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Teletherapy and telepsychiatry are mental telehealth services that use videotelephony (like Zoom), phone calls or other messaging systems to facilitate communication between mental health professionals and their patients. Several studies suggest partnering with a capable, trained mental health professional virtually can provide a similarly successful outcome to in-person visits.
Much depends on you, though, emphasizes Diane R. Gehart, Ph.D., a professor of counseling and family therapy at California State University, Northridge, and practicing psychotherapist. “If a client is going to be really honest with their therapist, then telehealth is safe and effective. If not, it’s better to do in-person therapy, because it’s easier for the therapist to pick up on nonverbal cues.” For example, it might be slightly easier over a computer screen for a patient to conceal the fact they haven’t bathed in days or just drank alcohol.
For patients who are honest brokers, though, telehealth proves convenient. Many people prefer telehealth because it eliminates barriers like lengthy commutes, paying for parking or even needing to leave the workplace for a midday appointment. More private practitioners than ever before offer teletherapy and telepsychiatry services, and there are quite a few companies devoted entirely to making online mental health services more accessible and affordable.
But before you start looking, be sure to understand the differences between teletherapy and telepsychiatry—and what you should expect from each service.
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What Is Teletherapy?
The term “teletherapy” usually refers to talk therapy, which is also known as psychotherapy. It involves a professional relationship between a therapist and a client. The therapist uses a range of evidence-based strategies to help the patient explore issues in their life and come up with healthful ways to handle problems.
There are many different styles of therapy, but the bottom line is a trusted relationship with a trained professional can be effective. In fact, research in The American Psychologist concluded that psychotherapy clients were better off than 75% of untreated individuals.
Teletherapy practitioners include:
- Psychologists (Ph.D., Psy.D.)
- Licensed marriage and family therapists (L.M.F.T.)
- Licensed clinical social workers (L.C.S.W.)
- Licensed professional counselors (L.P.C.)
- Licensed mental health counselor (L.M.H.C.)
Teletherapy offers a supportive environment in which you can talk frankly with someone who is professionally trained to listen, remaining objective, neutral and nonjudgmental. Teletherapists also dole out research-backed techniques—anything from worksheets to required reading to journaling—to help you develop healthier life skills.
What Is Telepsychiatry?
Telepsychiatry involves a psychiatrist, who is a medical doctor. A telepsychiatry session primarily focuses on psychopharmaceuticals—prescription medications for mental health issues. It generally doesn’t involve talk therapy.
Telepsychiatry can be either synchronous or asynchronous. Synchronous telepsychiatry involves meeting with your psychiatrist via your phone, computer or laptop in real time. Meanwhile, asynchronous telepsychiatry might have you talk to a trained health care provider who is not the psychiatrist first. Then, the psychiatrist reviews a recording of your conversation and prescribes or adjusts your medication as needed.
The U.S. currently faces a fairly acute psychiatrist shortage, according to research firm Merritt Hawkins. Asynchronous appointments provide a way for a limited number of psychiatrists to accommodate more patients.
Teletherapy and Telepsychiatry Similarities
Both therapy and psychiatry used to require in-person appointments, but they have adapted well to the world of telehealth. They are both forms of mental health services that are covered by most health insurance plans, and they can both treat common disorders like depression and anxiety.
Most important, teletherapy and telepsychiatry both have similar endgames—they aim to help people achieve mental stability and lead productive lives. The strategies they employ, however, are very different.
Teletherapy and Telepsychiatry Differences
Teletherapy involves engaging in conversation with your therapist, naturally forming a professional therapist-patient therapeutic relationship over time. The sessions give you a safe space to talk about anything—even things you don’t normally disclose to other people in your life.
Traditionally, a session lasts about 50 minutes, though plenty of therapists also offer opportunities to chat via text message or otherwise send messages back and forth outside of standard sessions. Depending on your arrangement, messaging may be a major part of your treatment plan.
Telepsychiatry, on the other hand, is more like a doctor’s visit. On your first visit, you’re asked a lot of questions about your medical history, including symptoms you’re experiencing and any medications you take or have taken in the past as it relates to your mental health. Follow-up visits typically focus on how well the prescribed medication is working and whether it’s triggering unwanted side effects. It’s not unusual for telepsychiatry appointments to be much shorter than teletherapy appointments—and much less personal, too.
Do I Need Both Teletherapy and Telepsychiatry Services?
Some people just need to talk in teletherapy. Others need the talk of teletherapy plus medication via telepsychiatry. And some may opt for medication exclusively, though many psychiatrists require their patients to attend psychotherapy in addition to taking medication.
Keep in mind that not all people who need medication need telepsychiatry specifically. Gehart says primary care doctors now prescribe much of the medication used for anxiety and depression. But if you don’t respond to the medication, if you require multiple medications or if your doctor suspects you have a condition that would benefit from more expertise, then telepsychiatry could be in order, she says.
How to Determine the Best Care Option for You
If you’d like to seek treatment without medication, teletherapy will likely be your approach. You can search online for a therapist, using tools like the American Psychological Association’s psychologist locator service. Most therapists will make it clear on their websites or through the APA Locator whether they’re accepting new patients via telehealth. They will also note if they accept health insurance and, if so, which plans.
You can ask your health insurance provider for in-network referrals as well. Online therapy companies like BetterHelp and Talkspace also make signing up for therapy and selecting a therapist faster and easier. Some are even covered by insurance.
The American Psychiatric Association has an online locator, too. You can also ask your medical doctor for a referral to a psychiatrist. Some online therapy companies offer telepsychiatry as well, such as Cerebral and Brightside.
If you’re uncertain what kind of treatment might be best for you, start with your primary care physician. They should be able to help you figure out your next steps.
Pro Tips for Picking Your Provider
Patients progress quickest with therapists who are highly empathetic and tailor their psychotherapy strategies to their specific patients, according to a 2018 study in Psychotherapy. Simply put, your therapist “gets you,” says Gehart. “The vehicle of psychotherapy works best with a strong connection, rapport and a feeling that the therapist understands your problem the way you understand it.”
For many people, it makes sense to look for someone who is knowledgeable about or shares your culture, lifestyle, neighborhood, work, family structure, race or anything else that could impact your level of comfort. The biggest thing is that you feel understood. All licensed therapists have the required education to offer therapy, but some may also have extra training and experience in certain areas. If it’s important to you, look for that expertise. Common focus areas include anxiety, divorce, eating disorders, fertility issues, grief, the LGBTQIA+ community and substance abuse, to name a few.
You can often glean a lot of helpful information from the bios therapists publish online. And most offer a free, brief introductory conversation or video chat where you can ask questions and gain a clearer sense of who they are and how they work.
Once you start your sessions, you should know whether you have the right therapist pretty quickly. “After four to five sessions, you really should feel like you’re making progress,” notes Gehart.
Since psychiatrists are in shorter supply, you may not have as many choices as you do with therapists. Still, you need a provider with whom you can be open and honest. Some people might feel most comfortable with a referral from a trusted medical provider or an experienced friend. Psychiatrists should also offer a brief introductory phone conversation or at least make someone in their office available for you to ask questions. At this stage, find out if you’ll be talking directly with the doctor (synchronous) or with another clinician (asynchronous) during your appointments. You can also ask about how easy it is to get in touch with the doctor, how long appointments last and anything else that’s on your mind.
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Sources
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Turgoose D, Ashwick R, et al. Systematic review of lessons learned from delivering tele-therapy to veterans with post-traumatic stress disorder. Journal of Telemedicine and Telecare. 2017;24(9):575-585.
Smith, M, Glass, GV. Meta-analysis of psychotherapy outcomes studies. American Psychologist. 1977;32(9):52–760.
Psychotherapy works. American Psychological Association. Accessed 05/25/2021.
Therapy. American Psychological Association. Accessed 05/25/2021.
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The Silent Shortage: Examining Supply, Demand and Recruitment Trends in Psychiatry. Merritt Hawkins whitepaper. Accessed 05/25/2021.
