Is Online Therapy Effective? What to Know About Telehealth, BetterHelp, and Virtual Mental Health Care

I have clients who I do both in person and telehealth with. I have clients, like I said, that I have never met in person, but I have strictly done telehealth. And I have clients that I only see in person. And they were like, nope, that's not for me. I don't want to do it. So it's a matter of personal preference. Welcome to the let's Talk about it podcast, where we are taking the fear and frustration out of asking for help when it comes to your emotional and mental health and giving you what you need. Need to think about things a bit differently. I'm Laurie Streeter, licensed therapist and certified hypnotherapist. And with each episode, I'll bring you thoughts, techniques, or a guest to help you find your breakthroughs and live a healthier, happier life. Are you ready? Let's Talk About It. Welcome back to another episode of let's Talk About It. So today we're talking about online therapy, and I asked you guys on Instagram what questions you had specifically about those services, like BetterHelp, Talk Space. You know, the things that, like, we see commercials for that are kind of making therapy really accessible to people everywhere and kind of making it mainstream that we can do this virtually. So I asked you guys what questions you had, and I want to answer a few of them because I think there are a lot of different opinions about online counseling in that regard, and there's a lot of maybe stigma to it. There's a lot of questions. There's a lot of assumptions. There's a lot of even maybe just like, negative opinions that are not based on any true experience. It's just maybe a snap judgment. The first thing that I think is important to address is I was asking it in terms of, like I said, those companies like Better Help and Talkspace and things like that. I had a few questions asking me about because of the pandemic, everybody with, you know, insurance and, you know, we had just way more access to telehealth. That's a little different, but let me talk about that real quick. So telehealth, telemedicine visits, virtual visits with a therapist, even telehealth in general, like, for a doctor, they weren't widely accepted or offered or paid for by insurance or just available unless someone was, like, lived in a really rural area and they were a certain distance away from a provider, a professional, or if there was a disability that didn't allow them to go in person. Telehealth, telemedicine wasn't just available for like the average person. And the pandemic kind of like blew that out of the water. All of a sudden insurance companies were like, yes, you know, we want you to see a therapist. If you need help, reach out. They were covering it. And as therapists we kind of had to pivot if we stopped seeing so many clients in the office. I did see some clients throughout the entire thing in the office, depending on risk level and stuff like that. But a lot of my clients did go virtual. And now a year and a half later, I still have clients that I've never seen in person because I've just solely been working with them via telehealth. So in that regard I was really grateful for that. It allowed me to help more people and it allowed people to have the help that they needed and wanted, not just from me, but from their doctors or other therapists or other providers. Right. Like we were just as a health community allowed to provide services that we weren't allowed to provide before. And all these platforms started coming out of the woodwork because video, it has to be HIPAA compliant. You can't use Zoom for therapy, even though some people do. I am very by the book. I want to do things that are safe and HIPAA compliant and confidential as possible. So I have two different platforms that I use and you know, we just had access to all that. So in that regard, telehealth is really great. I have clients who I do both in person and telehealth with. I have clients, like I said, that I have never met in person, but I have strictly done telehealth and I have clients that I only see in person and they were like, nope, that's not for me, I don't want to do it. So it's a matter of personal preference. And therapy wise, you'll see a lot of therapists who maybe say, now they only do telehealth. My concern with that is I don't know what the future holds and I just personally still like to have that in person contact with my clients. I find them both beneficial. I like both modalities, both in person and telehealth. So I offer both. But I, I, I'm just, I'm not straight Telehealth where a lot of therapists, they did, they were like, nope, telehealth only I've completely pivoted and that's all I offer now. And that's totally fine. To each their own. So that's telehealth in regard to everything that kind of the pandemic allowed us to like pivot quickly when we talk about services like BetterHelp and Talkspace, and there's probably several more by now. Actually, for a couple years I worked for one and I was a provider on one of those platforms on one of those companies. And I actually found it really beneficial. I liked being able to help in a completely different way. I know a lot of my clients told me that it allowed them again, access to a provider, a therapist that maybe they didn't have before. They offered hardship discounts, student discounts and things like that. I never knew what my clients were paying. They never told us as a provider or at least in my experience. So I never knew what they were paying. I want to be careful saying this. I don't work for them anymore. So it's totally fine. It's been a while, but that's why I, I gave myself some space and want to talk about it now because I do have some distance from the company. That's just the way kind of things have shaken. I didn't leave because there was a problem. Um, I just left because I'm focused on what I'm focused on now. It just, just kind of ran its course, but we weren't paid very well. It did its job though. Again, it was more about, you know, it supplemented my income. You know, it was helpful, but it wasn't what it is with other, you know, seeing clients individually, like in the office or via telehealth. Kind of like I described. These companies, from my experience, do not pay their providers what they're worth. Um, we do it because, you know, it's supplemental to income. We really want to help people. It offers us, you know, an ability to work from home and stuff like that. So it gave me a way to work from home long before working from home was widely acceptable because this was pre pandemic. So that was. That was that right? I never knew what my clients were paying. Um, I did, you know, know that they offered discounts and things like that. So on end I can't tell you in regards or like in comparison to therapy in my office versus a company like better help or talk space, what the price difference would be. I think that depends on your insurance plan and all of that. So that like cost wise I can't really speak to, but I can tell you what it looked like was clients would fill out a questionnaire. You know, they would fill out all of their information, background information. Have you seen a therapist before? What are you struggling with? Do you currently have any suicidal thoughts or Self harm thoughts, depressive symptoms, symptoms of anxiety, eating disorder symptoms, all that stuff. And based on me as a provider, what I was specialized in, I would get matched with clients and I would get back to people within 24 hours. That was what they encouraged. And that was, that's just my rule in general. I try to get back to people quickly. And then I was able to message on a daily basis. And then people could also set up telephone or video calls and half hour increments, they could set up telehealth, essentially visits with me to talk if they wanted something outside of the messaging. And the messaging I always kind of put a paragraph explaining my availability, that I check my messages at least once a day, that I will try to respond to you within 24 hours. On the weekends it might be 48 hours because I do have a family and stuff like that. So I set the expectations pretty quickly. I have heard a lot of people struggle because they're like, I messaged my therapist and they don't answer for a day. And the thing with that is, I think as providers, it's up to us to set those expectations and what people need to expect from us. But I think as consumers, you also have to realize on a platform like that you, if you think about it, right, and I'm not trying to like be mean, but if you think about it, you message someone, they're not going to be able to respond to you at all hours of the day immediately at your, you know, desire, right? Like as soon as you send a message, you expect a response because it's a human on the other end. They might be eating dinner, they might be with another client, they might be taking a break. And I think I heard a lot of that where people had a hard time realizing that they maybe weren't going to get a message immediately. So on us as a provider, we need to set those expectations and let people know, hey, here's how I work. But as a consumer on those platforms, I think it's important to realize, you know, the 247 messaging that they advertise, it's important to realize that that doesn't mean you might get a response 247 because again, it's a human on the other end. So those are just a couple ideas in, in regards to that kind of stuff. Somebody asked how do I know what the difference is between coaching and therapy? When it's conducted, when it's conducted virtually, it should be very clear if you're signing up for better help, Talkspace, one of those platforms, and they're saying licensed therapist. They should have therapists. That should be therapy. The trouble is that we are only given the first name, last, initial, and age. Personally, that's all we get initially about a client on those platforms, or again, at least the one I worked for, I needed to develop a rapport with that person and have conversations and figure out what they needed help with and use talking and texting and worksheets to help that person in the best way that I could. That's a form of therapy, right? That was what. That's what they are paying the service for. On a consumer end, when a platform like that is saying licensed therapist, a lot of what I saw was, how do I know if they're licensed? And stuff like that. We had to provide a license number. If you were to look at my profile, my clients could see my license number. You can take that license number, put it in the state search, and you can see that I am a licensed clinical professional counselor in the state of Illinois. So you are getting a licensed therapist. You can see if it's active. You can see if anybody has had any, like, reprimands to their license and stuff like that. So you can do that in general, you can go on any state, search a counselor and see the status of their license. So if you're a consumer on that platform and you are trying to vet a therapist and you're seeing like, well, are they really licensed? You should be able to see their license number. Or you could search their name on the state that they're licensed in and find them and say, oh, yeah, they're an active counselor or whatever, whatever the designation is in that state. So that's how you tell if someone's an actual therapist. Right. I think now as well, with social media, you can easily Google someone. My clients on those platforms had my first and last name, so I only had their first name, last, initial and age. They had my first and last name. So they could easily google me and find me and say, oh, like, Lori's a real person. You know, I'm not just getting a robot kind of thing. So you can search people, you can search their license numbers or their names in their state. When we're talking about something like therapy versus coaching, that should be designated. That person should be saying, I'm providing coaching or I'm providing therapy. And you as a consumer, if you're looking for a coach or a therapist, you can ask questions. And I have a YouTube video about this. I want to say I've done podcasts about this. I'll try to link them in the notes about the difference between coaching and therapy, because while they're similar, they are different. Coaching is unregulated. Therapy is very regulated. So there are differences. But you as a person searching for a therapist or a coach, it's important for you to know who you're hiring, who you're working with. So I think that's important, right? Knowing the difference, what you're looking for, what kind of service they're providing. But just because it's provided virtually doesn't make it any less therapy, any less therapeutic. It's not necessarily just coaching because it's virtual. We have plenty of therapy now that, like I said, it is virtual. And now these platforms better help Talkspace, all of that stuff. It is virtual therapy. It's just done in a different manner. So a couple other, like, things that when I asked you guys your questions about this kind of stuff, a lot of what I saw was, is it as beneficial? Is it going to help me? When I left the platform, I. I am just. I take what I do very seriously. Yes, I have a good time doing it, but I take what I do very seriously. And when I was leaving, I gave my clients on that platform, I gave them notice and I was given permission from the platform. But I said, you can either come with me and I can continue to do virtual therapy or see you in my office, or you can request a new therapist or whatever. So we decided what they were going to do, what was best for them. But I didn't just disappear, right? I didn't give them two weeks notice. I gave them like a month and a half. That's pretty, pretty decent. And I had a few people who came with me, and I still see them, so they were able to transition. And I still see them and have very good relationships with those clients that I initially met on that platform so that I could continue their care and they could continue with me and not have to get a different therapist because we had already built a solid relationship. So that was really cool about that. As far as it being beneficial, I do think it is. I think it can be very helpful to talk to someone, to have someone maybe to schedule a weekly appointment with that you can message and bounce ideas off of. A lot of times when we struggle, we're swirling these thoughts in our heads and we're not doing anything with them. And when you're sending a message to a therapist or they're having you work on a worksheet, it can be really beneficial. That interaction can be powerful. And Therapeutic. So I think it can be incredibly beneficial. Initially I did think there were like inherent limitations because it was virtual. But now with the pandemic and everything with telehealth, I realized it was a preference thing. You know, if you don't, if you want to see someone in person, you're not going to use a platform like better help or talk space or something like that. But there are limitations in regards to what we are allowed to do on that platform. I never provided a diagnosis to my clients because there was no insurance billing. I was very clear about that. We worked based on the symptoms and the things that they were describing to me. I, I had right, like this person struggles with anxiety, but there was never a formal diagnosis. So I don't know if that's a limitation, but that's just something that I did explain to my clients. If they were like, can you write me a letter for an emotional support animal? Or can you write me a letter to work? I really couldn't because I a didn't feel comfortable with it because of the platform we were using. So that was a personal ethics thing. But I also wasn't providing them a formal diagnosis. Therefore I didn't feel. And other therapists might feel differently and that's totally fine. But I didn't feel without a formal diagnosis and being able to provide that to them that I was able to write a letter and say based on X diagnosis, this person is exhibiting these symptoms and therefore, you know, you should approve their FMLA or whatever they were looking for help with. So I was always very clear about what I was willing and not willing to do and realizing those limitations. But I was able to use the platform to the best of my ability and help the clients that I had. And I think the realistic part is if you are really struggling, if you get on one of those platforms and you are suicidal, you are incredibly depressed or you're having active self harm behaviors, they're not going to have you sign in. They are going to recommend that you go to the nearest mental health professional or the nearest ER in your area. There were clients that weren't accepted based on what they were saying because they were an immediate risk, they were not safe, or there were things going on that didn't make them appropriate for that platform. And I think that is very good. So I think the tough part is it's, it's all per self report. If someone was like, yep, I'm doing okay, I'm just feeling a little depressed. But then they got to me and they were actively Suicidal. I, as a virtual provider, had to, like, encourage them to go to the ER or contact someone, right? So there were limitations in that regard because people either weren't accepted, and then maybe they didn't have the resources or didn't know what to do, or they were accepted based on what they said, but things were actually way more severe, and they needed more care. They needed a higher level of care than virtual counseling. And I always was very clear about that. I would say I'm here to support you. I'm here to help, but I really feel like you need to be evaluated at the hospital, or you need to make sure that you're with someone right now so that you feel safe. And let's come up with a safety plan, because I don't see you, I'm only reading messages or whatever it is. And it's just a different kind of relationship. So there are. In regards to, like, risk, there are limitations to that. I think that kind of gives the. The overall, I do think they're beneficial. I think if that is the mode that you want to go with and you're like, I think this could help, then I think go for it. If it's not working or you're feeling like you're not getting the benefit from it, I don't want you to say, okay, well, therapy didn't work. You know, I definitely want you to either request a different therapist, or I would encourage you to maybe find someone in your area or find a therapist who's providing telehealth. Because sometimes, like, it might not work, right? A platform like that might not be what you need. So if you want to try it, go ahead, but be really honest with yourself. And if you're not getting the help you need, just like anything, right? If you go to the doctor and you want a second opinion, you have every right to go get a second opinion. So you know what? You need it. I think it's good in the sense that it's allowing people who want and need help to get the help that they maybe weren't able to get before. I do think there are benefits to it. I think that you can form some really good relationships. I think now telehealth is so widely accepted that people are more accepting of those platforms. Because if you think about it, they came out before telehealth was really mainstream, and now those platforms, I think, are even more accepted because it's just telehealth, right? Like, that's essentially what it is. It's virtual. I think my experience was fairly positive I liked the clients that I worked with. You know, I think I was, for the most part, matched pretty well with people who were looking for, you know, my specialty. So I think the idea is good. I think there are always things they could improve and do better. But, yes, if you have other questions or you're thinking about a platform like that, go for it. I think if you're really struggling or things might be more severe, it might be better to see someone in person or go to a higher level of care than virtual counseling, because, again, there are limitations. So. And it's not for everybody. And that's totally fine. Again, some people are like, nope, I'll see you when the world opens back up. I don't want to do telehealth. And that's totally fine too. So if you have any questions, let me know. If you're wondering about those online platforms, ask away. Tag me on Instagram. That's just my experience. But also I hope that just the general information about telehealth overall that I was kind of talking about in the beginning of this episode gives you an idea of where we are as professionals in regards to, like, what telehealth looks like. So, yes, just because it's virtually doesn't mean that it's coaching virtual. It can. Therapy can be virtual. I think we've all seen the benefits of that. So, okay, if you have any questions, let me know. Tag me on Instagram. Laurastreeter. And yeah, I hope that kind of gave you a good overview of online therapy. Everything works. Not everything is going to work for you. It's up to you to figure out what is going to be best. I will talk to you in the next episode. Thank you so much for spending this time with me today. If you loved this episode, it would mean so much if you would share it with someone who you think would love it too. And don't forget to leave a review with your thoughts, what resonated or even what you'd like to hear more of. Because I promise you, if something's on your mind, it's on other people's minds too. I appreciate your help in getting these messages on mental health out into the world. And until next time, time. Cheers to living a healthier, happier life.