Looking for mental health care? There’s an app for that — or more accurately, several apps for that. Even before the COVID pandemic, new innovations were trying to take support for mental illness and health virtual.
Text-based therapy is just one of the contenders. It’s certainly convenient, but does it work? And if it works, is it worth the cost?
What is text therapy?
Text therapy, or messaging therapy, is an asynchronous way to access a mental health professional via a mobile device or computer. In simple terms, that means you don't have to wait until you have an appointment with your therapist to share with them or seek counsel. When you feel the need, help is literally just a text away.
That's the good part.
Even though it’s convenient and accessible, its effectiveness is still under debate. However, according to people that have tried it — as well as a few small studies — the innovative format makes a difference.
How does it work?
There are a number of text therapy providers available on the market today, but they all generally work in the same way:
- The platform will prompt you to answer questions about yourself, including about your history in therapy and any mental health diagnoses. The platform owner will use this information to choose a therapist to pair you with.
- Once you’re paired with a therapist, you can start sending messages. In text therapy services, the bulk of your contact will be via the secure messaging service. Some platforms also offer the opportunity to connect with your therapist for video or phone calls. While most of your communication will be asynchronous — meaning you send a message then wait awhile (most providers set the response window upfront so that you know what to expect) — you also may have the option to request a live chat session.
- Some platforms offer a free trial, some run as a subscription, while others offer pay-as-you-go methods with different service tiers. These are determined based on the level of access you have to your therapist and how frequently you meet. Almost all plans include unlimited messaging, but some include weekly live sessions.
What is the average price of text therapy?
The price of text therapy varies by platform. On the low end, plans usually start at around $40 to $60 per week. Plans that allow for live sessions — whether by video or text — typically cost more. Most plans give the option of paying per week, per month, or annually, with a discount for longer commitments.
Usually, insurance doesn’t cover messaging-based therapy plans. However, plans that include real-time, virtual sessions may be covered by insurance. Plans may also be HSA eligible. You can check the details with the individual platform or with your insurance carrier.
If the plan isn’t insurance-eligible and you need financial assistance, you might be able to request a lower price or flexible payment plan from the provider.
What are the benefits of text therapy?
Convenience
Text therapy is extremely convenient. As long as you have a device and a data connection, you can reach out to your therapist. You’re not limited by geographic location, and you don’t need to commit to a certain schedule. If you're not gelling with your provider, you can always switch therapists.
Availability
If your therapist has a full roster of clients, you may have to wait to get an appointment. With text therapy, that’s not a concern. You can reach out to your therapist whenever you have something on your mind or you have free time.
Easier to open up
Because the therapy platform provides a degree of anonymity, some may find it easier to open up to their therapist. Writing itself can be therapeutic, so the act of communicating via text or even email may help make you feel better, even before you receive anything back from your therapist.
Unlimited
Text therapy plans generally don’t put a limit on how often you can reach out to your therapist, This is different from traditional therapy programs, which are typically limited to one visit a week.
What are the disadvantages of text therapy?
Impersonal and static
Because all of the hallmarks of face-to-face communication (including inflection, voice, and body language) are missing, text therapy can feel very impersonal. It can take a long time — if ever — to develop rapport with a therapist you never see.
Similarly, therapists are trained to use all of the subtle signals of body language, inflection, and reaction to guide their interaction with a client. Therapy is typically a dynamic, relationship-based treatment.
Expensive
Message-based psychotherapy usually isn’t covered by insurance. While traditional therapy sessions are actually more expensive, some of the costs are absorbed by an insurance plan. Because of that, the out-of-pocket expense for text therapy can be considerable relative to traditional therapy.
Delayed response
It’s true that you can reach out to your therapist at any time — but that doesn’t mean that you’ll hear back right away. Your therapist is not sitting by the phone waiting for your text 24-7. If you send a text message at 3 a.m., you probably won’t get a response until normal business hours resume. The response you experience may feel closer to the schedule of a traditional therapist. That may not feel like enough responsiveness and engagement, especially if you find yourself needing immediate support.
Limited application
Text therapy is only appropriate for mild stressors and conditions. If you’re having a mental health emergency, like a panic attack or thoughts of self-harm, text messaging won’t be able to help you very much. You’ll need a “backup” support system on standby for situations where you need immediate help. The Crisis Text Line provides emergency support via message.
Is text therapy right for you?
There’s no doubt that text therapy is convenient and may seem less threatening or risky. That doesn’t mean it’s the right modality for you.
When choosing a therapist, it’s important to take the time to find the right person, on the right platform, that suits both your needs and your lifestyle. Here are some clues that text therapy might be a good fit for you:
- You’re always on your phone or computer
- You’re too busy to commit to a regular meeting time
- You’re comfortable with expressing yourself and your feelings in words
- You have regular access to a device with a data connection
- You’re comfortable with the cost
- You don't need psychiatry or medication management
Even with traditional therapy options, though, it’s possible for you and your therapist to just not be a good fit. If text therapy doesn’t work out, it could be a mismatch in platform or practitioner. Or it could be the format itself.
Here are some ways that you know text therapy is working well for you:
- You feel better after communicating with your therapist
- You use the platform regularly
- You feel good about the expense when you’re billed for it
- You refer to your therapist by name
- You are intentional about check-ins with your therapist
- You feel that you’re making progress
- You have more insight into the original concerns that brought you to therapy
- You tell other people about the impact that the platform has had on you
In short, if the platform’s making a positive impact on your life, then it’s working for you — and worth the investment of both money and time.
Other online therapy options
If text therapy doesn’t seem like the right fit for you, there are other virtual options out there. Some digital and online therapy options include:
Video counseling
Meeting with a counselor via a video conferencing platform can feel very similar to an in-person session. Teletherapy preserves much of the face-to-face experience and allows you to video chat with your therapist in real-time. Most online platforms are HIPAA compliant, so your video sessions are secure.
Video offers some of the benefits of improved accessibility and convenience, as well as offering a bit of distance that can make some people feel safer or more comfortable opening up. In addition, video therapy gives the therapist more information to work with as they can pick up more of the non-verbal cues and both therapist and client benefit from a real-time exchange that enables thoughts and reactions to flow more freely.
Group counseling
Therapy groups are usually small groups (about five to fifteen people) that are led by one or two licensed therapists. This form of therapy is often offered as a complement to individual therapy, although it is possible to experience benefits from group therapy alone. Similar to support groups, group therapy can be helpful in treating disorders related to social connection. This might include social anxiety, loss, eating disorders, or low self-esteem.
Support groups
Support groups are spaces for people going through a similar experience to connect with and help each other heal. They were traditionally in-person but the format can translate into virtual experiences as well, either real-time or asynchronous.
Usually led by a trained peer instead of a clinician, support groups have a long track record and are immensely effective. People often rely on their support groups when, due to trauma, they have trouble relating to the people in their lives. This might include depression, loss of a family member, infertility issues, or addiction.
Sliding scale therapy
Many gravitate towards text therapy because it’s available at a set rate, even to those who don’t have insurance. However, if you’d rather meet with a therapist face-to-face (even if virtual) text therapy isn’t your only option. You can always reach out to a practitioner who is willing to charge on a sliding scale. This can make the cost of in-person therapy much more manageable even without the help of insurance.
Emergency services
One of the main drawbacks of text therapy is its limited use in emergency situations. If you find yourself in need of immediate mental health treatment help, you can reach out to one of several emergency support services. The Crisis Text Line and National Suicide Prevention Hotline provide free, on-demand services no matter where you are.
There’s no wrong way to reach out
Despite the lack of research around its efficacy, text therapy has made a difference in many people’s lives. If it helps you, or makes therapy seem less intimidating, try it out. For many people, some connection is better than no connection, and having a prompt and structure to reflect and begin processing thoughts and feelings can be helpful. For at least some people, the delayed, impersonal nature of text is part of what makes it helpful.
As long as you don't have a serious clinical condition, there’s no downside other than the possibility of wasting time not making progress. There’s no wrong way to reach out for support. If you’re having trouble meeting with or finding a counselor for face-to-face therapy, text counseling can be a versatile and valuable solution.
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