A Detailed Guide to Teletherapy

There are a lot of things happening to stress you out this year. Finding a therapist shouldn’t be one of them.

A Detailed Guide to Teletherapy

It’s safe to say 2020 was a year of grief, frustration, and collective anxiety—and 2021 doesn't seem to be any more chill. Teletherapy is starting to look pretty good. 

If it hadn't before, the question of how to find a therapist has probably entered your mind. We are (not surprisingly) more stressed, anxious, and depressed than ever. In 2018, one in five American adults reported experiencing mental illness, and 2020 is pushing the number of people dealing with stress and anxiety to historic levels.

“The most common issue since March has been anxiety,” says Amy Cirbus, Ph.D., a licensed mental health counselor and director of clinical content at Talkspace, a platform through which therapists offer text, audio, and video support remotely. “For some users right now, the current climate has exacerbated chronic mental health problems. For others, their mental health challenges are brand-new. We know just how tough it can be to reach out for help for the first time.”

Online therapy has become more important than ever. And in an age of social distancing, connecting virtually is the new norm. "By wearing a mask, your facial expressions, around your mouth or by the creases around your eyes, are hidden," says Alyssa Petersel, licensed master social worker, founder of MyWellbeing, a therapist-matching service in New York. "A therapist might miss those psychosomatic cues, which are helpful in reflecting what you might not be saying, but are likely communicating nonverbally. A mask puts a barrier on emotional communication that might not be verbal."

Finding a good therapist you click with can be intimidating IRL, let alone virtually. So to help you tap into the many benefits of teletherapy, we’ve created a step-by-step guide to help you find virtual-therapy options that are right for you, from one-on-one talk sessions to virtual groups and on-demand texting.

What is teletherapy about?

When we picture therapy, we often think of a room with a couch, a lamp, a plant, and a bespectacled person with a notebook asking, “How do you feel about that?” But in an age of social distancing, therapy (like just about everything else in our lives) has gone virtual. “There’s a lot more intimacy when you're meeting a client in their home and they’re meeting you in yours,” says Atara Vogelstein, a licensed creative arts therapist in New York.

Teletherapy, the blanket term for therapy sessions done through a screen, has been around for a few years. But relatively few therapists offered remote therapy, preferring to see clients in person. Michelle Herzog, a licensed marriage and family therapist (LMFT) and certified sex therapist, runs a Chicago practice for couples and individuals and had never provided teletherapy before. When COVID-19 hit, she went all virtual, and her intakes have skyrocketed. “A massive chunk of my caseload I’ve never met in person,” she says. “But now meeting people over video feels normal.”

Hannah Singer, a licensed clinical social worker based in Boston, currently works with clients via Zoom and phone calls through a community mental health center. To support her clients, she tries to ”acknowledge the weirdness,” she says. “I give them the space to grieve that we don’t have answers.”

While therapists transition with clients online, Herzog explained that, as a therapist, “it’s important to have empathy that shit’s really hard right now, so we have to be flexible about how we do therapy.”

Teletherapy vs. in-person therapy

Doing therapy from home is definitely different from traditional therapy. But there are real benefits of teletherapy—in your own home, you may feel more safe. And getting vulnerable may feel less intimidating through a screen.  

To get in the right headspace before a session, make time to “commute”—consider shutting off your phone, lighting a candle, and grabbing a glass of water or tea. Keep in mind, it may take time to get into the teletherapy groove. Petersel recommends 3-5 sessions with a therapist to build rapport, and to discuss what’s working (and what’s not) openly.

If quiet time and private space are not available, teletherapy can still be accessed via text messaging services like BetterHelp and TalkSpace. “If you choose text-based models, try to set aside dedicated time to create accountability practices, at least once a week,” suggested Petersel.

So, does teletherapy work? Yes. A 2013 review of research on telemental health care found that virtual therapy appeared to be just as effective as in-person care and made mental health care more accessible.  

How to find a teletherapist

Finding the right therapist can feel a little like dating—it involves chemistry and a set of practical logistics. “You might want to set aside 10 to 20 hours to find, vet, and assess a therapist,” recommends Petersel. Here’s how to find the right (virtual) therapist for you.

Before you begin to vet therapists, sit down all by your lonesome for some personal prep work. “Set aside an afternoon or evening, a period of time without a hard stop, that you can get into your ‘flow state,’” says Petersel. “For some people, writing with pen and paper will be helpful. For other people, it’s a Google Doc or Evernote. Maybe you want to try a voice note—some people can free-associate or access better thoughts by speaking.”

To start, Petersel recommends answering a few questions about what type of therapy you're looking for:

• What are your hopes and expectations for therapy?
• What makes you feel hesitant or afraid of going to therapy?
• Are you looking to work through a specific challenge, or are you just curious about the general benefits of talk therapy?
• What would you want a therapist to know about you going into the first session?

To assess potential styles, Petersel suggests thinking about some of the most meaningful and clarifying relationships in your life so far. Maybe it’s a grandparent, friend, mentor at work, or even a TV character. “What was it about that person that was helpful to you?” she asks. “Maybe they called you on your shit, and you needed that. Maybe you’re used to being nitpicked, and instead this person was always there to give you a hug. Maybe they were inspiring and you want to set up a roadmap to be more like them in certain ways. Thinking of someone who was helpful to you already will help you think about what you’re looking for in a therapist.”

When you’re looking for a potential match, read therapist bios to get a sense of their style and whether or not it aligns with what you’ve written down. You can learn about what each potential therapist specializes in such as trauma, LGBTQ communities, or cognitive behavioral therapy. You can also schedule a consultation with a therapist (most offer them for free) during which you can run through your list live.

Next, call your insurance and ask to review your behavioral health benefits. Don’t be afraid to ask the representative you reach to clarify any terms you don’t understand—these are your benefits, and the representative is there to support you. You can find the phone number usually on the back of your card (or just google the name of your insurance plan and then “member services”).

We asked Herzog for a list of questions to verify with your insurance provider so there won’t be any surprise bills:

1. Do I have mental health/behavioral health insurance benefits as a part of my plan? What are they?
2. What is my deductible? Has it been met? Where can I track this online?
3. How many sessions per year does my health insurance cover? What is my expected copay per session? How many minutes is a covered session?
4. What is the coverage amount per therapy session with an out-of-network provider? What is the process for submitting a super-bill for out-of-network providers?
5. Is approval or referral required from my primary care physician?
6. Do you offer a telehealth portal that includes covered behavioral health providers? If so, how can I access that? What costs are associated?

Asking friends and family for referrals is increasingly common. But just because a therapist is right for your BFF doesn’t mean they’ll be right for you. “It’s important to have a point of comparison. Set up three to five therapist screenings as a foundation," Petersel says. She recommends contacting therapists you’re interested in and asking for a video or phone consultation for 15 minutes.

Here are several resources to help you find the perfect fit.

Psychology Today

Psychology Today offers a filterable search engine for teletherapy (and in-person therapy). Start by entering your zip code and you’ll see a bunch of smiling headshots: therapists in your area with profiles about their unique style, areas of expertise, and insurance accepted, along with contact information.

With teletherapy, you can expand your search statewide—especially useful for those living in rural areas, where local therapists may be harder to come by. Take Alabama, for example, where there are the fewest mental health counselors per capita out of all 50 states. If you’re living hundreds of miles away, you can now meet with providers in Birmingham without leaving your front porch.

Employee Assistance Programs

Your career can be a hugely valid source of stress. But it also may be your most direct access point for therapy. Many employers offer Employee Assistance Programs (EAPs)—third-party services that offer mental health referrals and short-term counseling (even for the months following a layoff). “It’s a big benefit a lot of employees don’t tap into,” says Gavriella Gold, an H.R. professional in Seattle. “We know that you might not want to talk to H.R. about what’s going on, so we connect you to a third-party service. They can help with any crisis, whether it’s work-related or personal.” Look in your employee handbook for a phone number for an EAP, or contact your H.R. team with a message asking if your company has an EAP and can provide you with the number.

Nonprofit therapy networks

Concerned about cost? Nonprofit therapy networks offer free or low-cost options for mental health care. OpenPath Psychotherapy Collective is a nationwide network of licensed mental health professionals which offers steeply reduced rate psychotherapy services, designed for those who are uninsured or inadequately covered by current benefits. If you meet their guideline qualifications, OpenPath offers services for copays of $60 or less per session—far below market rate in most places.

Resources for BIPOC

Members of minority communities report higher rates of mental health issues—and are less likely to receive resources and support. Therapy collectives like Therapy for Black Girls and Therapy for Latinix are working to change that with national growing listings of providers who identify accordingly. There’s also The Loveland Foundation, which is on a mission to offer therapy at no cost to more Black women.

Therapist-matching services

Want to take some of the work out of your search? Services that match you to the perfect therapist are popping up in local markets. MyWellbeing matches therapy seekers to therapists in New York; Therapy Tribe and Inclusive Therapists work in several cities around the globe; and Zencare facilitates matches in major U.S. cities.

If you feel overwhelmed by this search process, set a measurable goal, like contacting one therapist via email to request a phone consult, and then shut your computer. This process is not always light and easy, so be kind to yourself in the time it takes you.

You’re now ready for your first phone date with a therapist—let’s get down to business! “Let them know that you’re taking your search seriously and looking for the right fit,” says Petersel. “Therapists advocate for you finding the right fit,” so if you don’t click, don’t stress about letting them down. MyWellbeing offers this guide to help fight off any phone fear. “For the first few minutes, I recommend sharing about why you’re looking for therapists, what your hopes are, and what your fears are,” Petersel says. “You may want to ask an open-ended question, like, ‘Now that you know that about me, what might working with you look like? What would we do in a first session?’”

You’ll start to learn a bit about fit from a therapist’s response here, and how they talk about their work. “If, as they’re talking, your visceral reaction is like, ‘Absolutely not,’ and you’re prickling, honor that,” Petersel says. That said, for the people to move forward with, you may not have absolute certainty, and that's okay. “We’re so conditioned to not be vulnerable and not talk about these things,” Petersel says, “so you may not feel an electric ‘YES’ in a phone consult—you’re more likely to feel a ‘maybe,’ and that is worth exploring.”

In this “interview,” leave a few minutes to talk logistics: “If insurance is important to you, confirm that they accept it,” says Petersel. “More broadly, if you found them online and think their fee is $150 per session, confirm that to be true. You can say, ‘Hey, my understanding is “blank”—is that correct?’”

You may also want to confirm what video platform they use for sessions and that it’s HIPAA-compliant (which means your conversation is then protected as private health information by law). Are you welcomed to text or email them between sessions, and what kind of response should you expect? How frequently will you be billed, and how are payments processed?

In uncertain times it doesn’t hurt to ask a therapist whether they offer sliding-scale fees in case you lose insurance coverage. Often therapists will want to support you through that transition and understand you may not be able to pay their full rate when previously covered by insurance.

Before your first teletherapy session, think about the best physical place for the call: curled up in your favorite chair, sitting at your kitchen table with a mug of tea perhaps. Grab a glass of water, maybe a notebook, and get ready to do some talking. Log on a few minutes early to get signed in to the tool you’re using, and test out your microphone and webcam settings.

If you can’t stop staring at your own video screen, minimize it. You are entering a confidential, safe space. You are ready just as you are and don’t need to stress about an errant chin pimple. Wear something you’d be comfortable wearing to an in-person session (if you wouldn’t feel comfortable sitting in your therapist's office in your PJs, don’t wear them just because you’re streaming from your bed).

Also consider the time of the week you want to have a therapy session. When do you not only have the time but the ability to create the headspace for your work with a therapist to be resonant and valuable? “I try to be strategic about when I do my therapy,” Singer says of her experiences working with her own therapist. “For a few weeks I was doing therapy at 5 p.m. on a Friday, and it just felt like chitchat. I wasn’t in the mood—I was avoiding doing work because of that time of day.” 

Finding chemistry with a therapist as a personal thought partner can be a bit elusive. “Therapy is a deeply interpersonal relationship, and it can take a few tries,” says Singer. She suggests saying up front, “Let’s regroup after three sessions, and then discuss what we can change and evaluate if this is a good fit.” Build yourself some flexibility to make this an iterative process without the expectation it’ll just magically be perfect on attempt number one.

Therapists are trained in a variety of styles and can apply different methods, known as modalities, to help guide your thoughts. For example, some therapy seekers want homework assignments. Others want to enter and leave a session with no expectations offscreen.

“Don’t be afraid of advocating when things aren’t working. If your therapist is trying a modality for you, and it’s not landing, say, ‘This isn’t sticking for me,’” says Singer

So how do you know when therapy is working for you? When you feel comfortable and safe opening up about things you might have trouble admitting to yourself, Singer says. Therapy doesn’t unlock all the secrets of the universe, but it can help you unlock more of who you are and what you want over time.

Other options for teletherapy

Perhaps your loud roommates or unpredictable work schedule or new family duties don’t allow for an hour of quiet video-chatting a week. Bite-size (and free) therapeutic resources are still available to you, even when you’re tight on time. Check out MyWellbeing’s library of meditations, or Petersel’s five-minute “Small Talks” on Instagram for a few moments of thoughtfulness.

If you can’t stomach video calls, there’s also text therapy. “Text-based therapy is an asset for people who have multiple people in their home, who are juggling several obligations and have limited time and privacy, and who have an irregular schedule and may find it best to have a place to put their thoughts intermittently throughout the day,” says Cirbus.

Texting-based services like TalkSpace and BetterHelp allow you to subscribe and connect with a therapist on your own time via text, audio, or video clips. These services cost $40 to $100 per week, depending on the frequency and format of interactions that you choose. You can cancel and change plans, and often trials and coupon codes are made available.

The National Alliance on Mental Illness (NAMI) offers great resources for dealing with your own mental health challenges and opening up conversations with those you love. NAMI local chapters offer weekly support groups, for those living with or recovering from mental illnesses or for more on-demand onetime support, you can call its hotline at 800-950-NAMI or, in a crisis, text "NAMI" to 741741.

TalkSpace is also offering free therapist-led Facebook support groups for those of us affected by racial trauma, to help manage coronavirus anxiety, and for those feeling lonely or isolated.

Stefanie Groner is a perpetual optimist who has benefitted from therapy in dealing with emotional roller coasters: dating disasters, workplace woes, financial shifts, Zoom fatigue, loneliness, and a serious injury. You can DM her @stefsnapshots to talk mental health resources.

This story originally appeared on: Glamour - Author:Stefanie Groner