How to Choose an Online Therapist

The Short Answer

Choosing the right online therapist involves matching credentials, specialization, and personal fit:

• Essential credentials: Licensed in your state (LCSW, LMFT, LPC, PhD, PsyD, MD)
• Specialization match: Experience with your specific concerns (anxiety, depression, trauma, relationships)
• Therapy approach: Evidence-based methods like CBT, DBT, or psychodynamic therapy
• Communication style: Someone who makes you feel heard, understood, and not judged
• Logistics: Availability, session format (video, phone, messaging), and cost considerations

Start with 2-3 consultations to find the right fit. Good therapy requires both professional competence and personal rapport—don’t settle until you find both.

Understanding Mental Health Professional Types

Not all therapists are the same. Understanding credentials helps you make informed choices:

Licensed Clinical Social Worker (LCSW)

Education: Master’s degree in social work (MSW) + 2-3 years supervised clinical hours

Can do:

• Individual and group therapy
• Diagnose mental health conditions
• Create treatment plans
• Connect you with community resources

Cannot do:

• Prescribe medication (must work with psychiatrist if needed)
• Conduct psychological testing

Best for:

• Life transitions and adjustment issues
• Relationship and family concerns
• Trauma and abuse recovery
• Connecting mental health with social/environmental factors

Cost: Typically $100-200/session

Licensed Marriage and Family Therapist (LMFT)

Education: Master’s degree in marriage and family therapy + 2-3 years supervised hours

Specialization:

• Relationship dynamics
• Family systems therapy
• Couples counseling
• Communication patterns

Can do:

• Couples therapy
• Family therapy
• Individual therapy through relational lens

Cannot do:

• Prescribe medication
• Conduct psychological testing

Best for:

• Relationship issues
• Family conflict
• Pre-marital counseling
• Parenting challenges
• Divorce adjustment

Cost: Typically $100-200/session

Licensed Professional Counselor (LPC) / Licensed Mental Health Counselor (LMHC)

Education: Master’s degree in counseling + 2-3 years supervised clinical hours

Specialization:

• Mental health counseling
• Career counseling
• Substance abuse counseling

Can do:

• Individual and group therapy
• Diagnose mental health conditions
• Treatment planning
• Crisis intervention

Cannot do:

• Prescribe medication
• Conduct formal psychological testing

Best for:

• Anxiety and depression
• Life transitions
• Stress management
• Career and identity issues
• Substance use recovery

Cost: Typically $80-180/session

Clinical Psychologist (PhD or PsyD)

Education: Doctoral degree (5-7 years) + 1-2 year internship + 1-2 years supervised practice

PhD vs PsyD:

• PhD = Research-focused training
• PsyD = Clinical practice-focused training

Can do:

• Comprehensive psychological assessment
• Psychological testing (IQ, personality, neuropsych)
• Individual and group therapy
• Diagnose complex conditions
• Research-informed treatment

Cannot do:

• Prescribe medication in most states (exceptions: Louisiana, New Mexico, Illinois, Iowa, Idaho)

Best for:

• Complex diagnostic questions
• Psychological testing needs
• Severe mental illness
• Personality disorders
• Neuropsychological concerns

Cost: Typically $150-300/session

Psychiatrist (MD or DO)

Education: Medical degree + 4-year psychiatry residency

Can do:

• Prescribe and manage medications
• Diagnose mental health conditions
• Medical evaluation of psychiatric symptoms
• Therapy (though many focus primarily on medication management)

Best for:

• Medication evaluation and management
• Complex cases requiring medical monitoring
• Severe mental illness (schizophrenia, bipolar disorder, severe depression)
• Treatment-resistant conditions

Typical model:

• Initial evaluation: $300-500
• Medication management visits (15-30 min): $150-300
• Therapy visits (if offered): $200-400

Note: Most psychiatrists doing teletherapy focus on medication management rather than ongoing talk therapy.

Psychiatric Nurse Practitioner (PMHNP)

Education: Master’s or doctoral degree in psychiatric nursing + clinical training

Can do:

• Prescribe and manage psychiatric medications
• Conduct therapy
• Diagnose mental health conditions

Advantages:

• Often more affordable than psychiatrists ($100-200 for med management)
• Usually easier to get appointments
• Holistic approach to mental health

Best for:

• Medication management with therapy
• Depression, anxiety, ADHD
• Less complex cases than might require a psychiatrist

What to Look for in an Online Therapist

1. Proper Licensing and Credentials

Non-negotiable requirements:

• Licensed to practice in YOUR state (critical for legal protection and insurance)
• Active, unrestricted license (check your state’s licensing board)
• No disciplinary actions (searchable on state licensing websites)

Where to verify:

• Psychology: State Board of Psychology website
• Social Work: State Board of Social Work
• Counseling: State Board of Counselor Licensing
• Psychiatry: State Medical Board

Interstate practice note: Some states participate in the Psychology Interjurisdictional Compact (PSYPACT), allowing psychologists licensed in one member state to practice telepsychology in other member states. Check if your state participates.

2. Specialization Match

Therapists develop expertise through training and experience. Match their specialization to your needs:

For Anxiety Disorders:

• Look for: CBT (Cognitive Behavioral Therapy) training, exposure therapy experience
• Ask about: Experience with your specific anxiety type (GAD, social anxiety, panic disorder, phobias)
• Gold standard: Exposure and Response Prevention (ERP) for OCD

For Depression:

• Look for: CBT, IPT (Interpersonal Therapy), or behavioral activation training
• Ask about: Experience with treatment-resistant depression, suicidal ideation protocols
• Consider: Therapists who work with psychiatrists for medication coordination

For Trauma and PTSD:

• Look for: EMDR certification, Prolonged Exposure (PE) training, Cognitive Processing Therapy (CPT)
• Ask about: Trauma-informed care approach, experience with your trauma type
• Specialized credential: EMDR certification from EMDR International Association

For Relationship Issues:

• Look for: LMFT credential, Gottman Method training, Emotionally Focused Therapy (EFT)
• Ask about: Couples therapy experience, premarital counseling
• Consider: Therapists who see couples specifically (not all do)

For Eating Disorders:

• Look for: Specialized eating disorder training, experience with your specific disorder
• Ask about: Treatment approach (FBT for adolescents, CBT-E for adults), medical coordination
• Important: May need dietitian and medical doctor collaboration

For Substance Use:

• Look for: LMFT, LCSW, or LPC with addiction specialization, CADC credential
• Ask about: Recovery philosophy (12-step, harm reduction, motivational interviewing)
• Consider: Therapists experienced with dual diagnosis (addiction + mental health)

For ADHD:

• Look for: CBT training for ADHD, coaching certification, psychoeducation approach
• Ask about: Executive function strategies, medication coordination with prescriber
• Consider: Therapists who work with adults with ADHD specifically

For Personality Concerns:

• Look for: DBT (Dialectical Behavior Therapy) training, schema therapy, mentalization-based therapy
• Ask about: Experience with personality disorders, crisis management protocols
• Important: Personality work requires long-term commitment

3. Therapy Approach and Theoretical Orientation

Understanding therapy approaches helps you choose what resonates:

Cognitive Behavioral Therapy (CBT):

• What it is: Focuses on changing thought patterns and behaviors
• Session style: Structured, homework-oriented, skill-building
• Duration: Typically 12-20 sessions
• Best for: Anxiety, depression, OCD, PTSD, insomnia, eating disorders
• Evidence base: Strongest research support for many conditions

Dialectical Behavior Therapy (DBT):

• What it is: CBT + mindfulness + emotion regulation + distress tolerance
• Session style: Individual therapy + skills group + phone coaching
• Duration: 6-12 months
• Best for: Borderline personality disorder, chronic suicidality, severe emotion dysregulation
• Evidence base: Gold standard for BPD

Psychodynamic/Psychoanalytic Therapy:

• What it is: Explores unconscious patterns, past experiences, and relationship dynamics
• Session style: Less structured, client-led, interpretive
• Duration: Long-term (1-3+ years)
• Best for: Chronic relationship patterns, identity issues, complex trauma, self-understanding
• Evidence base: Strong for long-term outcomes, depression, and personality issues

Acceptance and Commitment Therapy (ACT):

• What it is: Accepting difficult thoughts/feelings while committing to valued actions
• Session style: Metaphor-based, mindfulness-focused, values-clarification
• Duration: 8-16 sessions typically
• Best for: Chronic pain, anxiety, depression, adjusting to chronic illness
• Evidence base: Growing support, especially for acceptance-based approaches

EMDR (Eye Movement Desensitization and Reprocessing):

• What it is: Bilateral stimulation while processing traumatic memories
• Session style: Structured protocol, memory-focused
• Duration: 8-12 sessions for single-incident trauma; longer for complex trauma
• Best for: PTSD, trauma, disturbing memories
• Evidence base: Strong for PTSD treatment

Emotionally Focused Therapy (EFT):

• What it is: Attachment-based couples therapy focusing on emotional bonds
• Session style: Emotion-focused, pattern interruption, restructuring interactions
• Duration: 12-20 sessions for couples
• Best for: Relationship distress, attachment injuries, emotional disconnection
• Evidence base: Strong for couples therapy

Solution-Focused Brief Therapy (SFBT):

• What it is: Future-focused, solution-building, brief intervention
• Session style: Highly structured, goal-oriented, strengths-based
• Duration: 5-8 sessions typically
• Best for: Specific problems, goal achievement, brief intervention needs
• Evidence base: Moderate support for brief treatment

Integrative/Eclectic:

• What it is: Therapist draws from multiple approaches based on client needs
• Advantage: Flexible, tailored to individual
• Consideration: Ask specifically what approaches they integrate and why

4. Communication Style and Personal Fit

Professional competence matters, but so does personal rapport:

What “good fit” feels like:

• You feel heard and understood
• The therapist validates your experiences without being patronizing
• You feel comfortable being honest
• The therapist challenges you appropriately (not too harsh, not too soft)
• You sense they genuinely care about your wellbeing
• Sessions leave you feeling like you’re making progress (even if it’s hard work)

What “poor fit” feels like:

• You feel judged or criticized
• The therapist talks more than you do
• You leave sessions feeling worse consistently
• The therapist pushes their personal beliefs or values
• You’re afraid to be honest
• You feel like they don’t “get” you
• No sense of progress after 4-6 sessions

Cultural considerations:

• Shared cultural background can enhance understanding (but isn’t always necessary)
• Culturally responsive therapist should acknowledge power dynamics, identity, and systemic factors
• Some prefer therapists from same community; others prefer outside perspective
• Most important: Therapist demonstrates cultural humility and willingness to learn

Gender preferences:

• Some prefer same-gender therapist (especially for gender-specific issues)
• Others prefer opposite gender (for different perspective)
• No right answer—trust your gut

Age/generational considerations:

• Younger therapists may better understand certain cultural references and modern stressors
• Older therapists bring more life experience and pattern recognition
• Choose based on who you feel most comfortable with

5. Practical Considerations

Scheduling:

• Availability that matches your schedule (evenings? weekends?)
• Session frequency they recommend (weekly, biweekly, monthly?)
• Cancellation policy (24-48 hours notice typical)
• Vacation/coverage policy (who covers emergencies when they’re away?)

Session format:

• Video preferred for most therapy (allows non-verbal communication)
• Phone can work for maintenance or established relationships
• Messaging-based platforms (BetterHelp, Talkspace) offer flexibility but may be less effective for complex issues
• In-person option if you ever want to meet face-to-face (hybrid providers)

Technology requirements:

• HIPAA-compliant platform (not regular Zoom, FaceTime, or Skype)
• Secure messaging for between-session contact
• Reliable video quality
• User-friendly interface
• Mobile app availability

Cost and insurance:

• In-network with your insurance vs. out-of-network
• Session fee and what it includes
• Superbill provision for out-of-network reimbursement
• Sliding scale availability
• Accepted payment methods
• Cancellation fee policy

Where to Find Online Therapists

Option 1: Online Therapy Platforms

Best for Most People: BetterHelp

• Model: Match with licensed therapist, unlimited messaging + weekly live sessions
• Cost: $260-360/month ($65-90/week)
• Pros: Easy matching, flexible communication, affordable compared to traditional therapy, largest therapist network
• Cons: Can’t choose specific therapist initially, therapist may change, not covered by insurance
• Best for: First-time therapy seekers, those wanting flexible communication

Best for Insurance Coverage: Talkspace

• Model: Similar to BetterHelp, messaging + video/audio sessions
• Cost: $276-396/month
• Pros: Some insurance coverage available, psychiatry services available, structured plans
• Cons: Video sessions limited on lower-tier plans, matching process
• Best for: Those with participating insurance, medication + therapy needs

Best for Medication + Therapy: Cerebral

• Model: Focuses on medication management + therapy
• Cost: $85-325/month
• Pros: Prescribers available, convenient for ADHD/anxiety/depression meds, fast appointments
• Cons: Primarily medication-focused, less emphasis on deep therapy work
• Best for: Medication management with therapy support, ADHD or anxiety treatment

Compare all online therapy services to find the best option for your needs.

Brightside

• Model: Psychiatry + therapy for depression and anxiety
• Cost: $95-299/month
• Pros: Psychiatrist-led, evidence-based protocols
• Cons: Limited to depression and anxiety, less flexibility
• Best for: Depression/anxiety needing medication + therapy

NOCD

• Model: Specialized OCD treatment via teletherapy
• Cost: $129-189/session
• Pros: Therapists specialized in ERP for OCD, evidence-based approach
• Cons: Only for OCD and related disorders
• Best for: OCD, contamination fears, intrusive thoughts

Option 2: Find Individual Therapists

Psychology Today Therapist Directory

• Search by location, insurance, specialization, therapy type
• Detailed therapist profiles with photos and descriptions
• Filter for online therapy providers
• Contact therapists directly
• Best for: Finding individual providers with specific qualifications

Open Path Collective

• Network of therapists offering reduced-fee services ($30-80/session)
• One-time $65 membership fee
• Individual therapists, not a platform
• Best for: Affordable therapy from licensed providers

Insurance Provider Directory

• Your insurance company’s online directory
• Filter for telehealth providers
• In-network rates (typically $0-50 copay)
• Drawback: Directories often outdated, may need to call multiple providers

Your Current Therapist (If You Have One)

• Many traditional therapists now offer telehealth
• Established relationship, continuity of care
• May be covered by insurance
• Ask: “Do you offer teletherapy? If not, can you refer me to someone who does?”

Professional Association Directories:

• American Psychological Association: locator.apa.org
• National Association of Social Workers: findahelpnetwork/professionals
• American Association for Marriage and Family Therapy: therapistlocator.net

Option 3: University and Training Clinics

Psychology training clinics:

• Supervised graduate students provide therapy
• Significantly lower cost ($20-60/session)
• Evidence-based approaches
• Close supervision by licensed faculty
• Some offer teletherapy

Find: Search “[your city] university psychology clinic”

Option 4: Employee Assistance Programs (EAP)

• Most employers offer 3-8 free therapy sessions through EAP
• Confidential (employer doesn’t know you’re using it)
• Can help you find longer-term therapist after EAP sessions end
• Many EAP providers offer teletherapy

Check: HR department, benefits portal, or insurance card

The Consultation Process

Preparing for Consultation Calls

Most therapists offer free 10-20 minute consultation calls. Prepare:

Your elevator pitch (1-2 minutes):

• What brings you to therapy
• What you’re hoping to work on
• What type of support you’re looking for

Example: “I’ve been experiencing anxiety about work and relationships for the past 6 months. I’ve noticed I’m avoiding social situations and my sleep is affected. I’m looking for someone who can help me understand these patterns and develop tools to manage anxiety better.”

Questions to ask (prioritize top 5-7):

About credentials:

1. What is your license type and license number? (Verify afterward)
2. How many years have you been practicing?
3. Do you carry malpractice insurance?

About specialization: 4. What’s your experience treating [your concern]? 5. What percentage of your clients have similar concerns? 6. What’s your typical treatment approach for [your issue]? 7. What outcomes do clients with [your concern] typically see?

About therapy approach: 8. What therapy modalities do you use? 9. How structured are your sessions? 10. Do you assign homework between sessions? 11. How will I know if therapy is working? 12. How long do you anticipate treatment taking?

About logistics: 13. What are your session fees? Do you offer a sliding scale? 14. Are you in-network with [your insurance]? If not, do you provide superbills? 15. What’s your availability for regular weekly sessions? 16. What’s your cancellation policy? 17. How do you handle crises or emergencies between sessions? 18. What technology platform do you use? Is it HIPAA-compliant?

About their approach: 19. How would you describe your communication style? 20. What do you expect from me as a client? 21. How involved are you in the therapeutic process? (Directive vs. non-directive)

Red flags during consultation:

• Reluctant to answer questions about credentials or experience
• Promises quick fixes or guaranteed results
• Shares too much about their personal life
• Makes you feel judged or dismissed
• Pushes their personal beliefs or agenda
• Rigid (“You must do therapy this way”) vs. collaborative

After the Consultation

Evaluate each therapist:

• Did they answer your questions thoroughly?
• Did you feel comfortable talking to them?
• Do they have relevant experience for your concerns?
• Does their approach resonate with you?
• Can they accommodate your schedule and budget?

Decision-making:

• Trust your gut—therapeutic relationship is crucial
• Don’t feel obligated to choose someone just because you had a consultation
• It’s okay to keep looking if no one feels right

Starting therapy:

• Book first session with your top choice
• Ask about intake paperwork (complete before first session)
• Plan for 3-4 sessions before fully evaluating fit

Red Flags to Avoid

Credential and Legal Red Flags

🚩 Not licensed in your state

• Even if licensed elsewhere, must be licensed where YOU are physically located
• Violates state law and puts you at legal/financial risk
• Check license verification on state board website

🚩 Disciplinary actions

• Search state licensing board for any sanctions, restrictions, or complaints
• Previous violations may indicate ethics concerns

🚩 Vague about credentials

• Should clearly state license type, state, and license number
• Unwillingness to provide this information is concerning

🚩 “Life coach” or “counselor” without license

• Not the same as licensed therapist
• No legal protections, no insurance coverage, no professional oversight
• May be helpful for some goals but not for mental health treatment

Clinical Practice Red Flags

🚩 Promises quick fixes or guarantees

• “I can cure your depression in 4 sessions”
• “This technique works for everyone”
• Real therapy: No guarantees, honest about realistic timelines

🚩 One-size-fits-all approach

• Pushes same technique for everyone regardless of presenting concern
• Doesn’t tailor treatment to your specific needs
• Good therapists adapt approach to individual clients

🚩 Excessive self-disclosure

• Talks about their personal problems extensively
• Makes sessions about them rather than you
• Some self-disclosure is normal and therapeutic; excessive is problematic

🚩 Crosses boundaries

• Suggests meeting outside therapy
• Contacts you outside session without clinical reason
• Becomes friends on social media
• Asks you for favors or help

🚩 Pushes personal agenda

• Imposes their religious, political, or personal beliefs
• Tries to convince you to make specific life decisions (leave relationship, change careers, etc.)
• Good therapists: Help you explore your values and make your own decisions

🚩 Makes you feel judged or shamed

• Criticizes your choices, lifestyle, or identity
• Consistently makes you feel worse about yourself
• Dismisses or minimizes your experiences
• Note: Temporary discomfort during therapy work is normal; consistent judgment is not

🚩 Breaches confidentiality

• Discusses other clients in detail
• Shares your information without consent
• Talks about you in public settings

🚩 Discourages medication when warranted

• Adamantly anti-medication despite clinical need
• Lacks understanding of psychiatric medications
• Good therapists: Collaborate with prescribers, support informed decision-making

🚩 Doesn’t have emergency protocols

• No clear plan for crises between sessions
• Doesn’t provide crisis resources
• Becomes defensive when asked about emergency procedures

🚩 Resistant to feedback or termination

• Gets defensive when you express concerns
• Makes you feel guilty for wanting to switch therapists
• Doesn’t respect your right to end therapy

Practical Red Flags

🚩 Frequently cancels or reschedules

• Occasional rescheduling is normal; frequent pattern is unprofessional

🚩 Consistently late to sessions

• Shows disrespect for your time

🚩 Technology issues every session

• Suggests inadequate preparation or poor tech setup

🚩 Distracted during sessions

• Looking at phone, clearly multitasking, not paying attention

🚩 Unclear about fees and billing

• Won’t provide clear information about costs
• Surprise charges
• Unclear cancellation fee policy

Starting Therapy: First Session

What to Expect in Your First Session

Paperwork (done beforehand usually):

• Intake forms (demographic information, medical history)
• Informed consent
• Privacy practices (HIPAA notice)
• Financial agreement
• Emergency contact information

First session structure (typically):

Introductions and building rapport (5-10 minutes):

• Therapist introduces themselves
• Explains how therapy works
• Discusses confidentiality and its limits

Assessment and history-gathering (20-35 minutes):

• Why you’re seeking therapy now
• History of your concerns
• Previous therapy or medication experiences
• Family history
• Current life circumstances
• Strengths and resources

Goal-setting (5-10 minutes):

• What you want to accomplish in therapy
• How you’ll know therapy is working
• Realistic timeline expectations

Next steps (5 minutes):

• Recommended treatment approach
• Session frequency
• Homework or preparation for next session
• Scheduling future appointments

First session goals:

• Begin building therapeutic relationship
• Clarify presenting concerns
• Establish preliminary treatment direction
• Assess safety and urgency

How to Get the Most Out of Therapy

Before sessions:

• Arrive on time (log in 5 minutes early for teletherapy)
• Find a private, quiet space
• Have notepad for notes
• Complete any assigned homework
• Reflect on what you want to discuss

During sessions:

• Be honest (therapy only works if you’re truthful)
• It’s okay to cry, be angry, or feel uncomfortable
• Ask questions if you don’t understand something
• Let therapist know if something isn’t working
• Bring up difficult topics even if uncomfortable

Between sessions:

• Complete homework assignments
• Practice skills you’re learning
• Notice patterns in your thoughts and behaviors
• Journal if helpful
• Use crisis resources if needed (therapist should provide)

Over time:

• Give it 3-4 sessions before fully evaluating fit
• Be patient with the process (therapy takes time)
• Communicate if something isn’t working
• Celebrate progress, even small wins

When to Switch Therapists

Valid Reasons to Switch

• No connection after 3-4 sessions: You don’t feel comfortable or understood
• No progress after 8-12 sessions: You’re not seeing any improvement (discuss with therapist first)
• Life changes: Your needs have changed and therapist doesn’t specialize in new concerns
• Approach doesn’t fit: The therapy style isn’t working for you
• Logistics: Scheduling, cost, or insurance changes make it unsustainable
• Ethical violations: Any boundary crossings or unethical behavior (switch immediately)

How to End Therapy Relationship

If relationship is generally okay:

• Tell therapist you’re considering switching and why
• They may adjust approach or refer you to someone more suitable
• Schedule a termination session to close properly
• Therapist can provide referrals

If there are serious concerns:

• You can discontinue without explanation if you feel unsafe
• File complaint with state licensing board if ethical violations occurred
• Request records transfer to new therapist

Don’t:

• Ghost your therapist (unprofessional and unhelpful for your growth)
• Stay out of guilt (your wellbeing comes first)
• Assume you’re the problem if therapy isn’t working (fit matters)

Cost Considerations and Financial Strategies

Insurance Coverage

In-network vs. Out-of-network:

• In-network: Copay typically $0-50/session, provider accepts insurance rate
• Out-of-network: You pay full fee, submit for reimbursement, may have higher deductible

How to maximize insurance:

• Verify coverage before starting
• Ask about mental health parity (mental health should be covered same as medical)
• Get pre-authorization if required
• Keep records of denied claims for appeals

Insurance drawbacks:

• Requires diagnosis (goes in medical record)
• May limit number of sessions
• Insurance company knows you’re in therapy (not specific content)

Affordable Options

Sliding scale:

• Many therapists offer reduced fees based on income
• Ask: “Do you offer a sliding scale? My budget is $X per session.”

Training clinics:

• University clinics: $20-60/session
• Graduate students with close supervision

Open Path Collective:

• $30-80/session with licensed therapists
• One-time $65 membership

EAP programs:

• Free sessions through employer (typically 3-8)

Platforms (BetterHelp, Talkspace):

• $260-400/month for unlimited messaging + weekly live sessions
• Financial aid available through some platforms

Group therapy:

• $40-80/session typically
• Effective for many concerns, especially interpersonal issues

Community mental health centers:

• Sliding scale based on income
• Some offer teletherapy

Creative Financial Strategies

HSA/FSA accounts:

• Therapy is eligible expense
• Use pre-tax dollars

Superbills for reimbursement:

• Pay out-of-pocket, submit superbill to insurance
• May get 50-80% back for out-of-network benefits

Monthly payment plans:

• Some therapists allow payment plans for sessions

Alternate session frequency:

• Biweekly instead of weekly to reduce monthly cost
• May be appropriate after initial intensive phase

Frequently Asked Questions

How long does therapy take?

It varies dramatically by concern and individual:

• Short-term (8-16 sessions): Specific phobia, adjustment to life event, skills-based work
• Medium-term (3-6 months): Depression, anxiety, relationship issues
• Long-term (6 months-2 years): Trauma, personality concerns, chronic patterns
• Open-ended: Personal growth, ongoing support

Discuss timeline with therapist—it should be collaborative.

What if I don’t like my therapist?

Tell them. A good therapist will either adjust their approach or help you find a better fit. Don’t stay out of guilt—therapeutic alliance is crucial for progress. Give it 3-4 sessions, then reassess.

Is online therapy as effective as in-person?

Research shows online therapy is equally effective for most concerns including depression, anxiety, PTSD, and relationship issues. Video therapy preserves visual cues important for connection. Less effective for: severe mental illness requiring close monitoring, safety concerns, complex assessment needs.

How do I know if therapy is working?

Signs therapy is helping:

• You’re sleeping or eating better
• Relationships improving
• Using coping skills from therapy
• Greater self-awareness
• Reduced symptom frequency or intensity
• Better emotional regulation
• Progress toward goals you set

If no improvement after 8-12 sessions, discuss with therapist.

Can my therapist prescribe medication?

Only psychiatrists, psychiatric nurse practitioners, and (in some states) psychologists with special training can prescribe. Most therapists (LCSW, LMFT, LPC) cannot prescribe but can coordinate with your prescriber.

What if I need medication?

Your therapist can refer you to a psychiatrist or psychiatric nurse practitioner. Many teletherapy platforms (Talkspace, Cerebral, Brightside) offer both therapy and psychiatry. You can also see a prescriber independently while doing therapy.

Is therapy confidential?

Yes, with legal exceptions:

• You’re in imminent danger to yourself
• You’re in imminent danger to someone else
• Child or elder abuse
• Court order
• You give written consent to share information

Otherwise, therapists cannot share anything without your permission.

What if I’m in crisis between sessions?

Therapist should provide crisis plan including:

• Crisis hotline numbers (988 Suicide & Crisis Lifeline)
• Local emergency room
• Crisis text line (text HOME to 741741)
• Their emergency contact protocol

Most therapists are not available 24/7—crisis resources bridge gaps.

Do I need a diagnosis to do therapy?

Not for out-of-pocket therapy. Insurance typically requires a diagnosis for coverage. Diagnosis is part of your medical record. Some people prefer to pay out-of-pocket to avoid diagnosis being documented.

Your Action Plan

Step 1: Identify Your Needs (15 minutes)

Write down:

• What you want to work on
• What type of therapist might help (credentials, specialization)
• Your budget and insurance situation
• Your scheduling availability
• Communication preferences (video, phone, messaging)

Step 2: Research Options (1-2 hours)

• Check insurance directory for in-network providers
• Browse Psychology Today with filters for your needs
• Consider platforms if you want easy access and affordable care
• Save 5-8 potential therapists to contact

Step 3: Schedule Consultations (1 week)

• Reach out to 3-4 therapists
• Book free consultation calls
• Prepare your questions
• Take notes during calls

Step 4: Make Your Decision (1-2 days)

• Compare notes from consultations
• Trust your gut on personal fit
• Consider practical factors (cost, availability, specialization)
• Choose your top pick

Step 5: Start Therapy (First month)

• Book first session
• Complete intake paperwork
• Give it 3-4 sessions to evaluate fit
• Communicate openly about what’s working or not

Step 6: Commit or Switch (After 3-4 sessions)

• Assess: Do you feel comfortable? Is the approach working? Any red flags?
• If yes: Continue and deepen the work
• If no: Discuss concerns with therapist or find someone new

Remember: Finding the right therapist is like dating—it may take a few tries, but when you find the right fit, it’s worth it. Don’t settle. Your mental health deserves a therapist who gets you, challenges you appropriately, and helps you grow.

Good luck on your therapy journey.

Related Resources

Mental Health Guides:

• Teletherapy vs In-Person: Which Is Right for You?
• Does Online Therapy Work? Evidence
• Online Therapy Cost Comparison 2025

Service Reviews:

• BetterHelp Review - Best for most people
• Talkspace Review - Best for insurance coverage
• Cerebral Review - Best for medication + therapy

Popular Comparisons:

• BetterHelp vs Talkspace

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This guide provides general information about choosing an online therapist and should not be considered a substitute for professional mental health treatment. If you’re in crisis, call 988 (Suicide & Crisis Lifeline) or go to your nearest emergency room. Last updated: January 2025.