E-Counseling or Online Traditional Therapy: How to Choose

Updated: Aug 1

Times are tough right now. With each passing day, it seems you’re experiencing a new roller coaster of emotions. One minute you feel calm and even a bit relieved, the next you are overwhelmed, stressed, and sort of paranoid.

Planning for the future and managing finances is challenging but you’re doing the best that you can.

The kids are driving you crazy and you’re struggling to get some much needed alone time.

Sharing such close quarters with your significant other for an extended period of time might even have you questioning your relationship.

It’s nice to throw in a load of laundry, get some house hold chores done, and eat home cooked meals while juggling your work schedule but you miss the socialization you get at the office or just simply being with your friends and family.

You’ve not been through something like this before and you’re finding it difficult to manage on your own.

Maybe you’ve reconnected with your mental health therapist (I know I sure have)! or even started therapy for the first time in an effort to manage the emotions and make sense of what you’re experiencing.

Perhaps you’ve been thinking about looking into online mental health therapy but you’re just not sure where to start.

When you Google options for online mental health counseling you immediately become overwhelmed with all of the choices. You click a few links and do some reading but you just wind up feeling even more anxious than when you first started looking for a local mental health therapist.

You might be struggling with the fact that there aren’t any local therapists to meet with in person because of the ‘stay at home’ order now in place.

The thought of online therapy is scary and you’re not sure if it’s going to be effective.

Allow me to put your mind at ease!

In this blog, I am going to

  1. Define and provide the distinction between e-Counseling and Online Traditional Therapy

  2. Advantages and disadvantages of e-Counseling

  3. Advantages and disadvantages of Online Traditional Therapy

  4. How to choose which option is best for you

What is e-Counseling?

E-Counseling, also known as e-therapy, online therapy, teletherapy, telehealth, and cyber-counseling, involves providing mental health services and support over the internet. This can occur via email, text messaging, video conferencing, online chat, messaging, or internet phone.

E-Counseling can occur in real time, such as in phone conversations and text messaging, or in a time-delayed format, such as through email messages.


What is Online Traditional Therapy?

Online Traditional Therapy is a simulation of an in-office mental health therapy session only the session occurs via an online platform, such as Zoom or Skype, with your local licensed mental health therapist.

In other words, you are essentially attending your typical 50-minute mental health therapy session only the venue has changed to being online versus in-person.

Online Traditional Therapy sessions can be offered as a feature of e-Counseling services; however, they are typically offered in a package format that includes other features such as texting and online chatting.

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Advantages of e-Counseling


1) Convenience – in this fast-paced world, it’s difficult to keep track of all of the appointments we have for ourselves, our children, our family members, etc. It always seems that we’re needed somewhere by someone.

Fighting traffic to get to your therapy session can also cause more stress and anxiety than you were already experiencing! e-Counseling makes it much easier to access mental health services at any time and from anywhere. You can talk to a mental health professional in your pajamas sitting at your couch!


2) Accessibility – it can be difficult for those living in rural and/or remote areas to make it into town to attend mental health therapy sessions.

Also, those with physical disabilities may not be able to come into the office at all.

Additionally, many tech-savvy teenagers prefer to connect more easily and quickly with a therapist on their hand-held devices.


3) Anonymity – one of the reasons people avoid mental health therapy is because they’re embarrassed to be there and would feel ashamed if others knew they were in therapy. e-Counseling allows the client to avoid passing other clients in the waiting room coming to and from their session; thus, keeping their anonymity intact while using services mental health online.


4) Affordability – many e-Counseling companies offer monthly, subscription-based packages offering a flat fee to access their mental health services. This allows the client the option to text, online chat, attend virtual sessions, etc. The cost of these subscriptions are typically on par, or somewhat cheaper, than the cost of attending therapy with most traditional, in-office mental health therapists with the added value of accessing a variety of online options.

Disadvantages of e-Counseling


1) Not Confidential/Big Business– It is important to know that e-Counseling giants, such as BetterHelp and Talkspace, proclaim to be “wellness tools” and are not “health care tools.”

Essentially what this means is that while these million-dollar companies exist within the healthcare realm, they also exist in the profit realm as well.

In order for big corporations to make money, they are heavily reliant on copious amounts of data to better inform and expand their services. To this end, information you are typing, chatting, or saying is subject to being “monitored for quality assurance.”

Translation = what you share is not really confidential.

I read BetterHelp’s privacy policy and found that they proclaim to “never sell nor rent any information exchanged in the platform.” However, they also go on to list various exceptions to this policy, including to “measure and improve the quality, the effectiveness and delivery of our services.”

This is pretty much an encrypted way of saying we have access to the conversation you just had with your trusted therapist in which you just bared your inner most thoughts, feelings, desires, and fears in the name of measuring the quality of our services.

BetterHelp has also faced criticism for sharing data with social platforms like Facebook, and for its use of YouTube influencers, who were profiting from fans’ mental health struggles, according to some critics.

Here’s a great article on the dangers of how wellness programs can put your health data at risk


2) Inconsistency – there are many complaints of users posting questions and comments to their therapists and taking hours to days to get back to them…or not getting back to them at all!

Memberships proclaim to give you “unlimited” access to mental health services; however, this is misleading because it does not mean that you have unlimited access to your therapist.

Each therapist on staff holds their own hours and has requirements around how often they are to provide responses to their clients – this could be a 5 minute conversation time limit or two responses per day.

This leads to the service being inconsistent and particularly troublesome for someone who is going through a very difficult time and needs help now.


3) “Therapist Hopping” – one of the features of this service is that if you don’t “click with” your therapist you can choose a new one right then and there, no harm, no foul, and without the awkward experience of firing them in person or via text.

However, it is not uncommon for many users to go through 2-3 different therapists before finding one they really “click with.”

Provided the getting-to-know-you process is virtual and oftentimes through text, this process becomes very slow. It can be very frustrating to go back-and-forth with a mental health therapist to get to know them in the first place but to do this a few times can be painstaking!


4) Tech issues – just as with any service on the internet, it is subject to glitches, freezing, shutting down, and troubles with connection. These platforms are no exception.

I have also read some complaints that e-Counseling services will not issue refunds in the event of technical issues that prohibit you from receiving services; however, they may be honored on a case-by-case basis.


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Advantages of Online Traditional Therapy


1) Confidential – when you are visiting your traditional therapist online instead of in-office, your mental health therapist is still bound by the same HIPPA laws and must keep your information private. Your therapist most likely will also ask that you attend sessions in a quiet, secluded place to keep confidentiality intact.

Traditional therapists are required, by law, to use a HIPPA-compliant platform to ensure your data is safe. This means that that platform is encrypted end-to-end making it less vulnerable to hacks; thus, protecting you from your data being stolen nor illegally accessed.

Note: During the Coronavirus, the federal government has lifted the HIPPA requirement so not all platforms being using during this time are HIPPA-compliant to allow more access for clients to services. Talk to your traditional online therapist about your concerns.


2) Reliable/Local Therapist – traditional online therapists do not have client quotas nor the same time restrictions as e-Counseling therapists. They are committed to you and providing the same type of service that you would receive in-office.

Additionally, many therapists using Online Traditional Therapy in lieu of the COVID-19 virus have met their clients in-person at least once so trust and familiarity is already established. Many clients already have a solid, working relationship and it is just a change in venue.

It is because of the relationship that both therapists and clients are more likely to attend sessions consistently and feel a social obligation to one another; thus, meeting treatment goals sooner and feeling better quicker.

You are more likely to get better results with someone you know and trust versus a stranger.

Additionally, each online traditional therapist is bound by law to only practice in their state so you are guaranteed to speak with someone in your state and in many cases not too far away.

How do I find a local online traditional therapist?

Provided most, if not all, in-person therapists are only doing therapy online during the pandemic, if you do any search for a therapist in your local area, they will most likely be providing online traditional therapy.


3) Convenient and easy to use – just as with e-Counseling, Online Traditional Therapy is available from anywhere! I, for one, have enjoyed conducting sessions from the comfort of my couch with my dog in my lap!

Further, some clients prefer the virtual method of mental health therapy provided they have difficulties in articulating thoughts and feelings in-person. Some clients struggle with eye contact or feel like they’re “on the spot” while in person and virtual sessions seem to ease this anxiety and fear.

Personally, I use an online platform that offers a chat feature while in session so clients are able to use this feature as well if they feel that they are not able to express themselves verbally but do a better job in written form.


4) Effective – there is mixed data that speaks for and against the efficacy of online therapy versus in-person therapy. However, as previously mentioned, Online Traditional Therapy is much more likely to yield more results and higher satisfaction ratings provided you likely already know your therapist and trust them.

Some other wellness tools, such as Wysa, Woebot, and X2 Foundation’s “Tess,” are essentially chatbots that clients can use while in a crisis.

Personally, I feel like these services are a nightmare because responses tend to be canned, therapists are not typically vetted and verified to be licensed, and there tends to be more information sharing of resources than actual counseling.

Disadvantages of Online Traditional Therapy


1) Absence of verbal and non-verbal cues – there’s something to be said about experiencing someone else’s energy while in-person. It’s our human instinct to be able to “size people up” based on our intuition and lets us know whether or not we can trust that person.

This is drastically reduced during online therapy.

Verbal and non-verbal cues do not come through virtually nearly as accurately as they do in-person. As a result, it can make diagnosis tricky and sometimes even inaccurate.

Assessing voice tone, facial expressions, body language, and eye contact are considered micro therapeutic skills that the therapist can mis-assess in the virtual world.

Glitches in technology, such as delays in the feed, screen freezing, and warped picture, certainly do not help matters.

It’s important to have a back up platform that can be used if the primary platform becomes too problematic.

You can also try disabling the camera feature and just using audio, in the worst case scenario.


2) Not as effective for severe mental health illnesses/crises – as mentioned previously, due to the limitations of not being able to properly read body language and verbal cues, this can make diagnosis challenging. Therefore, the severity of the condition can be underestimated and might require follow-up evaluation.


Online Traditional Therapy is not a crisis service; therefore, therapists are not available 24/7 as other services provide. This can make it difficult if you are going through a crisis and have to wait until the end of the weekend to get in touch with your mental health therapist.

e-Counseling and crisis services are your better option in this case.

Here are some crisis services you can use:

  1. North Carolina Department of Health and Human Services Crisis Center https://www.ncdhhs.gov/assistance/mental-health-substance-abuse/crisis-services

  2. The Santa Group https://www.thesantegroup.org/mecklenburg-county-crisis

  3. Crisis Intervention Team https://www.mecknc.gov/HealthDepartment/CommunityHealthServices/TJP/Pages/CIT.aspx

3) Tech issues – see aforementioned


4) Affordability – many e-Counseling services accept insurance while there are a number of Online Traditional Therapists who are out-of-network with insurance companies; thus, limiting access for some clients. Further, not all insurance companies reimburse for online therapy; thus, limiting access even further.

However, many Online Traditional Therapists offer a rate that is similar to the subscription fee for e-Counseling services. Online therapy clients are limited to virtual sessions only and typically do not have access to chats and texting.

Premiere or specialized online therapists ($100/session or more) may be challenging to afford for some clients but these clients report the best outcomes, achieve treatment goals in shorter amounts of time, are the most motivated, experience better fitness with therapist, and highest satisfaction overall.

How do I know if e-Counseling or Online Traditional Therapy is right for me?


e-Counseling is best for you if:


1) You need crisis counseling require assistance sooner than can be provided through weekly appointments


2) Need very short-term assistance (2-3 sessions) to get you out of panic or very acute pain only


3) You are able to withstand the “therapist hopping” process to find the best fit


4) You are aware of the confidentiality risks but are not concerned about them


5) Need immediate resources


Online Traditional Therapy is best for you if:


1) You enjoy the connection with someone local


2) Have the possibility of having in-person sessions instead of, or in conjunction with, online sessions (once the pandemic is over, of course)


3) You’re looking for authentic, quality services that are tailored to you and your specific needs with concise, thoughtful feedback and direction


4) Are struggling with problems outside of the pandemic (i.e. relationship issues, divorce, parenting, addiction, eating disorders, etc). that require more finely-tuned, longer-term attention


5) You are motivated and committed to therapy as a process and not a quick fix


Please take care of yourselves and each other during this very trying, challenging time.

At Blue Sage Counseling and Wellness, the health and needs of your family come first.

If we are not able to help you, we want to make sure that you get the help that you need.

We are a provider of Online Traditional Therapy and here to serve you now.

Ready to make an appointment? Click here or click the button below.

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