Written by Natalia Laspina
Medically reviewed by Susana Pontiggia (Psychologist, Specialist in Neuroscience and Human Behavioral Sciences, Consultant in Personal and Organizational Development)
Online therapy has become an increasingly common option for mental health care in the U.S., especially since the pandemic. It allows people to choose a comfortable setting, offers more flexible scheduling, and makes therapy accessible from almost anywhere. For many, this has opened the door to support that might otherwise feel out of reach—whether due to mobility limitations, geographic barriers, or a busy daily routine.
That said, for online therapy to be truly effective, it’s important to understand how it works, what it can offer, and what kind of follow-up it requires.
When Should You Consider Online Therapy?
Widespread internet access and the use of mobile devices have changed not only how we connect, but also how we seek care. Mental health support is no exception. Like any approach, online therapy has both strengths and limitations. Still, it offers meaningful possibilities and can be a solid option for beginning a therapeutic process, including psychodynamic or psychoanalytic work, depending on the practitioner’s approach.
When someone chooses to start online therapy, setting realistic expectations is key. Building trust may take more time in the early sessions, especially if this is the first experience with therapy. Mental health professionals also adapt their practices to the virtual format. In family or group therapy, for example, it may be important that all participants remain visible on screen, that session length is adjusted as needed, and that potential interruptions are anticipated.
Clear communication from the outset helps support a strong therapeutic relationship. This includes explaining how sessions will work, which platform will be used, how scheduling is handled, and how privacy and confidentiality are protected—following the same ethical standards expected in in-person care.
The convenience of online therapy has helped establish it as a widely accepted option, though it has also raised valid concerns among some mental health professionals. Psychologists, social workers, and other providers note questions around confidentiality, data protection, and legal responsibility when offering care online. At the same time, many recognize that virtual therapy can complement clinical practice and significantly expand access to mental health support.
One of the most commonly cited challenges of online therapy—particularly for ongoing or complex concerns—is the risk of dropping out and the difficulty of long-term follow-up, which can sometimes be easier to identify in face-to-face settings.
To illustrate this, a study examining fully self-guided online cognitive behavioral therapy (CBT) evaluated adolescents and young adults with mild to moderate symptoms of social anxiety. Participants between the ages of 15 and 25 showed significant improvements in anxiety and depression, with outcomes comparable to—and in some cases stronger than—those seen in in-person therapy.
The findings, published in JMIR Pediatrics, suggest that self-guided online therapy can be an effective first step for reducing social anxiety, generalized anxiety, and depressive symptoms in adolescents and young adults. It may serve as a more accessible entry point before transitioning to guided or in-person therapy.
However, the intervention was brief and did not include long-term follow-up, which remains an important factor in supporting lasting improvement.
6 Signs Online Therapy May Be a Good Choice
1. Flexibility and Convenience
Attending sessions from home eliminates travel time and logistical stress, which can be especially helpful for people with demanding schedules, caregiving responsibilities, or mobility challenges. Flexibility is one of the most commonly reported benefits of online therapy.
2. Living in Remote Areas or Places With Limited Access to Providers
Online therapy allows people to choose a mental health professional based on fit and expertise rather than location. It can also be a valuable option for individuals with physical limitations or chronic conditions who prefer—or need—to receive care at home.
3. Difficulty Expressing Yourself In Person
Some people feel more comfortable opening up through a screen. Whether due to social anxiety, shyness, or past experiences, online therapy can offer a gentler entry point into mental health care and, for some, a bridge toward in-person sessions later on.
4. Multiple Communication Options
In addition to live sessions, online therapy may include messaging or email support if both the therapist and client agree. This can be especially helpful for people who process emotions more easily through writing.
5. Continuity of Care
Travel, relocation, or unexpected life changes don’t have to interrupt therapy. As long as there is a stable internet connection, the therapeutic process can continue with minimal disruption.
6. Greater Accessibility and a Wider Range of Choices
Today, many platforms offer access to licensed mental health professionals with different areas of specialization. Forbes has compared several services based on cost, insurance coverage, therapy formats (such as couples therapy or ADHD support), and user reviews—helping people make more informed decisions.
Is Online Therapy Effective? Key Differences Between Online and In-Person Therapy
One of the main concerns associated with online therapy is client retention. Research comparing online and in-person interventions shows that the quality of the therapeutic relationship depends more on the connection between the provider and the client than on the medium itself. Still, working through a screen can make it harder for therapists to respond to certain nonverbal cues or complex emotional dynamics.
Because of this, there is still much to learn about best practices in virtual mental health care. It’s important to consider whether someone’s individual circumstances—such as symptom severity, living situation, or access to privacy—may increase the risk of disengagement or make online therapy less effective.
In Wish You Were Here (JMIR Mental Health), researchers emphasize the importance of addressing “missing cases,” or participants who do not complete follow-up assessments in online psychotherapy studies. They recommend incorporating risk factors (such as baseline symptoms and adherence patterns) into study designs and encouraging active follow-up.
The article also highlights the importance of thoughtful case selection. Some situations—such as highly intense conflicts, crisis scenarios, or environments where privacy cannot be ensured—may be better supported through in-person care.
Ultimately, online therapy is not a full replacement for in-person therapy, but it is a valuable and effective option for many people. For those seeking flexibility, accessibility, and continuity in mental health care, it can be an important part of a well-rounded approach to well-being.
When Online Therapy May Not Be Enough
Online therapy can be a helpful and effective option for many people, but it may not be appropriate in all situations. If you’re experiencing severe distress, thoughts of self-harm, or feel unsafe, immediate support is essential.
If you’re in the U.S. and need urgent help:
- Call or text 988 to reach the Suicide & Crisis Lifeline (24/7)
- Call 911 if you are in immediate danger
Seeking in-person or emergency support is a sign of care—not failure.
Mental Health Care Doesn’t Have to Look Just One Way
Online therapy can be a meaningful starting point—or a flexible long-term option—depending on your needs, preferences, and life circumstances. What matters most is finding support that feels safe, accessible, and sustainable for you.
If you’re considering therapy, taking that first step—online or in person—is already a powerful act of care.
