As technology comes to play a more integral role in our day-to-day lives, the services available to us have been adapted to fit the ways in which we use technology. You can now easily order food, find a ride, or purchase products with just a few clicks, so it may come as no surprise that mental health services can now be accessed online as well. 

Online therapy is a broad term that encompasses all types of mental health services delivered through the internet. This can include online chats, text messaging, audio calls, and video calls. Therapy can take place in real time, such as in audio or video calls, or in a time-delayed format, such as in text messaging or online chats. 

Does online therapy work?

There is much to consider when it comes to determining whether online therapy is right for you. One of the first and biggest concerns that people have is efficacy -- does online therapy really work? While this is still a new question and our understanding could benefit from further study, there is a promising body of research that suggests online therapy is effective. In fact, a meta analysis of internet-based therapeutic interventions found no difference in the effectiveness of online therapy compared to traditional face-to-face therapy. 

Less research has been done on time-delayed, text- or chat-based therapy specifically as it emerged more recently than therapy provided through audio or video calls. Still, there is some preliminary evidence that this modality can be an effective form of support for some people. 

An integral factor in the success of therapy is the therapeutic relationship, which includes the level of trust, empathy, and presence that exists between the therapist and client. As such, it is important to ask yourself through which modalities you feel comfortable forming relationships. For example, therapists who use videoconferencing software can hear your voice and read your facial cues the same way they could if you were in their office. Similarly, you can hear your therapist's voice and see their face in real time.

Therapists who use time-delayed, text messaging or online chatting have only your words to go off of, and vice versa, but this modality allows for more time to consider and craft responses. What is best for you is something you have the power to choose. Through which format do you feel comfortable expressing yourself? Which format gives you confidence that your therapist will understand what you’re feeling and saying? Through which format do you feel you can build a collaborative therapeutic relationship?

Why online therapy might be better

There are benefits of online therapy over traditional in person therapy that should be weighed in your decision as well. Online therapy is often more convenient and offers the comfort of speaking with a therapist from your home. It has additionally made mental health services more accessible, especially to individuals for whom the need to attend appointments in person is a barrier to getting support. Online therapy might be the best fit for you if:

• You live in a remote area 

• You are seeking couple or family therapy and your partner or family members don't live in the same city as you

• You are living abroad and unable to access in person therapy in your first language

• You have physical limitations or mobility issues that prevent you from getting support in person

• It is difficult or impossible for you to block off a considerable amount of time for participating in regularly scheduled therapy sessions (this is relevant to time-delayed, text- or chat-based formats only)

• You have complex needs and are looking for support to compliment other mental health services you are receiving (this is relevant to time-delayed, text- or chat-based formats only)

• You feel uncomfortable for any reason in a traditional face-to-face therapy setting

 Are online therapists qualified?

While it's a good idea to ask any therapist with whom you are thinking of working about their credentials, approach, and experience, this question is more pertinent if you are looking for an online therapist who uses a time-delayed text- or chat-based format. Online therapy that takes place in a time-delayed manner through texting or chatting is most commonly offered through therapy apps, which have stirred up controversy as many of them are not regulated. To reiterate, there has been some research to suggest that this format can be effective, and people have found valuable support this way, but if you are looking for support from a qualified therapist, it is important to ensure that's what you're getting. 

What else do I need to consider?

There are also some online-specific questions you may want to ask a potential online therapist, whichever format they use. It's a good idea to check that your therapist uses software that protects your personal health information, complies with their professional regulatory body's confidentiality standards, and adheres to the privacy legislation in their jurisdiction. 

If you are seeking support from a professional in a different province or country than where you, your partner, or your family member(s) are located, it's also smart to ask your therapist if they can confirm their legal ability to practice psychotherapy in the locations of everyone involved. This is because different jurisdictions may have different laws and standards for the practice of psychotherapy. 

The bottom line

The bottom line is that no type of therapy is one size fits all. Whether online therapy is the right choice for you depends on your needs and concerns, what you are comfortable with, and your expectations for and beliefs about professional support and relationship building.

Research suggests that online therapy can be just as effective as traditional in person therapy, especially when delivered in a more similar format (i.e. through regularly scheduled sessions conducted via audio or video calls). Studies are less conclusive for time-delayed text- or chat-based formats, but still point to the potential of this type of service.

Taking the time to ask yourself what you want out of therapy and what makes you feel comfortable is an important part of determining whether online therapy is the right fit for you, as is taking the time to ask potential therapists about their credentials and approach, software privacy, and ability to practice in different jurisdictions. 

Hayley Mangotich is the Intake Coordinator at Couple Therapy Toronto, and is currently pursuing a Masters degree in Counselling Psychology at the Ontario Institute for Studies in Education (OISE) through the University of Toronto. Hayley has a background in teaching mindfulness-based practices, including meditation and yoga, and she is passionate about exploring how these practices can be blended with psychotherapy. Having been there herself, Hayley understands that reaching out for support is not always easy. She recognizes people's courage and vulnerability, and feels grateful to help them get started on their therapy journey.