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Cost/Benefit Analysis of Tele-therapy

Updated: Sep 29, 2021


Everyone has mountain peaks and valleys in their lives. Let’s say you had a similar COVID experience to the rest of the world, and you went off the deep end a little bit. Or maybe you realized that you’ve been treading water in the deep end for quite some time. None of us like the thought of treading forever. That sounds downright exhausting. I’m ready for a snack break just thinking about it. So you, like many others, decide it's time to finally face those demons and get over some of your shit.


COVID has created some serious opportunities for more people to work toward getting over their shit. One of those opportunities is tele-therapy (aka tele-counseling, tele-behavioral health, tele-health, and the list is extensively long for synonyms). So, what is tele-therapy or tele-counseling? It is the ability to have sessions with a counselor from just about anywhere you want as long as you are in the state lines of a state they are licensed in and have a relatively good internet signal. Some counselors kick it old school and are willing to do mostly phone sessions, but for those of us that use a video-conferencing service such as Zoom, there’s no going back to the 20th century of plain old phones. We like to see your expressions. Empathy comes more naturally in a video session, and empathy is definitely one of the things you should look for in a counselor.


If anyone had told me I would be doing mostly video sessions for almost a year and a half, I probably would have laughed at them. As much as I love the modern day luxuries of the internet, I can admit I’m a bit old-fashioned in certain ways. I love taking notes by handwriting them, and pretty much hate typing. I avoid it unless it is absolutely necessary (which it is more than I care to acknowledge). I’ve always been more of a face to face person. I also preferred phone calls over texts until I was in my masters program (my early 20s). I know that kind of makes me a freak of a millennial. Naturally, I had a lot of reservations about doing tele-counseling when the pandemic first started. I thought I’d lose that ability to relate to my clients in a meaningful way. My fears proved to be unfounded, I was still able to share effective and meaningful counseling. That being said, it’s not a perfect system (nothing dealing with our personalities and brains ever is).


There are definitely times where it feels more difficult to build rapport and times where internet lags make me want to hurl my laptop across the room. After doing telecounseling for almost a year and a half, I have clients that have started and graduated therapy without ever meeting them in person, and we were able to build a meaningful, and therapeutic, relationship where they got the help they needed. There are people that have seen me prior to the pandemic and have expressed that sessions aren’t quite the same. There are some that are in a hurry to get back to in person services and there are some who could care less about going back to in person services. It really does all come down to personal preference and whatever works best for you during this time.



If you are a person who is hesitant to try online counseling, hopefully some of this Benefits vs Costs list can help you decide whether or not it will work well for you. The short and sweet of it is,

Benefit:

Convenience. That’s right. Tele-counseling makes counseling more convenient than ever. You can do it from just about anywhere, given you are in a safe space by yourself. I’ve seen plenty of people do sessions in their cars, in conference rooms they’ve booked out, or just in their living rooms. It really reduces the potential for a cumbersome drive time and means that you don’t have to take as much time away from family or work in order to get the help you might need.


Cost:

There isn’t a designated space. One of the aspects of counseling that can enhance the catharsis of it all is having a designated space that is your safe space to go dump all of your emotional baggage and leave it there. You have a room that is primed for emotional vulnerability in your counselor’s office because it may be the only room in your life that you truly allow yourself to be vulnerable in. When counseling is completed in other areas, it can be difficult to not have our traditional roles and behaviors override part of the therapeutic process. This con can be addressed by setting a designated space and preparing the space for the session, but again, it all comes down to personal preference.


Benefit:

You can create a space that works for you. Like stated above, sometimes that isn’t possible, but for other clients, creating a space for therapy is exactly what they need to get the maximum benefit. Creating a designated space where you go to teletherapy allows you to control the environment giving you the power to choose what will make you calm. Most counselor offices have dim lighting, pastel yellow painted walls, scenic pictures on the wall, and sometimes a candle or wax melt in the corner. Some people fucking hate vanilla, this is your chance to put the things that relax you personally, in your space. Maybe you’re grieving a loved one, so sitting in their car, in their space, or their favorite spot would be best. Maybe you’re trying to get away from an abusive spouse, so your car is the safest place. That may even help people who are location tracked by controlling spouses. Quite possibly, you’re trying to overcome your social anxiety, and the calmest place for you might be your living room. In telehealth, the choice is yours.


Benefit:

Accessibility. For those that live in rural areas, it really removed the barrier of not having a provider nearby. It allows people to get counseling that they would not have had access to before. You no longer have to worry about 30 minutes or more of driving to your counselor’s office. You also don’t have to worry about taking the extra time off of work in order to drive to your appointment. The accessibility of tele-health could not only save you a shit ton of time, but it could save you a shit ton of money. It also gives you the opportunity to potentially see counselors that have specific specialities, allowing you to pick a counselor that is more suited for you, rather than choosing the closest counselor to where you work or live. Imagine the freedom.


Cost:

The internet isn’t always the most reliable. Nothing is worse than having a client being extremely vulnerable and the internet cutting out. Although the internet is this magical miracle of the 21st century, it can’t be perfect. Sometimes you deal with connectivity issues, slow or lagging video, or call drops. It depends on the interface that is being used and internet speeds of course. Some interfaces have a lower likelihood of having connection issues, but you can’t necessarily guarantee your therapist will be on one of those interfaces. Beware that this might occur to you and has a small ability to influence the therapeutic process for you.


Benefit:

Sense of security. Some clients really do feel more comfortable and secure in being able to be vulnerable in an environment of their choosing. It takes the pressure off of meeting a complete and total stranger and expecting yourself to bear your soul to them. For some people, it totally lowers the anxiety of sharing things about themselves that they might normally be terrified to share. It gives you that feeling of a home court advantage while still getting your needs met and getting your comfort zone challenged.


Cost:

Connecting over video can be difficult for some people. Occasionally, genuinely connecting through video can be difficult. It can feel like something is missing and like there’s always that awkward dance of conversation where two people haven’t learned each other’s pauses and how to talk together. So don’t be surprised if you guys interrupt each other. Also, even if you feel like you are making genuine eye contact, you actually aren’t. The inability to make genuine eye contact can definitely affect the way you feel connected to another person. When it comes down to it, there is something about in-person interactions that cannot be replicated online.


TRDL - 2 minute explaination

So, TRDL (the real down low) that you have probably been waiting for; is if there is a difference in effectiveness. Because really, why would any of us go to therapy, deal with all of that heart-wrenching vulnerability, the puffy eyes from crying, the raw noses from tissues, and the missed time from our traditional avoidance mechanisms if there isn’t the pay off from getting better? Don’t worry, online counseling is shown to be just as effective as in person counseling. Most of the research done on this subject has primarily looked at cognitive behavioral therapy in person vs online. So there may be some differences for non-CBT approaches, but I don’t foresee that being the case. It is logical the other approaches will test similarly.


It isn’t like medicine where counselors need to deal with your physical body in order to diagnose and enact change for you. Counselors can get feedback from your physical presentation, but if you wanted to hide bad enough from a counselor (even in person), you could. Most people go to counseling because even if they aren’t ready to be seen, they are ready for something to be different. They eventually get more comfortable for being seen as their true selves over time. Really though, anything a counselor can do in person, they can figure out how to do over a video call. Any skills they can teach you, can be taught over video call (or plain old 20th century phone calls). Most of what we do exists in the space of spoken word, even if we are teaching skills. As long as your counselor can utilize their words and their presence, they can be effective.


I’d still recommend shopping around. Check out our blog on shopping around for the best counselor for you. I feel like this is even more important in a virtual setting where there may be more initial awkwardness or struggles with building a relationship with a counselor. You especially need someone that you vibe with and want to show up to talk to. Especially when you consider the fact that they’ll probably get more of a peek into your life based on where you are when you attend your sessions (i.e., inside your car, or a bedroom, or an at home office). Find that counselor that you are more okay being your authentic self with and feel like won’t judge you for your surroundings.


Licensure:

If you aren’t sure about your new counselor’s license, feel free to ask them for a copy of their license, or even just their license number. In most states, there is a legal and ethical mandate requiring counselors and therapists to disclose this information, and/or put the information where publicly visible. Should a counselor or therapist seem shy to give you this information, count it as a red flag and move on with your search, they aren’t the one for you. You don’t want to start a vulnerable relationship off with lies. Below is a list of searches (or the best I could find) for each state. If you don’t see a search option, pay attention to the rest of the page, I linked the best resources I could find if searches weren’t available. *If anyone finds a better resource, please let me know, I would love to update with better information, if available.


  • Alabama AL

  • Alaska AK

  • Arizona AZ

  • Arkansas AK

  • California CA

  • Colorado CO

  • Connecticut CT

  • Delaware DE

  • Florida FL

  • Georgia GA

  • Hawaii HI

  • Idaho ID

  • Illinois IL

  • Indiana IN

  • Iowa IA

  • Kansas KS

  • Kentucky KY

  • Louisiana LA

  • Maine ME

  • Maryland MD

  • Massachusetts MA

  • Michigan MI

  • Minnesota MN

  • Mississippi MS

  • Missouri MO

  • Montana MT

  • Nebraska NE

  • Nevada NV

  • New Hampshire NH

  • New Jersey NJ

  • New Mexico NM

  • New York NY

  • North Carolina NC

  • North Dakota ND

  • Ohio OH

  • Oklahoma OK

  • Oregon OR

  • Pennsylvania PA

  • Rhode Island RI

  • South Carolina SC

  • South Dakota SD

  • Tennessee TN

  • Texas TX

  • Utah UT

  • Vermont VT

  • Virginia VA

  • Washington WA

  • West Virginia WV

  • Wisconsin WI

  • Wyoming WY


A 2014 study published in the Journal of Affective Disordersfound that online treatment was just as effective as face-to-face treatment for depression.

A 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, "effective, acceptable and practical health care." The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.

A 2014 study published in Behaviour Research and Therapyfound that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.




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