How To Become An Online Therapist

An online therapist is a licensed mental health care professional who provides therapy, sometimes called teletherapy, virtually. “Sessions take place through a secure online portal instead of in person,” says Sarah Epstein, a licensed marriage and family therapist in Philadelphia and Dallas.

An online therapist typically offers the same services as an in-person therapist. “Online therapists are in tune with the same theories, approaches, methods, skills and competencies that a traditional therapist utilizes,” adds Matt Glowiak, Ph.D., a licensed clinical professional counselor at Choosing Therapy, based in Illinois. Just like a traditional setting, sessions often begin with a comprehensive assessment followed by a deeper exploration of the problems or circumstances the client is facing, he adds.

With telehealth, more people can access mental health support from the comfort of their own home. “Online therapy is unique in [the way] that it increases access to care, allowing people in rural locations, or those with busy schedules or non-conventional work schedules, to access therapy at their convenience,” says Melissa Boudin, Psy.D., a licensed psychologist at Choosing Therapy, based in California.

“All different types of therapy can be done through online therapy,” says Epstein. For example, online therapists may offer therapy to different age groups or multiple people at a time, such as child therapy, couples therapy, marriage counseling, family therapy or group therapy.

“Online therapy has also expanded its offerings to include alcohol, opioid and other substance use treatment, as well as ketamine-assisted therapies,” adds Dr. Boudin.

Limits to Care for Online Therapists

While online therapy can be more convenient and accessible, it can also pose some limits to care. For starters, therapists and clients need a reliable internet connection. Additionally, it may take some getting used to for both therapists and clients to communicate effectively without a full picture of the other person’s body language and other nonverbal cues. And finally, if a client is in extreme distress (for example, verbalizing suicidal ideation and intent to harm themselves), it can be more complicated to connect them to emergency services when the therapist is not physically in the same location with them; i.e. keeping them talking to make sure they stay safe until help arrives.

Which Conditions Can Online Therapists Treat?

For the most part, therapists who practice online can effectively treat many of the same conditions as they can in person.

There are, however, some interventions that require therapists and clients to physically be together. “For instance, some therapists do walking therapy outside with clients—though some virtual therapists do walk separately while connected by phone,” says Epstein. Certain types of interventions for trauma symptoms may also be safer and more effective in person as the therapist can help the client process very difficult sensations more directly when they’re in the same physical space.

Online therapists can treat people for the following conditions and situations (note that this is not an exhaustive list), according to Epstein and Dr. Glowiak:

• Stress and Trauma
• Interpersonal issues
• Life transitions
• Depression
• Anxiety
• Panic disorders
• Personality disorders
• Bipolar disorder
• Obsessive-compulsive disorder (OCD)
• Substance use/abuse
• Processing disorders
• Personality disorders
• Eating disorders

Therapists require many skills and traits to successfully offer mental health care both in person and online. “They should possess a natural disposition of compassion for all people and passion toward positive social change and life-long learning,” says Dr. Glowiak.

Required skills to practice therapy, according to Dr. Glowiak, include:

• Empathy
• Ethics
• Multicultural competence
• Compassion
• Excellent listening skills
• A deep understanding of the appropriate evidence-based psychology theories, approaches and methods

While Epstein says the skills needed to practice therapy in person are the same as those necessary for practicing online therapy, there are some bonus skills that can help online therapists excel. “Nothing replaces the experience of being physically in the room with a client,” she says. “Online therapists have to be creative and deeply attuned to their clients and make sure that a strong bond is built to ensure treatment can proceed successfully.”

To be more in tune with clients virtually, online therapists must rely on facial expressions and vocal tone since they have a more limited view than they would have in person, adds Dr. Glowiak. “Active listening and freeing oneself from distractions are critically vital.”

To become a therapist, a person must complete the following steps:

• Earn an undergraduate degree. Psychology, sociology, social work and education are all helpful undergraduate degrees for prospective therapists.
• Earn a master’s or doctorate degree. The minimum educational degree needed to practice most therapist specialties is a master’s degree. Some specialties, such as a clinical psychologist, may require a doctorate degree. According to Dr. Boudin, some of the most common higher-education therapy degree types include Marriage and Family Therapy (M.F.T.), Master of Social Work (M.S.W.), Doctor of Psychology (Psy.D.) and Doctor of Philosophy (Ph.D.).
• Complete clinical hours and pass licensing exams. Lastly, prospective therapists must pass required state licensure exams and complete a certain number of supervised clinical hours. Some types of licenses include a licensed professional counselor (L.P.C.), licensed marriage and family therapist (L.M.F.T.) and licensed clinical psychologist (L.C.P.).

“Most online therapy platforms and services employ or contract only fully-licensed or provisionally-licensed* mental health therapists,” says Dr. Boudin.

All told, therapists must complete a two-to-four-year graduate program and provide thousands of hours of therapy under the supervision of a licensed therapist during and after their graduate program

Whether you’re able to treat patients across state lines (in a state that you are not licensed) differs from state to state. You can see if your state has enacted or introduced legislation for the Psychology Interjurisdictional Compact (PSYPACT)—a licensing compact that’s helping drive interstate telepsychology—by visiting psypact.org.

Many therapists pursue advanced training in certain specialties or modalities, such as:

• Eye Movement Desensitization and Reprocessing (EMDR)
• Acceptance and Commitment Therapy (ACT)
• Dialectical Behavior Therapy (DBT)
• Mentalization-Based Therapy (MBT)

While Epstein says therapists require the same credentials to work online or in person, some online therapy may call for additional training. “In recent years many licensing boards have required additional training in telehealth to ensure best practices as it relates to confidentiality, HIPAA compliance, software and relationship building,” she says.

“Most modalities may be reformatted to be effective in an online environment,” adds Dr. Glowiak. However, he notes that in cases of experiential activity where fears are directly addressed, in-person therapy is most valuable.

*Provisionally licensed means an individual who completed the requirements of a master’s degree and a part of their post-degree training, but has not met all criteria for a full license. They may practice under weekly board-approved supervision.*

Therapists vs. Counselors: What’s The Difference?

Because the roles and responsibilities of therapists and counselors can overlap, both terms are often used interchangeably. However, this is inaccurate, as the two terms may refer to different types of jobs, and may not be interchangeable.

While certain types of counselors, such as school counselors and some substance misuse counselors, can practice without a state license (but will need to obtain certain credentials and/or certifications), individuals who work as psychotherapists, such as clinical social workers and marriage and family therapists must be licensed to legally practice in all of the U.S., including the District of Columbia and Puerto Rico. Laws for licensure require minimum standards for education, examination and experience, according to the American Counseling Association.

Psychotherapists who are state-licensed may be reimbursable by most insurance providers (however, this may differ when it comes to online therapy).

Salaries for online therapists can vary significantly depending on the level and amount of education completed, geographic location, type of license and focus area.

A therapist’s annual income also depends on how they charge clients and their caseload (which is the number of clients they see per week). “Therapists who are credentialed with insurance will get reimbursed based on that insurance company’s reimbursement rates,” says Epstein. “Cash-pay therapists can charge what they’d like, and different regions around the country have different norms.”

According to Epstein and Dr. Glowiak, therapists can make anywhere between $20 and several hundred dollars per session (which typically lasts around an hour). With that said, Dr. Glowiak cautions that a full 40-hour per week caseload could prove challenging and lead to burnout.

Therapists in private practice may earn more, according to the American Association for Marriage and Family Therapy (AAMFT), but Dr. Glowiak adds that certain fees also come with running a business, “It is important to consider here that although a counselor can charge whatever a client is willing to pay, there are fees for incorporating a business, purchasing business and malpractice insurance, setting up billing software, advertising and more.”

While the U.S. Bureau of Labor Statistics does not report salaries on every type of therapy specialty, it states that in 2021, marriage and family therapists earned a median pay of $49,880 and substance abuse, behavioral disorder and mental health counselors earned a median pay of $48,520^[1]Marriage and Family Therapists. Bureau of Labor Statistics. Accessed 02/27/2022. ^[2]Substance Abuse, Behavioral Disorder, and Mental Health Counselors. Bureau of Labor Statistics. Accessed 02/27/2022. .

Note: Keep in mind if you opt to contract your therapy services through an online therapy platform provider, the rate you’re reimbursed will differ from company to company.

After earning an undergraduate degree, which typically takes four years, a prospective online therapist will need to plan for two to five years of additional education and supervised clinical hours.

“Master’s level therapist training programs typically take from two to three years,” says Epstein. “After that, a clinician does thousands of hours of additional clinical work under the supervision of a trained supervisor and the clinician must take a licensing exam—among lots of other paperwork—to qualify for a full license.”

“There is no price tag on seeing someone go from a bad place to one in which they are not only doing better but maximizing their life’s potential. This is as fulfilling as it gets,” says Dr. Glowiak.

Additional information for this article was provided by Judy Ho, Ph.D.