In the online therapy model, there isn't really "out of session support." It's unique. Indeed with some of the newer services, email is the norm, although I appreciate the diversity of my own session types. Our sessions can range from from real-time online messaging to email to phone calls to Skype video sessions. It's all therapy and it's all paid for, which makes perfect sense to me- a pay as one uses model, where the therapist's time is consistently compensated.

In my case, we spend as much time if not more each week in written communication, and have also traditionally done a great deal of work through instant messaging as well.

I hear that many therapists will offer some between session contact without additional charge, they consider it included. Some also disdain regular email or phone contact as they aren't comfortable conducting therapy that way, so they don't want to create the expectation and bill for it. But my therapist has spent probably an hour per day most days for the past two and a half years with me on written communication (several thousand words per week, every week- we're writers!) or alternative session types and so I think it's really apples to oranges comparing this model to traditional 50 minute a week therapy or even 50 minute twice or thrice per week psychoanalysis.

I would not want to have five sessions a week for the price of one or two, it just wouldn't sit properly with me. In contrast, I can certainly understand where an occasional brief call or once-in-a-while email might not be worth billing for- I've had that type of therapy as well in the past.