[Alishia88]

Does anyone know a serious provider for online therapy?

I read about a study that showed good results in internet-based therapy for complicated grief and PTSD.

So far, I couldn´t find a study to participate in.

I found some online therapy, but I don´t know which ones are to be taken seriously.

I know not to trust just any website that will take your money...
but as said, the study showed effective results and in the Netherlands, internet-therapy is even payed by the insurance companies...

I´d be thankful for any information about internet therapy for PTSD/complicated grief.

[Leah123]

I am involved in online/phone/email therapy for PTSD. I've been working with my therapist for one year now. I have found the experience incredibly powerful and successful, though not without unique difficulties. I think it requires strong written communication skills. My own therapist was in private practice, in person, for seventeen years before beginning online therapy. She maintains licenses in her state. She has promised if the service we use folded or had difficulties, she would continue working with me in another format. She has special training, and ongoing education, with an emphasis on PTSD.

P.S. As far as not being sure which services to take seriously: I would focus most on finding an excellent therapist- base your decision on a good person, not necessarily the company. Make sure that person is experienced and verified- you can check licenses, look at LinkedIn pages, google, etc., use a few methods.

Here are my thoughts, off the top of my head

PROS

Availability
Online professionals typically have greater availability - good for folks who want support in unusual hours like evenings, weekends, more sessions per week than one.

Session time
Sessions are not limited to 50 minutes, the format supports talking as long as one needs or wants to, from a few minutes to hours.

Credentials
Some sites, like LivePerson, do independently verify credentials and you can ask providers for their License numbers as well to confirm them with their state licensing board

Customer feedback
Experienced online therapists at some services have hundreds of reviews from many users.

Convenience
No commute, no dressing up, no leaving a session in tears feeling vulnerable. I have most sessions in the comfort of my own home, but can have them anywhere that has wifi or a phone.

Specializations
Easier access for folks in small towns/remote areas to specialists

Progress tracking/review capability
I have transcripts of all my chat and email sessions. I can review them whenever I want.

CONS

Cost
Online therapy is less than in-person therapy in some cases, but not usually covered by any type of insurance in the U.S. anyway

No Physical cues or reassurance
No hugs
No touch
No eye contact (unless you go with one of the services/individuals that allow Skype or other video conferencing)
I have to rely on *telling* my therapist when I'm crying, how I'm feeling, being conscious of my body language and sharing that

Reliability
Most online providers are in private practice and may leave without a trace if they don't have integrity, and that would be the end of the relationship. (Working with an experienced, established provider minimizes this risk.) However, this has happened to lots of clients that see therapists in offices too, in terms of sudden terminations, personal issues arising, changing practices and being banned from taking clients, etc. No guarantees either way.

Miscommunications
Email sessions, which I do often, leave more room for miscommunication since there is no body language, verbal cues, or real time interaction. This gets much better with time in my experience, as a trusting relationship is established.

[rothfan6]

I do online therapy as well for PTSD. I've been with my T for 6 months. It's been really helpful. I've made more progress than I would have going to therapy face to face. I do once a week sessions (similar to IM or Skype messages) for a few hours each time and then contact usually once a day or more depending on how busy he is and what I need. They offer video chats if your comfortable with that vs typing. The company I use is talktala.

Here are my thoughts, off the top of my head ...

Leah-this a great post. i think we should make it a sticky.

[AmysJourney]

I tried out a few online therapy pages before I decided I really need the personal face to face real person counseling. I found that most sites LOVE to take your money but provide little value. I was on betterhelp and I had to wait days to get a response and when I did it was just stupid questions. The online counselors on there deal with 20 - 50 clients and there is (in my opinion) not enough time to help someone in need adequately.

But there are (more expensive) services where they offer video chat sessions or phone sessions and for some it works if they have a busy schedule. For some people it works great. But PTSD is complicated. For some people EMDR is the best course of therapy and that usually doesn't work online. And some people need the physical presence of someone in the same room to be open enough about what they want to say. So it depends what you seek in therapy and if you think online therapy can provide this.

[Alishia88]

Thank you all for your answers and advice.

I can imagine that for me it´s easier to write rather than to talk about traumatic material and not hold back emotions (crying etc.) because of embarrassment in front of somebody else.
Also, maybe, to be more open about it, than if you´re with someone in person.

I can totally understand though that some people would need and benefit from the personal contact aswell, no questions asked.

I was looking for something like a company or university that would offer a "set" programm for PTSD, like in the study I read about.
I don´t know if that even exists.

I feel that might be less expensive and also somehow, the methods used would be verified, more than if you´re just talking to any therapist who might make up his methods as he goes along.

I´m glad to hear about your positive experiences, though.
It gives me hope

[rothfan6]

Originally Posted by Leah123

She has promised if the service we use folded or had difficulties, she would continue working with me in another format.

Did you ask your T that or did she tell you? I want to ask mine that but I'm a little afraid of the answer if he says we can't continue if the site closes.

[IndestructibleGirl]

Originally Posted by skies

Leah-this a great post. i think we should make it a sticky.

100% agree!!!

This was so informative.

Personally, I love the internet and the idea of online therapy appeals greatly. I think I can be braver with my emotions in the written word - not sure about Skype though, as then I'm still very visible. So in a way, I'd love online (or actually phone) therapy but for me the face to face is important because it challenges me more in some respects. Plus I think I would miss the eye gazing, which at times for me is the epitome of experiencing love flowing back and forth.

However, I'd definitely do internet therapy with my T if I moved away (or if she did) and I am certain I would get plenty out of it.

[Perna]

I've done online therapy; a good site to check is Metanoia. They do background checks, etc.

[Leah123]

Originally Posted by rothfan6

Did you ask your T that or did she tell you? I want to ask mine that but I'm a little afraid of the answer if he says we can't continue if the site closes.

I asked her that. The site probably won't close, I guess, but you never know, and I've invested a lot of time and money into this course of therapy: I did not want to be caught unawares if there was some type of difficulty with the provider.

[owlpride]

As a rule of thumb, I would probably choose an experienced therapist in private practice, rather than go to an online agency with fresh-out-of-grad-school therapists.

Websites keep up to 50% of the fees you pay for online therapy. If their services are cheap to begin with, and the therapists only get to keep part of that fee, they really don't earn very much. Why would a skilled therapist agree to that when they could earn much more in private practice?

[Leah123]

Originally Posted by owlpride

As a rule of thumb, I would probably choose an experienced therapist in private practice, rather than go to an online agency with fresh-out-of-grad-school therapists.

Websites keep up to 50% of the fees you pay for online therapy. If their services are cheap to begin with, and the therapists only get to keep part of that fee, they really don't earn very much. Why would a skilled therapist agree to that when they could earn much more in private practice?

I have not seen any evidence that a disproportionate number of online therapists are inexperienced. My own has 20 years experience, 17 in a traditional office, and all the others on our service have at least a few years experience, up to 25 years, as I've seen on other sites also. I'm sure there are a variety of experience levels, but don't seem to be more inexperienced ones online.

Most therapists have to pay a share of rent, utilities, office expenses, additional insurance, and other expenses, plus take insurance-imposed fee cuts, so don't think a private practice T earns more than half of what they charge you- they typically do not. Also, therapists working from home have no commute, no wardrobe fees, parking, etc.

[sweepy62]

My preference, would be traditional therapy, thats just me, I guess I need that person to person experience, and the interactions that come with it. I have alot of interruptions at home.

[owlpride]

Originally Posted by Leah123

I have not seen any evidence that a disproportionate number of online therapists are inexperienced. My own has 20 years experience, 17 in a traditional office, and all the others on our service have at least a few years experience, up to 25 years, as I've seen on other sites also. I'm sure there are a variety of experience levels, but don't seem to be more inexperienced ones online.

Most therapists have to pay a share of rent, utilities, office expenses, additional insurance, and other expenses, plus take insurance-imposed fee cuts, so don't think a private practice T earns more than half of what they charge you- they typically do not. Also, therapists working from home have no commute, no wardrobe fees, parking, etc.

Here are the first four provider directories I found when I googled 'online therapy'.

breakthrough.com - a good mix of therapists, all of whom also appear to have a brick-and-mortar practice. Therapists set their own rates (which run from $100 to $200 per session).

prettypaddedroom.com - the owner of the website stated on national tv that their therapists get a flat rate of $30 per session (which costs clients $45) and that they work primarily with newly licensed therapists who are struggling to start out in private practice.

mytherapist.com - two of the four therapists don't have their education/credentials listed. Of the other two, one is licensed in Poland (she may have a heavy accent, which might be an issue for some folks) and one has a psychology degree from Australia but does not appear to be licensed to practice.

virtualtherapyconnect.com - a good mix of therapists with varying credentials and years of experience. Providers pay a flat fee to use the website ($30 to $50 per month) and seem to keep their client fees in full. That's a fair arrangement for all parties involved.

I am not trying to say that all online therapists are inexperienced or that all websites provide a bad deal for the practitioners. I am just saying that there appear to be enough inexperienced or unlicensed online therapists or ripoff websites out there to keep an eye out - especially when looking for low-cost services.

[Leah123]

Originally Posted by owlpride

As a rule of thumb, I would probably choose an experienced therapist in private practice, rather than go to an online agency with fresh-out-of-grad-school therapists.

Websites keep up to 50% of the fees you pay for online therapy. If their services are cheap to begin with, and the therapists only get to keep part of that fee, they really don't earn very much. Why would a skilled therapist agree to that when they could earn much more in private practice?

The thing is- your initial post sets up a false dilemma, which is a logical fallacy: two of them actually, first that the choice is between an inexperienced, lacking in credibility therapist versus an experienced established one. That's not the choice. The choice is between equally qualified professionals online and in person. No one's advocating for underqualified, fly-by-night operations. The second is that skilled therapists earn more in private practice, which isn't true of the entire demographic to which I referred, or that qualified therapists wouldn't be lured by the benefits of working from home or working online in general. More and more practitioners are willing to see clients via Skype while still maintaining an office.

Buyer beware, certainly, but those same things occur with interns and new practitioners in the office setting, exactly the same scenario, very commonly. It's important, as mentioned in my initial post, to seek an excellent, experienced, clearly, verifiably licensed practitioner. I wouldn't consider a random sounding site like mytherapist.com, but browse somewhere like LivePerson for example, but above all, as I mentioned, search for an individual who's a good fit, just as in real life.

I wasn't recommending the internet for rock bottom pricing, my own therapist charges $100 an hour, but that's a bargain given her qualifications and experience. Working online just has a lot less overhead in some cases, so I wouldn't say it's all about cheap sessions, but about reasonable pricing, particularly useful for those who maybe don't have great insurance, a convenient location, or want the other pros I initially listed.

I agree about not choosing inexperienced, unverifiable individuals as therapists, but that's exactly the same recommendation in person as via phone or internet. I understand though, your wariness of online service providers, it is important to be a careful consumer, but it's increasingly easy with licensing verification and such.

Of course online therapy won't work for everyone, and if someone has great insurance, they can often get a better deal than paying out of pocket. It's not the McDonald's of therapy, certainly.

[owlpride]

Leah123, I think we agree on the "buyer beware" part.

What I originally wanted to get at is that one doesn't need to go through an online therapy website to find an online therapist. In my area, there are a fair number of therapist with a traditional brick-and-mortar office who willl also work online on request (e.g. via Skype). Most of them don't work with online therapy platforms. They don't need the technology and they also don't need the advertisement; they already get enough referrals through free/cheap listings (e.g. Psychology Today, Yelp, own website) and by word of mouth.

Having a local online therapist also has the advantage that one can switch to face-to-face meetings later without changing therapists.

[Leah123]

Originally Posted by owlpride

Leah123, I think we agree on the "buyer beware" part.

What I originally wanted to get at is that one doesn't need to go through an online therapy website to find an online therapist. In my area, there are a fair number of therapist with a traditional brick-and-mortar office who willl also work online on request (e.g. via Skype). Most of them don't work with online therapy platforms. They don't need the technology and they also don't need the advertisement; they already get enough referrals through free/cheap listings (e.g. Psychology Today, Yelp, own website) and by word of mouth.

Having a local online therapist also has the advantage that one can switch to face-to-face meetings later without changing therapists.

Yes, online therapists with local practices are less common, but definitely an option. One often loses the advantages, though, of those set up for fully online, flexible practices like Live Person where a key benefit is therapists who don't keep traditional office hours, but often work opposite hours, just for example.

Also, I wouldn't necessarily judge the industry by the first four listings to come up, just because it's a bit like choosing a therapist from the alphabetized listings in the phone book and just looking at the ones whose names start with A, or who buy the most ad space, I don't trust Google to find one for me, haha.

At any rate, it's a unique option, not for all. I'm reminded of one more Pro, actually, which is the anonymity factor. I don't choose to be anonymous with my therapist, but it's a benefit the online platforms offer.

I've been thinking about engaging in online/distance therapy at some point in the future.

My T has a permanent office; he is also well established, board certified, experienced (35+ years) and sees some patients through Skype.

I have been thinking about relocating to somewhere warmer, and if I did, I might want to continue seeing him through online therapy. It probably wouldn't be as rewarding as being in the room with him, but he is by far the best therapist I've ever had.

[owlpride]

Originally Posted by Leah123

Yes, online therapists with local practices are less common, but definitely an option. One often loses the advantages, though, of those set up for fully online, flexible practices like Live Person where a key benefit is therapists who don't keep traditional office hours, but often work opposite hours, just for example.

Why would an online-only therapist be any more likely than one with a physical office to work non-traditional hours? Therapists in private practice generally set their own hours, regardless of the medium that they use for communication.

But since you mentioned Live Person, I just wanted to mention that they get a 38% commission from all client fees that therapists collect through the website. It's not a website that I would use because I do not support their business model - since the therapist does the bulk of the work, he should get the bulk of my fees.

[Leah123]

Originally Posted by owlpride

Why would an online-only therapist be any more likely than one with a physical office to work non-traditional hours? Therapists in private practice generally set their own hours, regardless of the medium that they use for communication.

But since you mentioned Live Person, I just wanted to mention that they get a 38% commission from all client fees that therapists collect through the website. It's not a website that I would use because I do not support their business model - since the therapist does the bulk of the work, he should get the bulk of my fees.

For the 38%, LivePerson provides:

1. A secure, hosted platform for email, chat, and phone sessions
2. Advertising for their professionals
3. A widespread built in client base
4. Secure, guaranteed payment
5. Anonymous service
6. Credential verification
7. Help desk services (for clients and providers)
8. Other miscellaneous services

I wish more of my fee went to the therapist, but remember- there is significant overhead in brick-and-mortar practice or accepting insurance, including some or all of these:

1. Office rental fees
2. Insurance limits
3. Property insurance
4. Utilities
5. Property taxes/fees
6. Receptionist
7. Cleaning service
8. Advertising
9. Other costs

Some therapists could avoid a lot of the overhead through home offices, but we know that's not a super-common option, not too many providers would necessarily feel comfortable seeing clients in their home, though some certainly do.

Keep in mind- the therapists aren't forced to use services like LivePerson, they invariably do it because it's the best of all the options they've found! Up to them to choose a method of practice, no one size fits all, again.

***Also, LP waives its percentage fees for any client the therapist brings to the site themselves or through their own advertising.

[owlpride]

Originally Posted by Leah123

Does your therapist not pay rent or shared office fees like insurance, utilities, receptionist, etc.?
Also, do they not accept insurance?

If they don't have any of those expenses, then, yes, perhaps they pay less than 38% overhead.

I don't know where you live, but around here therapists in private practice don't have receptionists. And even an online therapist will need a dedicated work space, lest you are okay with them conducting therapy from their living room with the kids running around.

Here's how I think about fair fees for web services. A profile on Psychology Today costs $30 per month. Credit card processing costs about 3%. Google Apps for Business is $5 per month (premium email, video chat, calendar, storage space). So, all combined, I could purchase the same services individually for $35 per month plus 3% credit card processing fees. That's already netting all of the companies involved a profit.

Now, I am willing to pay a premium for the convenience of having it all in the same place. 10% seems like a fair price. But no, they are charging 38%. That seems outragious!!!

What's the actual cost of an office anyway? I live in one of the more expensive parts of the Bay Area. Cash price for therapy with a licensed psychologist seems to average around $150 per session. I just checked Craigslist and found therapy office space in good locations for under $2,000 per month. At 30 sessions per week, this hypothetical therapist collects $18,000 in client fees per month. Only 10% of that goes towards office space.

Online therapists still have most of the overhead that does not stem from an "office with waiting area." They still need to pay for college, graduate school, 2,000 hours of supervised work to get licensed, license fees, and 20-odd hours of continuing education each year to stay licensed. They still pay self-employment taxes. They still need liability/malpractice insurance. And they still need to document their work with each client.

[owlpride]

3. A widespread built in client base

This and only this is why these websites can charge 38% for their services. Which is also why I refuse to use them. I would rather support reasonably-priced advertising venues like Psychology Today, which coincidentally also give me access to a much wider set of practitioners.

Originally Posted by Leah123

I wish more of my fee went to the therapist, but remember- there is significant overhead in brick-and-mortar practice or accepting insurance, including some or all of these:

1. Office rental fees
2. Insurance limits
3. Property insurance
4. Utilities
5. Property taxes/fees
6. Receptionist
7. Cleaning service
8. Advertising
9. Other costs

Former T paid about $2,000 a month just to the person who handled his insurance reimbursements. He was a psychiatrist, and all of his patients were not in therapy, so he probably had more overall claims to put through. But still, it was a percentage of his total gross revenue for the month and not based on volume alone. (I only know this because this sub-contractor happened to come by at my regular session time to pick up her check.)

The T I have now does not handle any insurance claims, which saves him time and money.