What to Expect from Telepsychotherapy and Telepsychiatry

Even if you have not personally sought out mental health help in the past, you may be familiar with traditional therapy approaches, having seen them in movies and television shows. You probably picture visiting a therapist or psychiatrist’s office, sitting in a comfortable chair, and discussing your problems. Hopefully you imagine them providing support and strategies to help you feel better.


Approaches to therapy have evolved over time. In the early days of classical psychoanalysis, people laid on couches and did not even look at their therapist. The therapist was fairly unresponsive and would simply listen and make minimal statements. In time, therapy evolved into what we now often picture, with therapists taking a more active role during sessions, providing psychoeducation about symptoms, coping skills, and strategies to improve mental health and functioning.

The next evolution of psychotherapy and psychiatry has manifested in the form of telemental health services, which use technology to connect people with a therapist or psychiatrist. You may be wondering what exactly this process entails. Learn more about what you can expect below.

What will a telepsychotherapy or telepsychiatry session be like?

When you use videoconferencing for mental health services, the sessions are a bit different, but not all that different from traditional therapy sessions. Most likely, your provider will be in their office, stationed behind a computer and ready to help you. You will also need access to the internet and a webcam (unless you are using a landline or cellphone for your sessions).

The first step is for you and your therapist to make arrangements for contacting each other remotely. When the session starts, it may feel a bit awkward as this is a new experience, but as you settle into the session you will probably forget that you are communicating via video or phone. Just like with in-person sessions, you will get to discuss whatever is important to you, your therapist will ask questions and help you make new discoveries. With the use of technology, you may follow-up between your appointments with online resources, tracking forms, journal entries or documents via email.


In my experience, after the first few remote sessions, patients feel quite comfortable and are able to continue the work of psychotherapy, medication monitoring, or other assessments that were started in person.  I do recommend having the option for in-person sessions in addition to the remote sessions as the in-person sessions do add something special and significant to the treatment.  Having the option of remote sessions, however, does increase the consistency and effectiveness of treatment.

When is telepsychiatry or telepsychotherapy the right choice?

For some people, telemental health approaches are the best or only choice. If you live somewhere remote, with limited access to mental health providers, then connecting with telehealth can be very helpful. For example, in many parts of the country, there are major shortages of psychiatrists, resulting in limited access and long waiting times. When you are working on medication management or need to check in about side effects, having remote access is much better than no access.

If you reside overseas, you might prefer to connect with a therapist from your home country, who shares your language and cultural connections. If you have other barriers to mobility, such as health conditions or a busy schedule, then telepsychotherapy can also be helpful. If you feel some stigma or fear about others knowing you are seeking services, you might experience a real barrier to getting help. In this case, telemental health services, which are very discreet and private may be the perfect solution to get into treatment.


Who benefits the most from telemental health services and who should select in-person treatment?

Research shows that many mental health conditions can be addressed by telepsychotherapy. These include Anxiety, Depression, Post-Traumatic Stress Disorder, Bipolar Disorder, Anger Management, and Borderline Personality Disorder. If your treatment includes the use of Cognitive Behavioral Therapy or Dialectical Behavior Therapy you will be learning new skills and strategies for managing your mental health. Easy access to your provider for coaching on the use of skills will be helpful. This can occur through perhaps frequent, brief video sessions. Coaching can also be done through text and email.

In contrast, there are some conditions that can be helped, but also reinforced by telepsychotherapy formats. Social Anxiety and Agoraphobia are two such conditions. In both cases, the symptoms of the condition might prevent access to services, in which case, telehelp may be the best and only solution to make some progress. However, in time, staying shut away behind a computer screen could just reinforce the symptoms. It can be helpful to start online and make a plan to move to in-person services. In these cases, you would benefit from a provider who offers both in-person and online approaches.


How do I connect with a teletherapist or telepsychiatrist?

If you are looking to start therapy services in a videoconferencing format, you may be unsure of where to start in your hunt for the right provider. The awesome thing about telehealth, is that you can access a provider anywhere in the world for a consulations, allowing you access to the very best to meet your needs. You can use internet searches to look for specialists, read profiles, and inquire about whether they offer telehelp. Most states have regulations that limit clinicians to seeing patients who reside in their state, so you may need to check on your state’s laws.

Most clinicians and patients elect to begin treatment with in-person evaluation. This can improve the assessment process and help you build the initial connection to your provider.

To get into treatment, ask for recommendations and conduct an online search according to your needs and location. For example, you might search for Psychotherapist in New York or Psychiatrist in Brooklyn. The clinician’s website may tell you about all the services they offer and whether they provide remote sessions.  The Psychology Today therapist directory also gives information about whether the clinician provides remote sessions.

Because in-person help is also very important, it may be ideal to find a provider who can do both in-person and remote sessions, which means finding someone who is relatively close to where you live.  Not having the option to ever meet your mental health provider in-person is not ideal, but better than nothing if there are no local options in your area.

As of this year, 56% of large companies in the U.S. offer telemental health to their employees as part of healthcare plans. Whether you have insurance through your employer, through the Affordable Care Act marketplace, or have Medicaid or Medicare, it is a good idea to check in with your healthcare provider to confirm whether or not telemental health services are covered. It could be covered in full or in part, you may have a deductible, and in some cases it will be an out-of-pocket expense.

If remote mental health services seem right for you, I encourage you to take the steps outlined above and seriously explore telepsychiatry or telepsychotherapy as an option for treatment.