There wasn’t anything wrong, really, with my last therapist. He was smart as a whip, caring, and thoughtful. But after more than a year of working together, I had this nagging feeling that I wasn’t getting out of this what I needed to be. Something wasn’t clicking.
As someone with agoraphobia, it was already challenging to get to another city just for therapy. The financial impact of a copay, transportation there and back, and the time taken away from work had already added up. If I was already spending that money, why couldn’t I just sign up for online therapy, and get the care I needed without leaving my apartment?
So (shrug emoji) I decided to give Talkspace a try.
I chose Talkspace in particular because I knew from talking to other folks that they are especially mindful of their queer and transgender clients (of which I am both).
They didn’t ask me to review their services, or offer me any kind of incentive to talk about them. This is not a paid advertisement, friends, so you can trust that everything here is my honest opinion!
(This was actually an article requested and funded by my patrons, who were interested in online therapy and wanted my perspective. Hi there, patrons!)
If you’re intrigued by online therapy but not sure if it’s for you, I wanted to create this no-nonsense resource to help you decide.
While Talkspace is the platform that I use, this is advice that I suspect will apply to other platforms as well.
As with any therapy experience, you ultimately get out of it what you put in. That being said, there are definitely some signs to look for when deciding if online therapy could work for you:
1. Paying out of pocket isn’t prohibitively expensive for you.
Between my $15 copay and the Lyft ride to and from the office, paying for online therapy wasn’t actually that much more expensive for me. For $39 dollars a week, I can send unlimited messages to my therapist (text, audio, or video, as lengthy as I want) and get two thoughtful responses per day.
If I need a video call for a face-to-face experience, I can pay extra for that, either as part of my plan or on an as-needed basis.
But I want to acknowledge upfront that not everyone can afford this.
If you have insurance and your therapy is already sufficiently covered, online therapy will not be cheaper. However, if you have travel expenses and copayments (like me), or you’re already paying out of pocket, online therapy might actually be cheaper or at least fairly reasonable.
I still think this is the best $39 bucks I spend every week. But for folks who are low-income, this isn’t necessarily accessible to you.
2. You find yourself wishing you could process in the moment.
One of my biggest issues with face-to-face therapy is that, by the time my appointment rolled around, a lot of the more intense situations or emotions had already passed, or I couldn’t remember them once it was time to talk about it.
I often walked away from my sessions thinking, “Jeez, I wish I could just talk to my therapist when things came up, instead of having to wait until our next appointment.”
I felt like I was wasting time, like our appointments were basically me trying to remember what was bothering me or just filling up our time.
If this sounds familiar, online therapy might actually be an awesome option for you. With Talkspace, I’m able to write to my therapist at any moment, so when situations or emotions come up for me, I can articulate those things to my therapist in real time.
I’ve noticed a difference, too — we’re actually talking about the issues that are most present and important for me, instead of what I happened to remember during a scheduled time.
It’s important to note: If you are the sort of person that needs an immediate response, online therapy might not feel as gratifying at first. It took a period of adjustment to get comfortable with spilling my guts, knowing that I would have to wait to hear back from my therapist.
But I did get used to it! And it’s a format that’s working much better for me.
3. You know or suspect that writing is a great outlet for you.
A lot of my best emotional work happens through writing (this probably doesn’t come as a shock, seeing as I’m a blogger). Online therapy has been like having a diary that actually talks back, compassionately and competently guiding me through my process.
If you know that you’re the kind of person that finds it cathartic to write everything out, online therapy can be an awesome platform for you. There aren’t time constraints or character limits, so you’re given permission to take whatever space and time that you need.
If writing isn’t your thing, you can always just monologue with an audio or video recording. Sometimes you just need five minutes to ramble uninterrupted, and online therapy is great for that, too.
4. You find it easier to be emotionally vulnerable in digital spaces.
I grew up in the age of AOL Instant Messaging. Some of my deepest and most vulnerable connections have happened digitally. For whatever the reason — maybe it’s social anxiety, I’m not sure — I find it much easier to be vulnerable online.
I think online therapy is the best possible platform for folks like me, who simply find it easier to be honest when there’s the safety of a computer or phone screen between us and our therapists.
In just a couple of weeks, I disclosed more to my Talkspace therapist than I had with my previous therapist that I’d worked with for over a year. Being online helped me access emotions that I found it difficult to tap into in a face-to-face appointment.
(I think it helps, too, that this is therapy that can happen in the safety of my apartment, whenever I’m ready, while I’m hanging out in my pajamas and hugging my cat and eating nachos…)
5. You feel like you’re texting your friends a little too often.
I’m the kind of person that, when I’m overwhelmed with my life, I find myself texting or messaging my friends, sometimes with a frequency that makes me feel a little annoying.
And to be clear: It’s absolutely okay to reach out to someone when you’re struggling, as long as those boundaries are negotiated between you!
But what’s great about online therapy is that I now have a safe space to express myself at any moment, without the fear that you’re “too much” for that person.
If you’re an “external processor” like me, where nothing feels resolved until you’ve actually gotten it off your chest, online therapy is actually awesome.
I feel like there’s more balance in my relationships across the board, because every single day, I have an outlet for what I’m thinking or feeling that doesn’t rely exclusively on my friends and partners. That means I can be more thoughtful and intentional about who I reach out to and why.
6. You have other clinicians on your team that can help during a crisis.
A lot of reviews I’ve read talk about how online therapy isn’t designed for folks with severe mental illness. But I don’t actually agree with that — I just think that folks like us have to be mindful of what support systems we put in place, and when we use them.
Every person with severe mental illness should have a crisis plan. This is especially true for those of us who use online therapy, which means we won’t always get an immediate response when we’re in crisis.
I use online therapy to explore my trauma history, manage my OCD and depressive symptoms, and navigate the daily triggers and stressors in my life. However, I don’t use online therapy exclusively.
I also have a psychiatrist that I see regularly, support groups that I attend on an as-needed basis, and I can also contact my previous therapist if I’m suicidal and need to be referred to local crisis resources (like outpatient resources or hospitalization).
My Talkspace therapist knows that I have a history of suicidality and self-harm, and we’ve talked about what steps we would take if I were in crisis again.
I think online therapy can be a great option for folks with severe mental illness. (For me personally, I feel much more supported checking in with my therapist ten times a week online, as opposed to seeing them just once a week, if that.)
The key is that online therapy should never be the only option, and you and your therapist should work out a crisis plan upfront.
7. You have very specific therapeutic needs that you’re having trouble meeting.
My therapeutic needs were a bit… complicated.
I’m a queer and transgender person with a history of complex trauma, struggling with OCD and ADHD. I needed a therapist that can handle all of the above, but trying to find one who was up to the task was daunting, to say the least.
When I signed up for Talkspace, I first talked with a consultation therapist (kind of like a clinical matchmaker) who would help me find my ideal therapist. Upfront, I gave them as much information as I could, and they gave me three therapists to choose from.
One of them was a trauma-informed therapist who was also queer and transgender, who was well-versed in the disorders I was dealing with. We also came from a similar perspective, valuing a social justice-oriented and sex-positive approach.
Talk about a perfect match!
I think that one of the benefits of online therapy is that you have more options. Rather than searching for someone within a reasonable distance, you can connect with any therapist that’s licensed in your state. This widens the pool of available clinicians, and ideally connects you with a therapist that meets more of your needs.
(The great thing, too, is that switching therapists on apps like Talkspace is super easy — and those therapists will have access to your previous conversation logs, so you won’t feel like you’re starting all over again.)
If you’re a marginalized person that needs a therapist from your own community, your odds of finding the right therapist are much higher with online therapy. To me, this is by far the best part of the process.
There are definitely some valid criticisms to keep in mind, though.
I’ve loved my online therapy experience, but I’d be remiss if I didn’t mention these. Some of the common issues that people encounter with online therapy, summarized for quick reading:
- You need to be 18 or older: As far as I know, for legal reasons, it’s not available to folks under the age of 18. Be sure to investigate this before signing up if this applies to you.
- It’s a different pace: Responses are “asynchronous,” meaning your therapist responds when they’re able to — it’s a little more like email rather than instant message. For folks who like instant gratification, this will take some getting used to. If you’re in acute crisis, this shouldn’t be your primary support system.
- There’s no body language: If you’re someone that is a little more withholding, and therefore you need a therapist to be able to “read” you, this can be an obstacle. If you’re someone that has difficulty interpreting emotion and tone through a text, this can also make things tricky. (Video calls and audio recordings are still options, though, so don’t hesitate to switch things up if you’re finding the text-only format to be tricky!)
- You have to spell things out (literally): Your therapist won’t know if something isn’t working if you don’t tell them directly (they can’t exactly see if you’re uncomfortable, or bored, or annoyed, for example), so be ready to advocate for yourself if you aren’t getting what you need.
Alright, so what should I know before I get started?
Online therapy is really like any form of therapy, in that it only works if you show up. Here are some quick tips for the best possible online therapy experience:
- Be as specific as possible when looking for a therapist: Better to tell your “matchmaker” too much about yourself than too little. The more you advocate for yourself, the better your matches will be.
- Disclose, disclose, disclose: Be as open, vulnerable, invested, and honest as you can possibly be. You will only get out of the experience what you invest into it.
- Talk about therapy in therapy: Talk with your therapist about what’s working and isn’t working. If something is helpful, let them know. If something isn’t, be sure to say so. If something needs to change, it’s important that you communicate that to get the best possible experience!
- Customize it: Online therapy has a little less structure, so be sure to talk with your therapist about how you can create accountability and a format that works for you. Whether it’s homework assignments, assigned readings (I like to share articles with my therapist on occasion), scheduled check-ins, or experimenting with formats (text, audio, video, etc), there are tons of different ways to “do” online therapy!
- Set some goals: If you’re not sure what you want out of the experience, take some time to think about it. Creating goal posts can be helpful in guiding the process, both for you and your therapist.
- Be safe: If you have a history of suicidality, substance abuse, or self-harm — or any kind of disordered behavior that could lead you to harm yourself or someone else — make sure your therapist knows this, so you can create a crisis plan together.
- Anticipate an adjustment period: I felt weird about online therapy at first. It feels distinctly different, especially in the absence of body language and the delayed responses. Give yourself time to adjust, and if things feel off, be sure to let your therapist know.
So is online therapy a good option for you?
Obviously, not knowing you personally, I can’t say for sure! But I can say with certainty that there are definitely folks out there who have benefited from it, myself being one of them.
While I was skeptical at first, it turned out to be a great decision for my mental health, though I recognize its limitations. Like with any form of therapy, it largely relies on finding the right match, disclosing as much as you’re able to, and advocating for yourself throughout.
Hopefully this guide gives you all the right information to make a decision that’s right for you. I’d also encourage you to research more on your own (I am by no means the ultimate authority on therapy!). As the saying goes, knowledge is power!
Hey, fun fact (added some time after I published, once I found this out): If you sign up with Talkspace using this link, we both get $50 dollars off. ¯\_(ツ)_/¯ If you’re on the fence, give it a whirl!
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This is a great guide, and a lot here applies to other therapy venues as well. I’ve been out of the therapy business for more than ten years now, so I really hadn’t paid much attention to the developments in online therapy, so its also a good update for me on that front.
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Reblogged this on cabbagesandkings524 and commented:
Sam provides a concise and knowledgeable patient’s eye view and guide to online therapy.
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Sam, it’s almost a year later (and I just found your blog!), are you still using Talkspace? Is it still working for you? I am designing an LGBTQ friendly health program and am looking for creative solutions for mental health support because our area has a psychologist/counselor shortage and very long wait lists for appointments! Thank you for sharing your experience!
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I’m still using Talkspace and I absolutely LOVE it! It’s truly changed my life! 🙂
It caught my attention when you said that the person needs to discuss with the therapist their previous suicidal attempts if they had any so that they can form a crisis plan. I will mention this to a friend since he did say he wants to give counseling a try. Since he attempted to jump off his apartment’s fourth story window once, I know he has a suicidal tendency. This needs to be addressed as well.
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Thanks Sam for a concise review. I’m looking for a therapist but wait list is ridiculous. In the meantime depression is affecting me despite an anti depressant. This might be what I need so thanks!!
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