How E-Counseling Can Help You: A Complete Review

This is a balanced analysis of the advantages and drawbacks of online counseling (e-counseling). Learn how e-counseling compares to traditional counseling.

“Professional counseling is too expensive, too time-consuming, and it’s inconvenient. Besides, I don’t want anyone to know I’m getting therapy.”

These are some of the many reasons why less than half of those with a mental health issue seek counseling, aka talk therapy. 

But e-counseling overcomes these and other objections, making quality mental health therapy more accessible to everyone.

What Is E-Counseling?

Psychologists and other mental health professionals use psychotherapy (talk therapy) to help their clients recognize and change thought and behavior patterns that negatively impact their lives.

Psychologists commonly refer to therapy conducted via an electronic device, rather than face-to-face, as telepsychology.

E-counseling is simply a more common term for telepsychology.

Depending on your therapist’s technical setup or the online counseling service you’re using, your therapy sessions can take place via phone call, webcam, online chat, email, or text.

Note: E-counseling goes by many other names, including online counseling, online therapy, e-therapy, teletherapy, cyber-counseling, web therapy, internet-based psychotherapy, distance therapy, and remote counseling.

Remote counseling is not new.

In fact, Sigmund Freud could be considered the original remote counselor since he frequently wrote letters to patients.

-counseling, as we now know it, has been around in some form since the advent of the internet.

Cornell University started the first online mental healthcare service for their students with their “Ask Uncle Ezra” column in 1986.

But online therapy has recently exploded in popularity due to the increase in smartphone use, the creation of online counseling services (like BetterHelp and TalkSpace), the Covid pandemic, and acceptance by both the consumer public and mental health care professionals.

E-counseling, as we now know it, has been around in some form since the advent of the internet.

Cornell University started the first online mental healthcare service for their students with their “Ask Uncle Ezra” column in 1986.

But online therapy has recently exploded in popularity due to the increase in smartphone use, the creation of online counseling services (like BetterHelp and TalkSpace), the Covid pandemic, and acceptance by both the consumer public and mental health care professionals.

Teletherapy has not been without controversy, and practitioner reluctance has been the biggest barrier to its use, but many therapists now acknowledge its value. 

They realize that e-counseling can be a positive step that makes therapy accessible to many people who would otherwise avoid professional care.

Online therapy sometimes transitions to traditional face-to-face therapy when the situation warrants.

Some counselors also offer blended counseling, a combination of both in-office therapy and e-therapy.

Research Confirms That Online Counseling Is Effective

Before we look at the advantages and drawbacks of online counseling, let’s address the most important concern first.

Does online counseling actually work?

Online counseling has been found to be effective for people of all ages, from children and adolescents to the elderly. 

Research has shown that online counseling works as well as, and sometimes better than, face-to-face counseling for: 

• anxiety disorders
• depression
• dysfunctional thinking
• eating disorders
• general distress
• mental distress from physical diseases (cancer, diabetes, IBS)
• post-traumatic stress disorder
• quality of life issues
• stress management

One large review of studies that included nearly 10,000 clients found that online counseling had outcomes “quite similar” to traditional, face-to-face therapy.

Another large review that encompassed nearly 12,000 participants found that online therapy helped them make positive behavioral changes. 

Online counseling helped them eat healthier, exercise more, and maintain weight loss longer.

The Major Advantages of E-Counseling

The evidence is clear that e-counseling is effective.

Here are some of the advantages that e-counseling has over traditional, office-based counseling.

1. Convenience

E-counseling allows you to make appointments that suit your schedule.

You can communicate with your therapist from the comfort of your home or any other secure location you choose.

Your therapist may also give you the option to text or email 24/7.

2. Affordability

Traditional therapy is expensive and, unfortunately, health insurance often provides minimal mental health coverage. 

In the US, the average cost for traditional therapy is $100 to $200 per session, but this can be more or less depending on where you live. 

In contrast, e-counseling is more affordable since appointments typically cost much less than paying out-of-pocket, or even paying co-payment amounts.

Since the Covid pandemic, more insurance companies are offering telehealth coverage, so check with your provider to know where you stand. 

3. Accessibility

E-counseling helps to democratize mental health therapy, making it more accessible to everyone.

Online counseling is ideal for many people:

• employees who can’t take time off for appointments
• anyone lacking mobility or transportation
• underserved populations (rural, inner cities)
• the uninsured or underinsured
• stay-at-home parents
• children, adolescents, and teens
• college students
• seniors

Depending on where you live, you may not be able to find traditional counseling locally. 

And even if you can find a therapist taking new patients, it’s not unusual to have to wait for weeks for your first appointment with an office-based counselor.

Online therapy services generally offer access to a therapist fast.

4. Privacy

Many people who could benefit from mental health counseling are ashamed or embarrassed, or afraid of being judged by employers, colleagues, or family.

Counterintuitively, e-counseling can be more private than traditional counseling.

You don’t have to take time off work or inform your insurance company.

No one is going to see you walking in or out of your therapist’s office.

With some e-counseling services, you can use a nickname so that you don’t have to reveal your real name to your therapist.

This anonymity can actually help some people be more forthcoming with their therapist, a definite therapeutic advantage.

5. Expertise

It can be hard to locate the right therapist, because the US is experiencing a severe shortage of mental health care professionals. 

With e-counseling, you no longer have to settle for a counselor just because they are close to home.

You can now find a therapist with the specific expertise you need, regardless of where you, and they, live or work.

6. Control

E-counseling helps you claim control over your own mental health.

You get to choose where, when, and how you want to communicate with your therapist.

7. Continuity

Every year, millions of Americans move.

Previously, if either you or your therapist moved, you’d have to find a new therapist.

With e-counseling, you can continue to maintain the connection with your counselor.

Drawbacks of Online Counseling

While there are numerous benefits to online counseling, there are also a few drawbacks that you should be aware of.

Diminished Nonverbal Communication

It’s widely accepted that a relatively small portion of the information of our personal communication is contained in the actual words we speak.

The rest of the information embedded in personal communication comes from body language and tone. 

A good psychotherapist is adept at picking up on nonverbal communication, but this information can be missed when you and your therapist communicate remotely, rather than face-to-face.

This can be mitigated by using video chat, rather than text or email.

While there is concern that diminished nonverbal communication prevents clients and therapists from building a strong trusting bond, this fear may be unfounded.

Some research has shown that online clients and therapists rate their bonds as strong as those who meet face-to-face. 

A few studies have found that asynchronous (non-simultaneous) messaging therapy (ie, email and text) can be as effective as in-person therapy. 

Credentials and Security

Before you start working with a therapist you find online, the burden is on you to be sure that they have the experience and credentials claimed.

You also need to confirm that they are using secure communications.

It’s not simply a matter of talking on Skype or Zoom.

If your therapist is not using the right technology and software, your interactions may not be secure.

Low Adherence

Therapy works best when you keep your appointments and follow through with the homework you are to do outside of your therapy sessions.

For example, you may be asked to practice stress management techniques, keep a journal, or take note of negative thought patterns or cognitive distortions.

Online therapy, compared to face-to-face therapy, has a relatively low adherence rate. 

So, if you know that you lack the motivation to follow through in this way, e-counseling may not be a good option.

Not Right for Everyone

E-counseling is not suitable for people suffering from serious mental health problems, such as bipolar disorder, schizophrenia, or addictions.

According to the American Psychological Association, online counseling is not advised for anyone in extreme crisis, who has suicidal tendencies, or is a danger to others. 

How to Find a Reputable E-Counselor

First, see if you can get a referral from a health professional you trust, such as your primary care physician.

Or, your insurance plan may be able to give you a list of available providers.

If neither of these options is helpful, there are two main ways to find a therapist who offers remote services.

Locate an E-Counselor on Your Own

You can find an online counselor by searching on Google or by using a directory such as Psychology Today’s Online Counseling Directory.

But you must do some due diligence if you opt to find one on your own.

You’ll need to confirm that this person is a legitimate practitioner, ie, that they have an academic degree and are licensed to work with patients in your area or state.

You can check a prospective therapist’s certification and credentials at the Association of State and Provincial Psychology Boards or the National Board for Certified Counselors.

Additionally, you should confirm that they will be conducting your sessions using software that is compliant with HIPAA (Health Insurance Portability and Accountability Act) regulations.

This assures that your sessions and other communications are safe, secure, and private.

Use an Online Counseling Service

The second way to find a reputable counselor is to use an online service.

Some popular online counseling services include:

• BetterHelp
• Online-Therapy.com
• Talkspace
• 7 Cups

Some, like Doctor on Demand and MDLive, offer all kinds of health care services, including online counseling.

Others specialize in certain demographics, such as teen, couples or LGBTQ counseling.

One benefit of using an online therapy service is that they almost certainly use HIPAA-compliant software to keep communications secure.

But not all of them have counselors with the same high level of expertise.

On the low end of the spectrum, 7 Cups relies mostly on a group of “trained listeners” who are not mental health professionals.

On the high end of the expertise range is BetterHelp.

They have the world’s largest network of licensed, accredited, and experienced counselors.

These therapists must have a masters or doctorate degree and be certified by their state’s professional board.

BetterHelp also performs a rigorous background check on every therapist in their system.

So when BetterHelp’s algorithm matches you with one of their therapists, you can feel confident that your therapist is well qualified.

Getting the Most From Your Online Counseling Sessions

For online counseling to be successful, you need to have access to the required communications technology and feel comfortable using it.

If you feel nervous when using a webcam to meet with your counselor, for example, you will not have the most productive therapy sessions.

To keep your sessions private and secure on your end, it’s imperative that you have private and secure internet access.

This means that you should not conduct your therapy sessions while at work, a coffee shop, or other public space.

Arrange to be at home or some other private space where you will not be interrupted.

Remove all potential distractions.

Your therapist should do the same.

Some online counseling services let you be anonymous, ie, you use a nickname rather than your actual name.

But you should be transparent in every other way.

You need to be completely honest about your struggles and your goals.

The foundation of productive therapy is your relationship with your therapist.

You need to establish a bond of trust to feel connected and safe.

If, for any reason, you don’t feel comfortable with your therapist, it’s your prerogative to end the relationship and find another counselor.

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