Before the pandemic, talking to a therapist or psychiatrist on a video call was novel. Now it's fairly common. One recent analysis, for example, found that video appointments within the massive Veterans Affairs Health Care System jumped from about 2% of all mental health care encounters in January 2019 to 35% of these encounters in August 2023.
What are some advantages and disadvantages of virtual mental health care visits? Does seeing a therapist or psychiatrist by video instead of in person affect your response to treatment? If you haven't yet used virtual mental health counseling, what do you need to know? Below, Stephanie Collier, MD, MPH, a psychiatrist at Harvard-affiliated McLean Hospital, shares her expertise and insights.
What are some advantages of virtual mental health visits?
Virtual visits are convenient for many people, including those who might have trouble getting to an office or who live in areas where it's not easy to find mental health care providers.
"You can chat with your mental health care clinician in the setting of your choice, which might make you feel more comfortable," says Dr. Collier. "You don't have to worry about getting to and from an appointment. And you can be confident that your outcome will be similar to receiving in-person treatment. For example, in a 2022 study of about 1,500 people, participants being treated for anxiety or depression reported the same level of symptom improvement on standardized scales, whether they received virtual or in-person treatment."
How do virtual visits work?
A virtual visit with a mental health care clinician works in much the same way as a virtual visit with your doctor.
You make an appointment to speak with an expert, typically a licensed therapist, psychologist, or psychiatrist. They may be in a private practice or work with your insurance plan or a hospital system. Or they might be affiliated with an online mental health care platform. Often, you can read a bit about their professional background, expertise, and other information to help you decide if they are a good fit for your needs.
Shortly before your appointment, you'll log on to a specified video platform, and then find yourself in a virtual waiting room. When it's time for your session, the expert will appear on the screen and conduct a 30- to 50-minute session, depending on what you've agreed on, just as they would during an office visit.
Will your insurance pay for virtual visits?
Not necessarily. Make sure your sessions will be covered. Medicare and Medicaid cover virtual mental health care visits, but not all private insurers cover the service. Even if you think you're covered, double-check in advance.
What should you check on ahead of time?
Getting ready for a virtual visit involves prepping for both a mental health appointment and a video meeting.
- Go over the instructions. The mental health care clinician should give you instructions for accessing the platform where the virtual visit will take place. If you don't have instructions, contact the clinician's office or the online service to get them.
- Look for compliance. The platform your clinician specifies for your session should clearly state if it's HIPAA-compliant, ensuring the privacy and security of your information. If you don't see any evidence of HIPAA compliance, ask your clinician about it or consider choosing another mental health provider.
- Do an equipment inventory. You'll need a smartphone, tablet, desktop computer, or laptop to take part in a virtual mental health care visit.The device needs a camera, a microphone, and an internet connection.You'll also need a quiet space (so you and the expert can hear each other) and decent lighting (so the expert will be able to see you).
- Do a practice run. Well before your appointment, log on to the platform your clinician has specified. Check to see if you need to upgrade your software in order to use the platform. You don't want any surprises just before appointment time. Try out the volume and your camera angle.
How can you help make video sessions work well for you?
When you have an in-person visit, it may be easier to see body language and express yourself. But many people –– especially younger people –– feel very comfortable online. And others might find the technology and apps easier to navigate with a little guidance.
Here are some tips to ensure that you're seen and heard.
- Set a reminder to charge your equipment. The device you use should be well charged or plugged in to an electrical outlet for the appointment.
- Gather some supplies. You might want to have a drink of water, a box of tissues, and a pad and pen handy for taking notes.
- Make a list of questions or topics on your mind. "Think of a few topics you want to discuss in advance, so you can get through them during your session," Dr. Collier says. "If you keep a journal or sleep log, and the information will be important, have it with you at appointment time."
- Be willing to share your thoughts and emotions. You won't have to carry the whole conversation. Your therapist will ask you questions and prompts to guide the session and help you open up about your feelings and experiences. For instance, they might ask, "How has your mood been since our last session?" or "What are some challenges you faced this week?"
- If you like, ask a friend to join you. If you'll feel more comfortable with a friend in the room to support you or help you with the technology, arrange it in advance. During your appointment, tell the expert that someone else is there with you.
- Be patient. Sometimes experts run late. That means you might be stuck in an online waiting room, wondering if the appointment is still on. Dr. Collier advises waiting for about 10 minutes, and then leaving a voice message (if possible) or an email for your expert, explaining the situation.
Should you make another appointment?
If you feel your appointment was productive, consider scheduling another one. Again, make sure your insurance will cover it.
What if you didn't "click" with the expert? "It's an important consideration, since your relationship with your therapist is the best predictor of how you'll do in therapy. So give it a few sessions. If you still don't think your therapist is a good fit, it's ok to change clinicians. Many telehealth platforms allow you to do that pretty easily."
