When Roni and Oren Frank hit a rough patch with their marriage, they didn’t think they’d make it. On the verge of divorce, they tried counseling. Lucky for them, and a couple of revolutionary sessions later, their marriage turned around, and ultimately, saved it. Roni became so fascinated with the practice of psychology and the power of communication that she enrolled in the master’s program at the New York Graduate School of Psychoanalysts. The pair then created TalkSpace, an online therapy platform.

“Oren and I discovered just how broken the mental health care system is and founded the company on a mission to make therapy more accessible, flexible and affordable for all,” says Roni, co-founder and head of clinical relations at TalkSpace.

Launched in 2012, the platform has already connected more than 80,000 users with 200 therapists and is available for as low as $19 a week—a steep discount from an in-person session averaging at $150. TalkSpace is only one of many tech spaces that offers digital counseling; sites like BetterHelp and Cope Today also offer services such as video conferencing, phone chat, and public forums with licensed clinicians.. Those who have tried e-therapy say it helped them feel more aware of anxieties and found the therapists sympathetic and engaging. Could this new wave of counseling be a viable alternative to in-person sessions?

The Benefits

Online therapy comes with perks such as having more flexibility, lower cost, and increased accessibility. “We wanted to make therapy a convenient part of everyone’s lives, so they can be proactive about their mental health,” says Roni. E-therapy means you can search for and be connected to a licensed professional within minutes, transcends geographic boundaries and fits into a typical busy schedule easier.

For some, face-time may be too confrontational or embarrassing and in many communities there is still a large stigma of mental illness. So, Internet-based interventions can provide the space needed to work through issues while maintaining a greater sense of privacy. In a survey published in the journal PLOS ONE, 98 percent of respondents said they would be willing to try online therapy, citing the advantage of anonymity as one of the top reasons.

In terms of results, science shows that certain digital programs can be effective. Recent research published in the Journal of Affective Disorders found that Internet-based therapy improved depression as much as face-to-face consultations. In the study, two groups of participants were randomly assigned a cognitive behavioral therapy program, either online or in person. Post-treatment, both groups had fewer feelings of hopelessness and negative thoughts, and increased self-confidence. Interestingly enough, at the three month follow-up the online group scored higher on overall wellbeing. The researchers speculated that the hike happened because the online programs cultivated more self-responsibility. “We think that the participants mastered a higher degree of initiative and self-control during their tasks,” says study author Andreas Maercker, Ph.D. Other studies have evaluated online treatment for social phobia, obsessive-compulsive disorder, panic disorder, and specific phobias, and found web-based programs just as successful as in-person visits.

From a provider’s perspective, digital consultations can help with time management. A study from the University of New South Wales estimated that face-to-face sessions required up to 240 total minutes per patient, whereas online therapy was shorter, only taking 18 minutes—a striking 93 percent drop.

Why It’s Not for Everyone

The research behind Internet consultations sounds promising but it’s still just scratching the surface. Depression, generalized anxiety, and social phobia are frequently tested but not a lot of studies look at OCD, PTSD, eating disorders, and addiction, and it’s possible these concerns might not be a good fit for e-counseling due to the nature of the symptoms and how they progress, says Maercker.

Meta-analyses also indicate that while tons of studies deem online therapy valuable, not many actually compare the results of Internet and face-to-face therapy side by side. One study from the Karolinska Institutet in Sweden originally sifted through more than a thousand online therapy articles, but only found 13 that analyzed the two styles directly. Without that comparison, it’s hard to exactly prove that one style has precedence over another or is equivalent in effectiveness.

Another potential hurdle is treatment adherence. Some studies have found that online therapy has higher dropout rates compared to face-to-face treatment. While increased anonymity could help some people begin treatment, it could also mean less incentive to finish a program. Certain cases could be too overwhelming to tackle solo, and motivation can slide if no one is guiding or rooting for you along the way.

Even with the challenges, online therapy has greatly expanded mental health care by removing the price, stigma, and access barriers, says Roni. The most successful therapy programs are ones that are individualized and create a safe space for patients to disclose and work through problems; online therapy provides another outlet to be able to do just that.

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