How Does Teletherapy Work?

By Rachel Schneider



This guide explores the advantages and disadvantages of teletherapy, with advice and contributions from experts. The current COVID-19 pandemic has led to an expansion in teletherapy and other remote services. Some experts believe teletherapy services will continue to expand across many practices due to their flexibility and convenience.

What is Teletherapy?

Teletherapy offers treatment provided by a licensed and certified therapist through a secure audio or video connection. Patients can interact with their therapists the same way they do during in-person sessions, just from a distance.

All telephone and online teletherapy sessions must comply with state and local laws to follow a specific set of HIPAA-compliant standards. To participate in this innovative type of therapy, users must have a secure internet connection, a private place to talk, and access to a phone, computer, or tablet.

Is Teletherapy Effective?

Many therapists agree that, depending on the patient, teletherapy can be just as effective as traditional in-person therapy. Dr. Chloe Greenbaum, a licensed psychologist and adjunct professor at New York University, points out that "some people have difficulty accessing in-person psychotherapy due to their geographic location, the cost of childcare, physical disabilities, chronic illness, or lack of transportation." She explains that online therapy can eliminate those barriers, making it more accessible for clients.

Licensed clinical social worker (LCSW) Grace Dowd agrees that the effectiveness of teletherapy depends on the client, mentioning that some clients have screen fatigue if they work with computers during the day and that clients with ADHD might struggle with focusing on the video interaction.

Dr. Kyle Zrenchik, a co-founder and couples and sex therapist at ALL IN Therapy Clinic in Minnetonka, Minnesota, notes that while there is promising research available showing the effectiveness of teletherapy in certain circumstances, it is limited.

"The overwhelming vast majority of all mental health research is based on in-person sessions," he says. "We just don’t fully know how effective video sessions are yet overall. But, we do know that we are able to reach certain populations easier."

Video-Based Therapy Versus Phone Therapy

Patients and clients can access different types of teletherapy, including video- and phone-based methods. Different clients might prefer one type of therapy over the other, depending on their circumstances.

Clarissa Harwell, an LCSW in private practice, feels that video-based sessions are more effective than phone appointments.

Harwell explains that most therapists pay attention to their clients' body language rather than just what they are saying verbally. "While phone therapy is likely preferred over no therapy, it's not the preferred method for most practitioners."

"For therapy to be good, we are doing more than just talking. Therapists are observing, listening, and responding to everything that happens in the room," Dr. Zrenchik echoed.

Clients experience different levels of effectiveness for teletherapy formats, however. While therapy messaging apps like TalkSpace can provide access to therapeutic services for clients with barriers to treatment, these types of nonverbal cues can be lost through messages even more easily.

What Are the Benefits of Teletherapy?

Clients and patients using teletherapy enjoy distinct benefits. First and foremost, many people have difficulty accessing in-person psychotherapy due to a lack of transportation, trouble finding or affording childcare for their appointment, their location, and illnesses or disabilities.

Some people have severe phobias or family obligations that prevent them from leaving their houses. Others may have compromised immune systems or provide care for vulnerable populations.

During the current COVID-19 outbreak, the benefits are particularly significant. "During and after the COVID-19 pandemic, some therapists may not imminently return to their offices," Dr. Greenbaum points out, adding that "clients who wish to resume in-person therapy would need to decide whether to begin treatment with a new provider who is doing in-person therapy or to continue doing online therapy with their existing provider."

Dr. Greenbaum recommends that patients and care providers continue to communicate about the benefits and limitations of online therapy during the COVID-19 outbreak. She explains that patients should feel encouraged to ask questions, and therapists should focus on making their clients comfortable with the security and privacy of their sessions.

What Are Some Limitations of Teletherapy?

Dr. Zrenchik says that the biggest limitations of telephone and online therapy sessions are technology and network connectivity issues. He adds that it can be harder to build a solid relationship with clients using teletherapy. "People crave human connection, and there are certain aspects of that which simply cannot translate to a digital format."

For these reasons, teletherapy can become taxing for therapists, since they face more screen time and have to deal with sound or video errors more regularly. A lack of privacy might be another issue for clients with roommates or those who don't have a private area to talk to their therapist.

"Meeting with a therapist in one's own home can be a double-edged sword," says Dr. Greenbaum. "If a client feels safe at home and has privacy, teletherapy offers a more private encounter than if the client were to attend a session in person, including spending time in a waiting room. However, for those who feel unsafe or lack privacy at home, teletherapy is not as effective since those individuals may censor themselves or disclose less."

Does Insurance Pay for Teletherapy?

Teletherapy costs typically align with prices for in-person sessions. Despite in-person factors not coming into play, clients still take the same amount of time with their therapists. Likewise, therapists use the same resources to help their clients. All interested patients should check with their insurance companies to explore teletherapy coverage.

With the current COVID-19 pandemic and the shift to more teletherapy services, many insurance companies continue to adapt and offer coverage for telehealth services across areas of practice.

The Future of Teletherapy

Dowd believes that the popularity of teletherapy will continue to grow. "Many people are enjoying the flexibility and accessibility that telehealth provides," she says. "Now, people can attend appointments in the middle of the day without worrying about traffic or transportation." She mentions that before COVID-19, many mental health practitioners began adapting to new technology and integrating online therapy practices in their daily work.

Dr. Greenbaum agrees, as long as the service remains affordable. "I believe that if insurance providers cover or reimburse for teletherapy at the same rates as in-person therapy, many providers and patients will continue utilizing teletherapy."

How to Get the Most Out of Your Teletherapy Visit

Patients transitioning to therapy or just beginning their journey should focus on minimizing their distractions, according to Dowd. She encourages these clients to prioritize their online visits just as they would an in-person visit.

"Make sure you are in a quiet, private place with no distractions. Turn off your phone and other alerts. Resist the urge to do other things on your computer while in session," Dowd says. She also emphasizes that clients should let their therapists know if something about teletherapy is not working for them.

Dr. Greenbaum recommends that clients and therapists need to invest the same amount of emotion, thought, and energy into their online sessions as they would in an in-person session.

"You might even prepare for our online therapy sessions by devoting the time you would typically spend commuting to your therapist's office to centering yourself, gathering your thoughts, reflecting on your reactions to your last session, and deciding what feels important for you to cover this time," she says.

Dr. Zrenchik suggests that clients participating in sessions at home make sure they are in an environment that does not offer room for interruptions. "You may be tempted to read your email or do some chores while talking with your therapist. Don't do that." The key to successful teletherapy sessions is to ensure you can offer your undivided attention to your therapist, allowing you to gain the most out of your discussion.

For clients hesitant about telehealth, Harwell suggests they familiarize themselves with the platform before their first appointment. She also suggests "having a backup plan, such as a charged cell phone in case there is a lost internet connection."

Additional Resources

  • GoodTherapy.org Users can access this site to search for the right telehealth therapist. Patients can input their geographic area and the type of therapy they are interested in to find the best results.
  • Anxiety and Depression Association of America On the ADAA website, clients can search for telemental health providers in their area to learn more about teletherapy.
  • TherapyNotesReviews.com Individuals can access this site to find out more about the best teletherapy opportunities available across populations.
  • NextAvenue.org This website provides information about how clients can make the most of their telehealth visits.
  • TheraNest Blog This blog serves as a resource for telehealth, exploring what it is, what benefits it promotes, and associated statistics.
  • TherapyWorks.com Users can look to this site for more information about what teletherapy is and the types of clients it favors.

Meet Our Contributors

Chloe Greenbaum

Chloe Greenbaum, Ph.D., is a licensed psychologist, adjunct professor at New York University (NYU), and an educational consultant. She owns a psychotherapy practice in Cambridge, Massachusetts, and specializes in assessing and treating adolescents and young adults. During the COVID-19 pandemic, Dr. Greenbaum has transitioned exclusively to teletherapy to work with existing and new patients through phone- and video-based platforms.

Dr. Greenbaum also teaches online graduate courses in mental health counseling at NYU and directs a graduate school consulting service. She completed her psychology training at Harvard Medical School, Dartmouth College, and NYU.


Grace Dowd

Grace Dowd is an LCSW with a private therapy practice located in Austin, Texas. In 2011, Grace graduated from the University of Georgia with a bachelor of science in psychology. Following her undergraduate studies, she attended the University of Texas at Austin to receive a master of science of social work. Before starting her private practice, Grace worked with individuals in inpatient psychiatric units, intensive outpatient programs, partial hospitalization programs, and residential treatment centers.


Kyle Zrenchik

Dr. Kyle Zrenchik is a co-founder and couples and sex therapist at ALL IN Therapy Clinic in Minnetonka, Minnesota. As a featured expert in couples and sex therapy for WCCO Radio, iheart Media, The Star Tribune, he has been published in books and academic journals.


Clarissa Harwell

Clarissa Harwell is an LCSW in private practice. She completed her undergraduate degree at New College of California with a dual-specialization in psychology and social change. Hartwell also holds a master's in social work from Rutgers University. Her work focuses on attachment and trauma, family systems, and working with parents to increase positive connections with their children.

She works with gender-expansive and trans youth, with expertise in suicide, self-harm, and oppositional behavior. She infuses humor and play into her sessions -- you can often find her sitting on the floor with clients and reminding them that all their feelings are invited to the session. Clarissa resides in the Bay Area with her husband, two children, and many pets.