Online Therapy Options: Video, Phone, Chat
Virtual therapy can come in many different forms and each form can have its advantages and disadvantages. Depending on your provider, you may have the ability to pick from several different options. I am thankful that I was provided with training in different methods prior to the pandemic and continue to be able to use all of them, as needed. My patients have 3 options when it comes to virtual sessions (in order of popularity):
Video
Chat (synchronous or asynchronous)
Phone
All three options are conducted via HIPAA-compliant technology and are safe for my patients to use. As my previous posts state (and various other documents and notifications), no matter the virtual option you pick, I am required to have your location on file and will check it at the start of each session. You are also required to be in a state that I am licensed in during the time of the session (currently: NJ, NY, FL, and VT). Virtual sessions are also not the most effective or best approach for all individuals and all mental health concerns.
Video (most popular option)
Video sessions allow for me and you to see and hear each other at the same time. Video sessions allow the for closest experience to an in-office visit. Many people enjoy video sessions as it allows us to see and hear each other in real-time and have a conversation. Think FaceTime, Duo, and Skype. Although, none of those are used!
Advantages:
Closest to in-person/in-office sessions that you can get.
You and I can see each other in real-time.
I may be able to pick up on some non-verbal cues, especially facial expressions.
Allows us to work on interventions at home that might have been difficult for us to work on in the office.
Comfort from your own home and space.
Convenience.
Disadvantages:
You don’t like to see yourself on camera. I hide my thumbnail.
Being able to see the entire room that you are in is weird. Feel free to sit against a wall, in your car, or with a specific background behind you.
I can’t pick up on all non-verbal behavior, as I only usually see your torso and up.
You may have to stay stationary for the video to stay on.
Lack of privacy depending on where you are located.
Technology and internet connection issues. Was that the power that just went out?
Chat (second most popular)
There are two forms of chat-based therapy: synchronous and asynchronous.
Synchronous- happening at the same time
My synchronous chat option means that you and I have a scheduled appointment time that we agree to meet. We will chat through the chat platform for the full 45 minutes of your session time. We will not see or hear each other, and only be able to see what each other types. It’s like “old school” instant messaging.
Advantages to Synchronous:
Added privacy if you cannot talk on the phone or over video.
You don’t have to be stationary.
You may feel more comfortable talking about topics that are uncomfortable.
Comfort from your own home and space.
Convenience.
Disadvantages to Synchronous:
I cannot see your face or non-verbal cues.
I cannot actually hear you.
If you (or your provider!) don’t type fast it could waste time during the session.
Someone could look at your messages if you don’t log out.
Cloud storage of the messages on your device.
Technology and internet connection issues.
Asynchronous- not happening at the same time
My asynchronous chat option is most similar to an e-mail, but NOT an e-mail. You and I can still message each other, but it happens throughout the day/week on the chat platform. I do not reserve a set time to speak with you and you do not have an appointment. However, you will know how many responses per day/week you can expect from me.
Advantages to Asynchronous:
Privacy if you cannot talk on the phone or over video.
You don’t have to be stationary.
You can respond on your own time. Yes, even 2am!
You could feel more comfortable talking about topics that are uncomfortable.
Don’t have to worry about technology and internet connection issues happening in real-time.
Comfort from your own home and space.
Convenience.
Disadvantages to Asynchronous:
It’s not in real-time and things can change in between messages.
You could forget to respond.
I cannot see your face or non-verbal cues.
I cannot actually hear you.
Someone could look at your messages if you don’t delete them.
Cloud storage of the messages on your device.
Phone (coming in third in popularity)
Yes, people still talk on the phone! Phone sessions are audio-only and are also conducted in real-time. Shockingly, this method comes in last. When I was first trained in online therapy, I thought for sure people would prefer this option over chat, but I was wrong!
Advantages:
You and I can hear each other in real-time.
If you don’t like seeing yourself on camera, you now don’t have to.
You could feel more comfortable talking about topics that are uncomfortable.
You can move around and don’t have to be stationary. This could help decrease anxiety with certain topics when talking, as well as increase privacy. Walk anyone?
Comfort from your own home and space.
Convenience.
Disadvantages:
I can’t see your face or non-verbal cues.
Lack of privacy depending on where you are located.
Cell phone service might be an issue.
Before you decide on which modality you want to use, be sure to talk to your provider to see if they have a recommendation. If your provider is okay with it, I encourage you to try out each option and see which one works for your needs and schedule. You might be surprised that the video option isn’t as scary as you thought it would be or that the chat option is actually more convenient with your schedule.
Note: Not all states, licensing boards, and insurance companies have the same definition of “online/remote/virtual therapy.” Your provider may not be able to provide a certain modality due to state, license, or insurance restrictions.
This post was updated on 4/30/21 to reflect VT as an added state of licensure.