Online Therapy: What to Expect and How to Choose the Right Therapist

Mental Health
Written By Elizabeth Schane, LPC, LMHC, LCMHC, PMH-C, TN-C
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Most people consider therapy for months or even years before reaching out. (Doherty et al., 2021, pp. 882-890) Barriers include commuting, finding childcare, getting time off, and gathering the courage to speak honestly about your life. (Sweetman et al., 2021, pp. 44-63)

Online therapy has removed many of these barriers. (Amill-Rosario et al., 2024) You can join a session from home, your car on break, or any private place with a stable internet connection. Research consistently shows it is as effective as in-person therapy for most issues. (Fernández et al., 2021, pp. 1535-1549) For busy professionals, parents, rural residents, or anyone uneasy about office visits, it may be a better fit. (Schmidt, 2024)

If you're considering online therapy, this guide will walk you through how it works, what to expect, and most importantly, how to choose a therapist who is the right fit for you.

DOES ONLINE THERAPY ACTUALLY WORK?

Yes. The research on this is now extensive and consistent. To clarify: therapists reported using fewer therapeutic skills online than in person during the COVID-19 pandemic (Perina, 2023). However, studies of online cognitive behavioural therapy (CBT) show outcomes for anxiety, depression, PTSD, and OCD that match in-person CBT. A meta-analysis of 154 randomised controlled trials found that internet-delivered CBT can be effective, with positive effects often lasting at least a year. Notably, this study did not investigate whether the therapeutic alliance develops as strongly online. For many people, a small reduction in physical presence is balanced by gains in consistency, comfort, and accessibility. In summary, while therapeutic skills use and alliance may differ online, outcomes are comparable, and convenience is greater for many.

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In my practice

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I've worked with clients in both formats, and I genuinely see online therapy work beautifully for the vast majority. People are more relaxed in their own space. They don't lose the first ten minutes of a session decompressing from a commute. They can attend during weeks they otherwise couldn't have, sick kids, work travel, postpartum recovery. The work is the same; the access is dramatically better.

Schedule Free Consultation

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WHO IS ONLINE THERAPY A GOOD FIT FOR?

Key takeaway: Online therapy is a strong fit if you need flexibility, live remotely, prefer privacy, or have practical or emotional barriers to in-person sessions.

  • You have a demanding work schedule and can't easily commute.

  • You're a parent of young children, postpartum, or pregnant.

  • You live in a rural area or in an area with few specialised therapists.

  • You need a specialist (e.g., perinatal, EMDR, EFT) who isn't available locally.

  • You travel for work and need consistency.

  • You have anxiety or sensory sensitivities that make new physical environments harder.

  • You want to attend sessions from a private, comfortable space.

When in-person may be a better choice

Online therapy is not always the right fit. Consider in-person care if:

  • You're in acute crisis or experiencing active suicidal thoughts (you need higher-acuity care than weekly outpatient therapy provides).

  • You don't have any private, reliable space to hold sessions.

  • You have severe symptoms that benefit from immediate in-person support.

  • You're considering certain trauma therapies that work best with in-room presence.

  • You specifically value the ritual of leaving home for the session.

WHAT TO EXPECT FROM ONLINE THERAPY

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Before the first session

Most online therapists offer a free 15–20-minute consultation to check the fit before you commit. Take this opportunity. The biggest factor in therapy's effectiveness is how you feel with the therapist. A consultation lets you see their style, ask questions, and clarify your goals.

You'll complete paperwork: an intake form, telehealth consent, and HIPAA documents. Your therapist will send a secure video link, usually via HIPAA-compliant platforms such as SimplePractice, Practice Q, Doxy.me, or Theraplatform, rather than via standard Zoom.

The first session

The first session focuses on your history. Your therapist will ask what brought you in, family and relationship background, medical or mental health history, and what you hope therapy will address. The goal is to understand your context, not to diagnose or assign labels. You won't need to share everything in one session; start with what feels most important.

Ongoing sessions

After the first session, most therapy sessions are weekly or biweekly, lasting about 45 minutes. Structure varies by therapist. Some sessions will be guided exploration; others focus on skill-building. A review of 87 meta-analyses found that internet-based interventions are effective for many issues, although the optimal number of sessions for improvement remains unclear. (Zhang et al., 2024)

The practical setup

  • Choose a private space where you cannot be interrupted or overheard.

  • Headphones can help with sound quality and privacy.

  • A reliable internet connection is more important than camera quality.

  • Sit somewhere comfortable where you can be present; avoid places that feel too informal, like your bed.

  • Have water nearby and tissues if you anticipate emotional work.

HOW TO CHOOSE THE RIGHT THERAPIST

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Elizabeth Schane, LPC, LCMHC, LMHC, PMH-C, TN-C

Founder of Well Roots Counseling

Learn More About Elizabeth

Key takeaway: A good therapist match depends more on their qualifications and fit with you than on the therapy platform used.

A therapist who specialises in your concern is more effective than a generalist. (Hutsebaut, 2024) For perinatal mental health, seek PMH-C certification. For trauma, look for EMDR or specific trauma training. For couples, look for EFT or Gottman training. "All issues" rarely signals expertise.

2. Credentials and licensing

Your therapist must be licensed in the state where you'll be located during sessions (not where they're located). Common licence types include LCSW, LCMHC, LMHC, LPC, LMFT, and psychologists (PhD/PsyD). All require master's or doctoral training and supervised clinical hours. (North Carolina General Statutes Chapter 90. Medicine and Allied Occupations § 90-336. Title and qualifications for licensure, 2023) Verify their license on your state's professional regulation site. (South Carolina Code Section 40-42-20 (2024) - Requirements for licensees who provide health care via telehealth, 2024)

3. Approach

Different therapeutic approaches work differently. The main ones:

CBT structured, skills-based, particularly good for anxiety and depression

EMDR trauma-focused, particularly effective for PTSD and birth trauma

IFS (Internal Family Systems) works with internal "parts," good for self-criticism, trauma, complex emotions

EFT (Emotionally Focused Therapy) couples and individual; works with attachment and emotional cycles

Somatic approaches include the body in the therapy; helpful for trauma and chronic stress.

Psychodynamic explores deeper patterns and their origins (Molendijk & al., 2024, pp. 567-580)

4. Fit

Key takeaway: Feeling understood and respected is more important than immediate comfort. If the fit feels wrong after a few sessions, it’s okay to try another therapist.

5. Practical fit

  • Do their available session times work for your schedule?

  • What's their cancellation policy?

  • Do they take your insurance, or what are their out-of-pocket rates?

  • Will you receive a superbill for out-of-network reimbursement?

  • Are they accepting new clients now, or is there a waitlist?

INSURANCE, COST, AND THE PRACTICAL QUESTIONS

Key takeaway: Therapy cost varies by insurance, location, and provider credentials. Out-of-network options may offer partial reimbursement if you submit a superbill.

Key takeaway: If cost is an obstacle, ask about reduced-fee spots, sliding scales, or lower-cost providers such as community mental health centres and online directories like Open Path Collective. Also inquire about student interns. At Well Roots Counseling we aim to have a student intern available who will always have advanced training in perinatal mental health. Their rates are significantly lower than a licensed therapist and they are supervised by a licensed clinician.

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Frequently Asked Questions About Online Therapy

Is online therapy confidential?

Key takeaway: Online therapy is confidential if you use a private location and your therapist uses secure, HIPAA-compliant platforms.

Do I need to be in the same state as my therapist?

Your therapist needs to be licensed in the state where YOU are located during the session, not in the state where they live. So a therapist licensed in North Carolina can see clients across NC, but not see a client who is physically in Virginia, even temporarily. If you travel often or are about to move, mention this in your consultation. Some therapists hold multiple state licenses. (Well Roots Counselling therapists are licensed in NC, CO, VT, MA, and SC.)

What if I cry, get angry, or feel overwhelmed during an online session?

Your therapist is trained to support you through this, whether you are in their office or meeting online. The format does not change their ability to be present with you. In fact, you have the comfort of being in your own space when the session ends, so you do not have to walk back to your car to compose yourself before driving home.

How do I know if therapy is "working"?

Signs of progress include: increased self-awareness, beginning to notice patterns in the moment rather than after the fact, small changes in how you respond to triggers, less avoidance, more honesty with yourself and others, and gradually feeling more like the person you want to be. Symptoms reduce too, but the bigger marker is usually a change in how you relate to yourself.

What if I don't like my first therapist?

It is common, and it is okay. Therapy fit is highly individual. (Schmalbach et al., 2022) If after two or three sessions you do not feel a connection, you can switch. Most therapists will help you find someone who is a better fit. This is not a failure; it is simply information about which approach or personality works for you.

Can I do online therapy if I'm in crisis or having thoughts of self-harm?

Online therapy is generally not appropriate as the primary care for an active crisis; you need access to higher-acuity support. (Lemoine et al., 2026, pp. 1-12) If you're having thoughts of self-harm or suicide, call or text 988 (Suicide & Crisis Lifeline in the US) or go to your nearest emergency room. Once stabilised, online therapy can be a strong, ongoing source of support.

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If you're ready to take the next step, Well Roots Counseling offers online therapy across North Carolina, Colorado, Vermont, Massachusetts, and South Carolina. Our therapists specialise in women's mental health, perinatal mental health, relationships, and trauma. Every new client starts with a free 20-minute consultation — no pressure, just a conversation to see if we're the right fit. Book a free consultation →



REFERENCES

Elizabeth Schane, LPC, LMHC, LCMHC, PMH-C, TN-C

Elizabeth Schane is a therapist specializing in maternal mental health, infertility, and trauma. She helps women navigate fertility journeys, motherhood transitions, and emotional healing through a compassionate, evidence-based approach.

https://www.wellrootscounseling.com/elizabeth-schane-perinatal-therapy-expert
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