- We spent more than 10,000 hours researching over 70 online therapy platforms, and our testers signed up for the 20 most popular platforms to bring you our top picks.
- Our testers test each platform for at least four weeks, focusing on the sign-up process, therapist selection, therapy session quality, and customer service interactions.
- We surveyed over 2,000 online therapy users, held focus group interviews with both users and therapists, and consulted over 60 mental health experts.
- We score each platform according to affordability, data privacy, availability, and inclusivity.
- Our pages are updated regularly to update pricing and service information and reflect our ongoing testing of new online therapy platforms.
Key Takeaways
- BetterHelp is our best online therapy platform overall due to the site’s extensive therapist network, extra features, and competitive pricing.
- We’ve learned that online therapy users without insurance can expect to pay between $200 and $450 a month for virtual therapy. With insurance, copays can be as low as $20 or less per visit.
- Through surveys, focus groups, and testing, we determined important factors to consider when choosing an online therapy platform, including pricing, types of therapy offered, therapist availability and connection methods, data privacy, and ease of use.
We know that getting access to affordable mental health care as soon as you need it has become, for some, an insurmountable task. Virtual therapy can help connect you to a licensed professional therapist or online psychiatrist who can help—fast. Whether you’re looking for online therapy that takes insurance or a platform where you’ll pay out of pocket, we want you to find the right match for your needs.
To help you narrow your search, our Handbook team researched 70 sites, signed up, and tested 14 excellent options. As part of our process, we created an index of the four most critical concerns users face when choosing online therapy: affordability, data privacy, availability, and inclusivity. We deeply researched each platform against our centralized standards in these categories to provide you with an index to show how well they perform. These are the top seven we recommend.
7 best online therapy services of 2024
Here are our top online therapy platforms:
- BetterHelp: Best overall
- Online-Therapy.com: Best for making lasting changes
- Talkspace: Best for using insurance
- Sesame: Best for in-person or online care
We recommend these platforms if you are looking for a specific type of care:
- Brightside: Best online therapy with psychiatry
- ReGain: Best for couples
- Zocdoc: Best provider directory
Compare the best online therapy platforms of 2024
| Best For | People new to online therapy | People who want to make lasting changes | People who also want in person or online care | People who want to pay with insurance | Couples or people seeking online relationship therapy | People who want online therapy and psychiatry | People who want a large provider directory |
| Services | Individual therapy | Individual therapy; Couples therapy | Individual therapy for adults; Psychiatry | Individual therapy; Couples therapy; Teen therapy; Psychiatry | Individual therapy; Couples therapy | Individual therapy for adults; Couples therapy; Psychiatry | Individual therapy; Couples therapy; Psychiatry |
| Ways to Connect | Messaging; Text, audio, or video sessions | Messaging; Text, audio, or video sessions | Messaging; Video sessions | Messaging; Text, audio, or video sessions | Messaging; Video sessions | Audio or video sessions | Audio or video sessions |
| Monthly Cost for Individual Therapy | $260–$360 | $200–$440 | $300–$349 | $276–$436 | $260–$360 | Depends on provider | Depends on provider |
The best online counseling reviews
BetterHelp: Best overall
Pros and cons
Why we chose BetterHelp as our best overall
BetterHelp earned our top spot thanks to a combination of user satisfaction, therapist selection, and features. We liked how easy it was to switch providers—a process that can be challenging on other online therapy platforms. Additionally, BetterHelp includes bonus features that we believe add value to a subscription—including group sessions, webinars, a digital journal, and worksheets assigned by your therapist.
Who should use BetterHelp: BetterHelp is the best option for those seeking extra features with their online therapy subscription and who want to connect with their therapist prior to their first session
Who should not use BetterHelp: Those seeking an online therapy platform that takes insurance or who require psychiatric care should choose a different platform.
BetterHelp says that it has more than 30,000 licensed therapists on the platform. Our Handbook Team tester went through the therapist matching and switching process to find out how easy it was for users to find a good therapist fit. Here are a few of the features we found that can help you find the right therapist:
- A therapist-matching questionnaire that considers your gender identity, sexual orientation, areas of focus, and therapist expectations.
- Ability to chat with your therapist to get to know their approach before booking an appointment.
- Easy process to switch therapists anytime.
- Ability to choose a new therapist based on a list of matches.
To learn more, read our in-depth BetterHelp review.
Online-Therapy.com: Best for making lasting changes
Pros and cons
Why we chose Online-Therapy.com as the best for making lasting changes
Online-Therapy.com specializes in cognitive behavioral therapy (CBT), a treatment approach that encourages a shift to more helpful behaviors and thoughts. We liked that Online-Therapy.com’s structured, CBT-based approach provided bonus tools like worksheets – which we believe will be helpful for anyone who wants to make a lasting difference.
Who should use Online-Therapy.com: Those with specific goals they hope to accomplish through therapy will benefit from Online-Therapy.com’s CBT-focused approach.
Who should not use Online-Therapy.com: If you’re seeking a therapist for ongoing counseling rather than to treat a specific concern or prefer a different approach to therapy than CBT, you should pursue other platforms.
CBT is well-researched in treating individuals with depression, anxiety, obsessive-compulsive disorders, and addictions.
Ling Lam, a licensed therapist and academic lecturer at Santa Clara University, explains that one of CBT’s strengths is how it leverages intentional practices like the activities assigned outside of therapy sessions. “I think journaling, CBT worksheets—these are important parts of any therapy, CBT or not.”
All of Online-Therapy.com’s therapists are trained in CBT. A subscription also includes access to additional resources to support therapy, such as CBT explainer sections, worksheets, and a digital journal. Our Online-Therapy.com review can help you learn more about the platform and its features.
Brightside: Best for online therapy with psychiatry
Pros and cons
Why we chose Brightside as the best for online therapy with psychiatry
We liked that Brightside integrates online therapy and online psychiatry, which is ideal for those who may find a combination approach more beneficial than therapy alone.
Psychiatrists can prescribe and help you manage medication, while therapists cannot. But in traditional therapy, having both a psychiatrist and a therapist can mean coordinating your appointments between two separate offices. So, we appreciated that Brightside Health, or Brightside, made it easy to message multiple mental health providers on one platform.
Who should use Brightside: We recommend Brightside for those looking to combine their online therapy and online psychiatry needs into one convenient platform.
Who should not use Brightside: Brightside does not treat kids or teens, and the psychiatrists on the platform cannot prescribe controlled substances, including many ADHD medications.
Brightside’s care coordination and customer service were responsive and helpful, and its providers are in-network with some insurance plans, including Medicare Part B. Additionally, your provider’s notes can be shared with any other providers on the platform, so switching between therapists or psychiatry providers is a seamless experience. To learn more, read our in-depth Brightside review.
Talkspace: Best for using insurance coverage
Pros and cons
Why we chose Talkspace as the best platform for insurance
Talkspace is one of the few online therapy platforms that accept in-network insurance from major providers, such as Aetna, Cigna, and Optum. Our testers found it easy to determine how much you’ll have to pay for therapy on the platform without signing up for an account first. That’s why it earns our top spot for therapy platforms that accept insurance.
Who should use Talkspace: If you’re hoping to use your insurance for online therapy, Talkspace accepts almost every major insurance provider.
Who should not use Talkspace: Those hoping to pay out of pocket for their online therapy can find more affordable options than Talkspace.
When switching therapists on Talkspace, you can see a detailed profile of your therapist matches. Therapist profiles included information such as their experience level, availability, and a brief video bio. You can also include your gender preference for a therapist, but the questionnaire doesn’t include other preferences, like a POC or LGBTQ+ provider.
Talkspace also provides psychiatry services. While its out-of-pocket fees for psychiatry and medication management can add up, if your insurance is covered, you could find Talkspace a more affordable online therapy or psychiatry option. We also liked its detailed therapist profile features, and that messaging therapy is included with all plans.
Read our in-depth Talkspace Review for additional details.
ReGain: Best for couples
Pros and cons
Why we chose ReGain as the best platform for couples
While other online therapy platforms may offer couples therapy as a service, we liked that ReGain specializes in couples and relationship therapy. You and your partner can have separate profiles and join sessions from your own devices, which is convenient for couples with tight schedules. You don’t even need to be in the same state to complete your sessions.
Who should use ReGain: Anyone seeking couples counseling can benefit from ReGain’s user-friendly interface and three-way calling for sessions.
Who should not use ReGain: ReGain is not the right platform for those seeking one-on-one counseling from their therapist.
Since ReGain is a sister brand of BetterHelp, a subscription comes with many of the same benefits as BetterHelp—including access to four monthly live sessions and unlimited group sessions.
It also offers live therapy sessions for couples and a running schedule of group webinars called “Classes.” We liked the webinars because partners can learn more about relationship skills such as communication, conflict resolution, and parenting, which can make therapy more effective. We found the webinar topics to be wide-ranging and scheduled often enough for busy couples to be able to attend.
Additionally, note that while you and your partner will have your own profiles and journals, you’ll share a chat room with your therapist. So, your partner can see your messages.
Read our in-depth ReGain Review for additional details.
Sesame: Best for in-person or online care
Pros and cons
Why we chose Sesame as the best for in-person or online care
We liked that Sesame Care, or Sesame, shows providers who may be available in person as well as for online therapy. When you choose a therapist who offers both options, you have more scheduling flexibility, and have the opportunity for a hybrid care program that suits your needs. We also like Sesame’s pay-per-session structure, making online therapy and psychiatry more accessible for those without mental health insurance coverage. Additionally, we also liked Sesame’s detailed provider profiles and availability schedules, which made it quick and easy to book appointments
Who should use Sesame: Sesame is a good option for those seeking to pay by appointment without getting locked into a subscription.
Who should not use Sesame: Those seeking extra features like webinars, group sessions, or online learning won’t find it in Sesame’s “no frills” approach.
According to one survey, the national average wait time for therapy services is 48 days, almost seven weeks. Getting an appointment with a psychiatrist can take even longer. But Sesame’s easy signup process can connect you with providers quickly. In fact, many providers even had same-day availability.
Warning
If you need help urgently, don’t wait for an appointment. Crisis care is available to support your mental health immediately. Call or text 988 to connect to the Suicide and Crisis Lifeline, available 24/7.
However, the number of licensed providers available on Sesame varies by location. Depending on your state, you may have a different level of choice regarding provider availability. For example, as of this writing, users in Vermont can choose from 11 providers, whereas users in Alaska only have two providers to choose from.
Zocdoc: Best provider directory
Pros and cons
Why we chose ZocDoc as the platform with the best provider directory
Zocdoc has a detailed search tool with filters to help you find a provider you’re comfortable with who accepts your insurance. We enjoyed this extensive provider directory and filters, which made it easy to find providers who fit certain criteria – like ethnicity, gender identity, or cultural background.
You can filter therapist search results using the following categories:
- Preferred appointment date.
- Preferred appointment time.
- Visit reason.
- Specialty.
- Distance (If you’re looking for in-person therapy).
- Type of visit (Whether it’s a virtual video visit or an in-person visit).
- Gender.
- Patient age range.
- Modality (Couples, individual, family, or group therapy).
- Provider ethnicity.
- Provider languages spoken.
- Provider sexual orientation.
- Provider faith.
- Treatment approaches.
Who should use Zocdoc: If choosing your provider is important to you, Zocdoc offers an extensive provider directory and the ability to narrow down your search through multiple categories.
Who should not use Zocdoc: Zocdoc’s varying pricing and appointment availability may not work for those who need to know their budget and schedule in advance.
Other brands to consider
We tested many other online therapy platforms in order to find the best. Though they didn’t make it into our top recommendations, these platforms might be right for your specific situation.
Talkiatry is an online psychiatry provider available in 43 states. It’s a large network of virtual psychiatry providers treating patients as young as five who have an in-network insurance plan. Any patients under 18 will require treatment consent from a parent or guardian. Users can switch providers anytime, and Talkiatry’s providers offer psychiatry services and medication management. They can also refer you to a therapist to provide supportive care. Unlike Brightside, Talkiatry doesn’t have an app or extra resources that can integrate your mental health care with its providers. Instead, the platform uses the HIPPA-compliant Healow app to connect patients directly with their provider for messaging and video sessions.
In between sessions with your psychiatry provider, you can message them through Talkiatry’s platform. Our tester reviewed her message history and reported, “My current psychiatrist responds back within three hours each time.”
Talkiatry billing is pay-per-session, so you won’t have to worry about a membership fee or monthly subscription, and you can switch providers at any time. Although the cost of a session with Talkiatry varies by your provider and insurance plan, copays may range from $20-$50 per session.
Unfortunately, this platform isn’t yet widely available for everyone. Its providers are in-network with a few insurance plans, and the platform doesn’t accept out-of-network patients or those who want to pay out of pocket. As of this writing, it’s currently unavailable in North Dakota, South Dakota, Idaho, Wyoming, New Mexico, Alaska, Hawaii, and Delaware.
Talkiatry’s website clarifies that not all conditions and patients are a good fit for virtual treatment. The platform does not provide treatment for certain complex conditions, such as schizophrenia and eating disorders, which require in-person care. Talkiatry specializes in treating the following conditions:
- Anxiety
- ADHD
- Bipolar disorder
- Depression
- Insomnia
- OCD
- PTSD
- Substance use disorder
We recommend Talkiatry if you’re in-network with its providers, live in one of the 43 eligible states, and are looking for pay-per-session online psychiatry providers.
“I was going through intense anxiety, and finding a psychiatrist in person was impossible. The closest ones to me were an hour away as I live in a relatively small town. Additionally, seeing a psychiatrist seems more difficult than finding a therapist. I wanted to find something quick and online, and Talkiatry was the first platform to pop up. I was specifically looking for someone who could prescribe me medications, and that was the biggest draw for me with Talkiatry.” -Online Talkiatry user
Calmerry is a subscription-based online therapy platform with three plans:
- Messaging: $228 per month.
- Messaging + One Live Video: $298 per month.
- Messaging + Four Live Videos: $360 per month.
The platform has a reflection chatbot with daily prompts, and unlimited messaging is included with every plan.
We didn’t like that provider choice may be limited depending on location. Our tester had a difficult time finding providers that fit their needs and were only offered three possible providers by customer service.
From our tester
I was only given three (therapist) options and still couldn't get the type of therapist I was looking for. When I didn't find the therapist I was looking for, I felt unseen and underrepresented. Often, I'm reminded that I am a minority due to the lack of representation of someone who looks like me. This was just another example of that.
Additionally, with brief 30-minute live sessions, sometimes our tester didn’t get the full session time with their provider if the provider entered late and had more appointments to attend right after. We recommend Calmerry if you prefer connecting with your provider regularly through messaging.
Open Path Collective is a directory of providers who offer lowered rates to make therapy more accessible. To book with providers, you’ll have to become a member by paying a one-time fee of $65 for a lifetime membership. You’re eligible for a membership if you:
- Cannot afford the full cost of therapy.
- Don’t have insurance coverage or are underinsured.
- Have an annual household income below $100,000.
Providers on Open Path Collective offer members sessions that cost between $40 to $70. Student interns in the network offer therapy for $30 per session, which Ling Lam, a licensed therapist and academic lecturer at Santa Clara University recommends considering. “Actually, sometimes there are very experienced therapists who may not be a good fit for [you], and sometimes there are interns and trainees who are more affordable and who actually have that therapeutic presence and that sort of personal connection [you] can feel,” he says.
Similar to other networks of therapy providers, Open Path Collective doesn’t offer messaging or other features with its membership.
Mental health resources for underserved populations
We believe mental health care should be accessible to everyone, and individuals should be able to find therapists who can relate to their unique identities.
In researching online therapy platforms, we took note of the resources and directories for underserved minorities. For example, networks like Inclusive Therapists offer therapy for intersectional identities.
Therapy for Black Girls is a great mental health resource (including a blog and podcast by a licensed therapist) for Black women and girls. It has a provider directory to find providers who can provide supportive care.
Similarly, Therapy for Black Men is a directory of providers specializing in creating access to mental health care for Black men. It also has a financial assistance program to provide free therapy sessions for Black men.
Brands we don’t recommend
In our research, we encountered some online therapy platforms that we thought weren’t safe for our readers. We advise our readers to avoid Cerebral, an online platform offering therapy and psychiatry. Cerebral has a history of overprescribing controlled medications, making it difficult for its users to cancel their subscriptions, and sharing patient data with advertisers. As of May 2022, Cerebral providers can no longer prescribe controlled substances.
We also can’t recommend the online therapy platform 7 Cups, a chat-based platform that advertises “free online therapy and counseling.” However, messaging with a therapist is actually $150 per month, the “free” messaging is either with an AI chatbot or a volunteer “listener.” Listeners on 7 Cups have no credentials and aren’t verified to be safe. We do not recommend 7 Cups because of its misleading “free therapy” claim and its listener chat, which can be unsafe for vulnerable users looking for mental health support.
Handbook’s research into online therapy platforms
There are many different options out there when it comes to online therapy services. Not every site offers therapist-matching services. Some simply serve as directories, where it’s up to you to search through the listings and connect with professionals. Other online therapy platforms allow you to apply search filters for factors like location, gender, faith, and age. Others have you complete an assessment and pair you with a suitable therapist.
We are continuously reviewing and evaluating mental health services to provide you with the information you need to find the right therapy fit. Collectively, the Handbook Team has put in more than 7,500 hours of research, testing, and evaluation so far to review different online therapy platforms, down to the fine print. We wrote this review to guide you in finding a provider who can best fit your mental health care needs.
Learn more about our online therapy review methodology.
Online therapists may not be the most appropriate resource to help in a mental health crisis. If you or someone you know is a danger to themselves or others around them, it is an emergency, and cannot wait for an online therapist’s response.
Don’t wait. You can find help immediately by:
- Visiting urgent care
- Calling or texting 988 for the Suicide & Crisis Lifeline
- Chatting online at 988lifeline.org
- Calling the Substance Abuse and Mental Health Services Administration (SAMHSA)’s Helpline at 1-800-662-4357 or text your zip code to 435748
All the above options will connect you with trained professionals who can provide crisis support. You can find even more resources, including international options, on our helpline directory page.
What is online therapy?
Online therapy, also known as virtual therapy or online counseling, is a way to receive therapy virtually on your mobile device, laptop, or personal computer. Unlike traditional in-person therapy, which takes place at a therapist’s office, online therapy enables a patient to connect with a qualified therapist from the comfort and privacy of their own home. To attend an online therapy session, you only need an internet connection, a device with a microphone and camera, and a safe and quiet space.
Online therapy vs in-person therapy
While both online and in-person therapy can be effective treatments for mental and emotional health problems, the biggest difference is how treatment is delivered. Online therapy platforms may offer messaging, live texting, weekly phone calls, or live video chats. But the latter gives people the closest experience possible to traditional, in-person therapy, which means it’s most likely to offer the same rewards.
The ability to communicate between sessions with a therapist can be valuable, but most experts agree that online therapy is most effective when it includes regular face-to-face sessions. That’s because body language and other nonverbal cues play an important role in how we communicate as human beings. Facial expressions, mannerisms, posture, and tone of voice are all forms of communication, and subtleties here can be critical in helping your therapist pick up on inconsistencies between your verbal and nonverbal responses.
Face-to-face interactions with a therapist, whether online or in person, can also help create a connection by building trust. It’s much easier to do that when you’re face to face, rather than exchanging written messages or speaking over the phone.
Benefits of online therapy
- Convenience: Online therapy allows you to access help from anywhere as long as you have a fast, reliable internet connection. It eliminates the time and money spent traveling to and from appointments, arranging for childcare, or taking time off work.
- Comfort and safety: Seeing an online therapist from the comfort and security of your own home may make it easier to open up about your feelings. For those with mobility issues, chronic illness, or a condition that makes it challenging to leave home, online therapy can be ideal.
- Selection: With online therapy, you aren’t limited to local therapists. Regardless of where you live, you’ll have access to a greater selection of qualified therapists. That means a greater likelihood of finding someone you trust who specializes in the treatment you need. Plus, online therapy platforms often make it easy to switch therapists until you find the right match.
- Ease of communication: The ability to communicate with your therapist between live sessions to share your emotions and problems in real-time can be very helpful. The messaging feature of many online therapy platforms also serves as a valuable way to track your progress and monitor any setbacks.
- Privacy: For some people, there is still a stigma associated with seeking treatment for mental health problems. It may feel easier to receive treatment online than to visit a therapist in person and risk being seen in the waiting room or parking lot.
Drawbacks of online therapy
- Technical issues: One of the biggest challenges of online therapy is the potential for technological issues. Without a fast, reliable internet connection and device, you won’t be able to complete a video chat session with your therapist. What’s more, even with reliable connections and equipment, internet outages can still occur. It’s important to consider personal limitations with technology as well. Some people may struggle to navigate online platforms.
- Loss of emotional connection: With online therapy, patients don’t share the same physical space as their therapist. Even with video sessions, that loss of in-person intimacy can make it harder to connect emotionally.
- Unqualified providers: When using online services, you may be at risk of falling prey to an unqualified or disreputable provider. Make sure to check a therapist’s credentials carefully.
How to get the most out of online therapy
The biggest benefit from any kind of therapy comes when you find the right therapist. Making that happen online can take time and effort, so be prepared to ask questions, read reviews and take advantage of free introductory sessions. Do your research before you proceed with a particular platform and therapist, and be open to change if you decide it’s not working out.
It’s also helpful to be very clear about what you hope to achieve in therapy. Having specific goals makes measuring your progress much easier and ensures you’re getting the most out of the experience. Whatever your reasons for seeking therapy, communicate them with your therapist.
Finally, remember to prepare for your sessions by limiting distractions at home, creating a quiet and private space, and ensuring your internet connection and device are in good working order.
What you need to know about our online therapy research and testing
These are the five things you need to know about online therapy:
BetterHelp is our top pick for best online therapy platform.
Other best online therapy platforms: Online-Therapy.com, Talkspace, Sesame, Brightside, ReGain, and Zocdoc.
We don’t recommend Cerebral or 7 Cups.
Online therapy platforms may include unlimited messaging and resources like journals and worksheets.
There are ways to safeguard your privacy and data while receiving online therapy.
Our online therapy testing experience
The Handbook team researched more than 70 online therapy platforms, directories, and networks. Based on our research, we signed up for the top 14 platforms to test out for ourselves. Here’s what we did with each online therapy platform:
Fill out the intake assessment.
Subscribe as a new user.
Get matched with a therapist.
Schedule and attend sessions on the platform for one month.
Go through the steps to switch therapists.
Contact customer support with questions.
Explore platform features such as journals, worksheets, and group sessions.
Cancel subscription.
First-hand testing experience
Testers explored the platforms and attended online therapy sessions for at least four weeks. Our testers were instructed to test the platforms through the lens of a real user, paying attention to how easy or difficult it was to find a therapist they could talk to. Additionally, testers were located throughout the United States, allowing us to gauge the availability of providers in different locations. Testers logged their experience in a diary and came together to share their findings when testing concluded.
Online therapy surveys
We received survey responses from over 2,000 online therapy and psychiatry users in varying age groups. These surveys asked current users of 10 of the most popular online therapy and online psychiatry platforms to evaluate each service. Their feedback taught us firsthand how users leverage each platform’s unique features and helped us learn how users feel about important issues such as data privacy.
Focus groups
We hosted focus groups of practicing online therapists and current online therapy and psychiatry users to understand what each group values on their side of the screen. We asked the therapists about the pros and cons of teletherapy and learned what factors influence online therapy and psychiatry users to choose one platform over another.
Our online therapy rating indexes
We created a unique rating index to see how varying platforms measure up to four key factors:
- Affordability: We looked for platforms with affordable out-of-pocket prices. We also included services that accept insurance or offer financial aid.
- Data privacy: We examined how each platform collects and handles user data. If a brand didn’t have this information available on its website, we reached out to learn from it directly.
- Therapist availability: We collected data on a brand’s total number of in-network therapists and their appointment availability in different states.
- Inclusivity: We evaluated platforms on their inclusivity and diversity of practitioners. We also noted if a platform allows you to filter therapists by ethnicity or gender identity.
Mental health experts
A group of seasoned mental health professionals offered insight on online therapy platforms for this article, helping us ensure that it contains up-to-date information and expert knowledge.
Data privacy on mental health platforms
Conversations between you and your mental health care provider can be very personal and sensitive. In our October 2023 survey of online therapy users, about three in four (77 percent) of respondents said that the digital privacy of an online therapy platform was extremely or very important to them. Online therapy platforms have a responsibility to safeguard their users’ data in the following ways:
- Health care providers are responsible for protecting your personal health information (PHI) under HIPAA.
- Platforms aren’t allowed to sell or use your PHI for marketing purposes without your permission under the Health Information Technology for Economic and Clinical Health (HITECH) Act.
What’s covered by HIPAA?
The HIPAA Privacy Rule protects your PHI from being disclosed to other parties to ensure your privacy. Your PHI can include your name, zip code, birth date, and contact information, collected from your medical record and used to make your health care decisions.
Although the information shared between you and your online therapy provider may be considered PHI, data collected by the online therapy platform may not be. In contrast to PHI, personally identifiable information (PII) can still be the same information—your name, date of birth, zip code, etc.—but it’s not covered under HIPAA. PII can also be data collected through questionnaires (i.e., onboarding questionnaires for online therapy platforms), which may be disclosed to third parties with your consent.
How your data is collected and used can be outlined in a Terms and Conditions agreement, Privacy Policy page, or a website disclosure. Many sites have Terms and Conditions that assume your consent to data collection simply by using its website, but some online therapy sites we visited had a popup asking you to acknowledge their data-sharing policy.
Your PII is protected under the Privacy Act of 1974 from being disclosed without your consent. Unlike the HITECH Act, there currently aren’t any laws that regulate the collection and sale of PII by private companies like online therapy sites. The Federal Trade Commission (FTC) is a federal agency that enforces laws that protect consumers’ privacy.
Despite this, data privacy concerns have been raised about major online therapy platforms like BetterHelp and Talkspace, namely for disclosing users’ personal data to advertisers without users’ consent. In July 2023, BetterHelp settled with the FTC and agreed to pay $7.8 million to affected users, among other remedial steps to protect user data. When we reached out to BetterHelp, the company clarified that it is not regulated by HIPAA because they are not a covered entity—a health plan, health care clearinghouse, or a health care provider. BetterHelp states that its platform is now certified by the Health Information Trust Alliance (HITRUST), a health industry data security program, and that all messages between you and your therapist are encrypted using 256-bit encryption.
According to the Mozilla Foundation’s *Privacy Not Included, Talkspace updated its privacy policy to state that it “doesn’t sell client information to third parties.” However, it still uses its users’ personal data for marketing, tailored advertising, and research purposes.
Data privacy concerns aren’t limited to online therapy platforms. We recommend reading through their privacy policies with any online app or platform to understand what data will be collected, how it will be collected, and what the platform does with your data.
Here are links to read more about the privacy policies of the platforms we recommend:
Handbook Tip 1
In addition to understanding how your data is collected and used before signing up for a platform, we recommend the following basic steps that we learned from the U.S. Department of Health and Human Services (HSS) and Mozilla Foundation’s *Privacy Not Included project:
- Attend your online therapy appointment in a private location, preferably not on a public Wi-Fi network.
- Use your personal computer when possible.
- Look out for checkboxes during sign-up to opt out of data tracking or medical information disclosure.
- Sign up with your email, not using a social login like Facebook.
- Choose a strong password to create a secure account login.
What a therapist can disclose
Although your sessions with your therapist are private and confidential, licensed therapists are required to disclose whether their clients are a danger to themselves or others around them. This means alerting local emergency services if they believe you are going through a mental health emergency.
If you have any concerns about your privacy and confidentiality while receiving therapy, we recommend asking your provider about the limits of confidentiality. This conversation may help you fully understand when and why your provider may disclose your information outside your sessions.
Frequently asked questions
Online therapy platforms may offer the following ways to connect with your therapist:
- Messaging: Like a text exchange, you and your therapist can leave and reply to text, audio, or video messages in between sessions.
- Live text sessions: A session where you and your therapist communicate through text only.
- Live audio sessions: A session where you and your therapist communicate through a phone or audio call.
- Live video sessions: A session where you and your therapist communicate through a video conference call via an app, browser, or video conference program.
The cost of online therapy can vary widely. Depending on whether you’re using your insurance coverage or paying out of pocket, prices can span from a $10 copay to $300 per session. For subscription-based online therapy platforms, we found that a weekly session costs $81 on average, and an average monthly subscription with four live sessions costs $325 per month.
Some health insurance companies cover online therapy, so check with your provider. Depending on your income, you may qualify for low-cost online therapy at a community clinic or Federally Qualified Health Center (FQHC). Colleges and universities often offer counseling services, both in-person and online, through their psychology department or a campus social worker. Some businesses also provide employee assistance programs, which may include free online therapy trials.
You can also look online for therapy services offering free trials, which is a good way to sample a particular platform before officially signing up. Some platforms offer the option of paying for therapy monthly or annually to reduce costs. There may also be packages that allow you to purchase multiple sessions at a discounted rate. Other platforms offer free or reduced rates if you work with a trained volunteer rather than a professional therapist.
Many different platforms offer online psychiatry in addition to online therapy. While online therapists can’t prescribe medication, online psychiatrists are able to diagnose and prescribe certain medications if they’re deemed appropriate. Controlled medications, such as stimulants, often require an in-person visit with a health care provider, though restrictions vary by state.
Online therapy sessions on the platforms we tested were between 30-45 minutes long, but other platforms may offer longer session times.
Evidence suggests that online therapy is just as effective as in-person therapy for many people. Not only does it improve accessibility and avoid the time, money, and inconvenience required to meet in person, but receiving therapy at home may make it easier for you to open up about your problems.
Online therapy can be effective in the treatment of conditions such as depression, panic disorder, social anxiety disorder, generalized anxiety disorder, stress, and generalized anxiety. But it’s not right for everyone and in every situation. Online therapy isn’t recommended for anyone experiencing thoughts of suicide or self-harm or in cases of severe mental health conditions. Those with serious addictions will benefit from the more intensive treatments available with in-person therapy.
- Hilty, D. M., Ferrer, D. C., Parish, M. B., Johnston, B., Callahan, E. J., & Yellowlees, P. M. (2013). The Effectiveness of Telemental Health: A 2013 review. Telemedicine Journal and E-health, 19(6), 444–454. Link
- Lin, L., Stamm, K., & Christidis, P. (2018, February). How diverse is the psychology workforce? Monitor on Psychology, 49(2): 19. Link
- Access to Care Data 2022. (2022). Mental Health America. Link
- NYC Teenspace. NYC Health Department. Link
- What is Cognitive Behavioral Therapy? (2017). American Psychology Association. Link
- Cognitive Behavioral Therapy. (2016, September 8). InformedHealth.org Link
- Certified Community Behavioral Health Clinics Providing Expanded Access to Mental Health, Substance Use Care During COVID-19 Pandemic. (2021, May 25). National Council for Mental Wellbeing. Link
- Brooks, M. (2023, May 24). U.S. psychiatrist shortage causing months-long wait times. Medscape. Link
- Kamenov, K., Twomey, C., Cabello, M., Prina, A.M., & Ayuso-Mateos, J.L.. The efficacy of psychotherapy, pharmacotherapy and their combination on functioning and quality of life in depression: a meta-analysis. Psychological Medicine, 47(3): 414–425. https://doi:10.1017/S0033291716002774
- What Part B Covers. Medicare.gov. Link
- Average Cost Per Procedure, Mental Health Services. (2023). MN Community Measurement. [PDF] Link
- Consumer Expenditures – 2022. (2023, September 8). U.S. Bureau of Labor Statistics. Link
- Types of Mental Health Professionals. (2020, April). National Alliance on Mental Illness. Link
- Your Rights Under HIPAA. U.S. Department of Health and Human Services. Link
- CAMS Framework. CAMS-care. Link
- HITECH Act Enforcement Interim Final Rule. (2017, June 16). U.S. Department of Health and Human Services. Link
- The HIPAA Privacy Rule. (2022, March 31). U.S. Department of Health and Human Services. Link
- The Privacy Act. (2022, August 31). U.S. Department of Health and Human Services. Link
- Protecting Personal Privacy. U.S. Government Accountability Office. Link
- Privacy and Security Enforcement. Federal Trade Commission. Link
- FTC to Ban BetterHelp from Revealing Consumers’ Data, Including Sensitive Mental Health Information, to Facebook and Others for Targeted Advertising. (2023, March 2). Federal Trade Commission. Link
- Kelly, M. (2022, June 23). Talk Therapy Apps Face New Questions About Data Collection From Senators. The Verge. Link
- BetterHelp, Inc., In the Matter Of. (2023, July 14). Federal Trade Commission. Link
- Covered Entities and Business Associates. (2017, June 16). U.S. Health and Human Services. Link
- Talkspace. (2023, April 25). *Privacy Not Included. Link
- Telehealth Privacy and Security Tips for Patients. (2023, October 17). U.S. Department of Health and Human Services. Link
- Protecting Your Privacy: Understanding Confidentiality in Psychotherapy. (2019, October 19). American Psychological Association. Link
- Winkler, R. & Walker, J. (2022, March 26). Startups make it easier to get ADHD drugs. That made some workers anxious. Wall Street Journal. Link
- Winkler, R. & Safdar, K. (2022, June 14). Mental-health startup Cerebral investigated by FTC. Wall Street Journal. Link
- Wetsman, N. (2022, May 17). Telehealth startup Cerebral halts controlled substance prescriptions. The Verge. Link