMH). Psychotherapies
- National Institute of Mental Health (NIMH). Help for Mental Illnesses
- World Psychiatry (via PubMed) (2023). Therapist-supported Internet-based cognitive behaviour therapy yields similar effects as face-to-face therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis (Hedman-Lagerlöf E, et al.), World Psychiatry 22(2)
- Clinical Psychology & Psychotherapy (via PubMed) (2018). Working alliance and outcome effectiveness in videoconferencing psychotherapy: A systematic review and noninferiority meta-analysis (Norwood C, et al.), Clinical Psychology & Psychotherapy 25(6)
- Clinical Child Psychology and Psychiatry (via PubMed) (2024). Effectiveness of technology-assisted vs face-to-face cognitive behavioural therapy for anxiety and depression in children and young people: A systematic review and meta-analysis (Bevilacqua L, et al.), Clinical Child Psychology and Psychiatry 29(4)
- Journal of Medical Internet Research (via PubMed) (2023). Comparing Message-Based Psychotherapy to Once-Weekly, Video-Based Psychotherapy for Moderate Depression: Randomized Controlled Trial (Song J, et al.), Journal of Medical Internet Research 25
- Psychiatric Services (via PubMed) (2024). Randomized Trial of the Effectiveness of Videoconferencing-Based Versus Message-Based Psychotherapy on Depression (Areán PA, et al.), Psychiatric Services 75(12)
- American Psychological Association journal (via PubMed) (2018). The alliance in adult psychotherapy: A meta-analytic synthesis (Flückiger C, Del Re AC, Wampold BE, Horvath AO), Psychotherapy 55(4)
- American Psychological Association journal (via PubMed) (2018). Alliance rupture repair: A meta-analysis (Eubanks CF, Muran JC, Safran JD), Psychotherapy 55(4)
- Journal of Clinical Psychology (via PubMed) (2018). The impact of accommodating client preference in psychotherapy: A meta-analysis (Swift JK, Callahan JL, Cooper M, Parkin SR), Journal of Clinical Psychology 74(11)
- American Counseling Association (ACA) (2014). 2014 ACA Code of Ethics (Section H: Distance Counseling, Technology, and Social Media)
- Counseling Compact Commission (2026). Counseling Compact (home page and member-state status)
- U.S. Federal Trade Commission (FTC) (2023). FTC Gives Final Approval to Order Banning BetterHelp from Sharing Sensitive Health Data for Advertising, Requiring It to Pay $7.8 Million
- Medicare.gov (Centers for Medicare & Medicaid Services). Telehealth coverage
- U.S. Office of Personnel Management (OPM). What is an Employee Assistance Program (EAP)?
- 988 Suicide & Crisis Lifeline. Get Help
- Crisis Text Line. Crisis Text Line
- Substance Abuse and Mental Health Services Administration (SAMHSA). Crisis Text Line (resource listing)
- ThroughLine (findahelpline.com). Find A Helpline
- International Association for Suicide Prevention (IASP). Crisis centres and helplines
This guide is for education and self-care. It is not a diagnosis or a substitute for professional care. Please talk to a counselor or clinical provider about your health. Reviewed October 2026.
