How to Navigate Online Therapy

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Good therapy is good therapy. Things are a bit different though, when you’re meeting through a screen. You and your therapist aren’t in the same room, which changes therapy in some important and unique ways.

Online therapy became the norm during the pandemic, and has really changed the game. Now many therapists offer it, more people want it, and it’s been shown to be effective. The “distance” between you and your therapist can be helpful. It can also be quite unhelpful.

Whether you’re currently in online therapy - or looking for an online therapist - you can avoid some potential harms and find high-quality support by looking out for a few red and green flags.

Two specific things should matter to you in an online therapist.

These are privacy and confidentiality, and professionalism and boundaries. Both are essential to any therapy, but they hold particular relevance to online therapy. They’re not the only things that matter, but they’re non-negotiable.

Here are the red and green flags to watch for.

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Privacy and Confidentiality

Your privacy and confidentiality are of top-shelf importance. Not to mention a legal and ethical imperative for any therapist, always. You should know who can see or get information about you. You should know where your records and credit card information are stored. Technology makes all of this a little more complicated.

To start, unlike face-to-face therapy, you can’t observe how an online therapist is protecting you, for example locking cabinets, using computer passwords, or putting a sound machine at the door. You might not be able to tell if they’re alone in the room.

You’re meeting on a device, through the internet. Technology - the very thing that makes this therapy more convenient and accessible - also creates new and different threats to your privacy and confidentiality. An online therapist should take this seriously, and you should see some specific actions.

Your therapist should clearly explain how outsiders are blocked from your personal and health information (e.g., secure and encrypted network, and HIPPA compliant platform). They should tell you the risks to your privacy and confidentiality - and how to protect yourself - like using a secure internet connection and talking where no one can overhear the conversation. They should be open, willing, and happy to answer any questions you have about your privacy and confidentiality.

You should be able to ask your online therapist, at any moment, “Where are you?” and “Can I see the room you’re in?”

They should be alone.

Red Flags

1. The therapist is uncomfortable or unwilling to show you the space they’re in, or to tell you where they are and if they’re alone.
2. You see another person (e.g., child, partner) in your therapist’s video screen at any time.
3. They are inexplicably outside during your session, or they meet with you in public where other people are present.

Green Flags

1. The therapist asks you if you’re alone, to see the room you’re in, and if anyone can hear the conversation.
2. You see signs that they’re protecting your privacy, such as using headphones and meeting through a secure teletherapy platform (e.g., SimplePractice, Doxy.me).
3. They answer freely, and to your satisfaction, “What do you do to protect my privacy and confidentiality?"

Professionalism and Boundaries

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All therapists should act professionally and have good boundaries. They should be dressed appropriately and listen to you without distractions. They should be in a professional space. It doesn’t have to be an office, but it shouldn’t be a bathroom. You should feel connected to them, but the relationship shouldn’t feel like friendship.

At times, professionalism and boundaries can feel looser in online therapy. Unlike traditional face-to-face therapy, you and your online therapist are likely in each other’s homes, so to speak. You can typically see only your therapist’s head and upper body in the square of your screen. Like any therapy, online therapy can become too casual if professionalism and boundaries aren’t taken seriously, which can be unhelpful or downright harmful.

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Also, online therapy isn’t suited for everyone. Sometimes, a different form of support is more appropriate and in your best interests. An online therapist should explain this to you, including what circumstances would lead them to refer you to face-to-face therapy.

Red Flags

1. The therapist’s video is off while you’re meeting and you don’t know why, or when you haven’t agreed to meet without video.
2. They seem distracted while you’re speaking, such as smiling inappropriately or looking down or at another tab on their computer.
3. They meet with you while driving or in an unprofessional space.

Green Flags

1. The therapist is fully and professionally dressed.
2. Your sessions feel like a mental health appointment, rather than a video chat over brunch.
3. They easily answer the question, “What makes someone a good candidate for online therapy?”

Online therapy can be safe and beneficial…or not. The same is true for face-to-face therapy. The flags outlined in this article can help to guide you, but always trust your instincts to tell you if you found “the one.”

Psychology Today’s directory of therapists lists professionals who state their virtual and in-person availability.