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Before the pandemic, talking to a therapist or psychiatrist on a video call was novel. Now it’s fairly common.  

One recent analysis, for example, found that video appointments within the massive Veterans Affairs Health Care System jumped from about 2% of all mental healthcare encounters in January 2019 to 35% of these encounters in August 2023. 

If you haven’t yet used virtual mental health counseling, what do you need to know? Stephanie Collier, M.D., MPH, a psychiatrist at Harvard-affiliated McLean Hospital, shares her expertise and insights. 

Some advantages  

Virtual visits are convenient for many people, including those who might have trouble getting to an office or who live in areas where it’s not easy to find mental healthcare providers. 

“You can chat with your mental healthcare clinician in the setting of your choice, which might make you feel more comfortable,” Collier said. “You don’t have to worry about getting to and from an appointment. And you can be confident that your outcome will be similar to receiving in-person treatment.”  

For example, in a 2022 study of about 1,500 people, participants being treated for anxiety or depression reported the same level of symptom improvement on standardized scales, whether they received virtual or in-person treatment. 

How do virtual visits work? 

A virtual visit with a mental healthcare clinician works in much the same way as a virtual visit with your doctor.  

You make an appointment to speak with an expert, typically a licensed therapist, psychologist or psychiatrist. They may be in a private practice or work with your insurance plan or a hospital system. Or they might be affiliated with an online mental healthcare platform.  

Often, you can read about their professional background, expertise and other information to help you decide if they are a good fit for your needs. 

Shortly before your appointment, you’ll log on to a specified website and then find yourself in a virtual waiting room. When it’s time for your session, the expert will appear on the screen and conduct a 30- to 50-minute session, depending on what you’ve agreed on, just as they would during an office visit. 

Does insurance cover it? 

Not necessarily. Make sure your sessions will be covered.  

Medicare and Medicaid cover virtual mental healthcare visits, but not all private insurers cover the service. Even if you think you’re covered, double-check in advance. 

How does one prepare? 

Getting ready for a virtual visit involves prepping for both a mental health appointment and a video meeting. 

• Go over the instructions. The healthcare office should provide instructions for accessing the platform where the virtual visit will take place. If you don’t have instructions, contact the clinician’s office or the online service to get them.
• Look for compliance. The platform your clinician specifies for your session should clearly state if it’s HIPAA-compliant, ensuring the privacy and security of your information. 

If you don’t see any evidence of HIPAA compliance, ask your clinician about it or consider choosing another mental health provider. 

• Do an equipment inventory. You’ll need a smartphone, tablet, and desktop computer or laptop to take part in a virtual mental healthcare visit. 

The device needs a camera, a microphone and an internet connection. You’ll also need a quiet space and decent lighting (so the expert will be able to see you). 

• Do a practice run. Well before your appointment, log on to the platform your clinician has specified. 

Check to see if you need to upgrade your software in order to use the platform. You don’t want any surprises just before appointment time. Try out the volume and your camera angle. 

How to improve virtual visits 

When you have an in-person visit, it may be easier to see body language and express yourself. Here are some tips to ensure that you’re seen and heard virtually: 

• Set a reminder to charge your equipment. The device you use should be fully charged or plugged into an electrical outlet for the appointment.
• Gather some supplies. You might want to have a drink of water, a box of tissues, and a pad and pen handy for taking notes.
• Make a list of questions or topics on your mind. “Think of a few topics you want to discuss in advance so you can get through them during your session,” Collier said. 

“If you keep a journal or sleep log, and the information will be important, have it with you at appointment time.” 

• Be willing to share your thoughts and emotions. You won’t have to carry the whole conversation yourself. Your therapist will ask you questions and offer prompts to guide the session and help you open up about your feelings and experiences. 

For instance, they might ask, “How has your mood been since our last session?” or “What are some challenges you faced this week?” 

• If you like, ask a friend to join you. If you’ll feel more comfortable with a friend in the room to support you or help you with the technology, arrange it in advance. During your appointment, tell the expert that someone else is there with you.

You can change therapists 

If you feel your appointment was productive, consider scheduling another one. Again, make sure your insurance will cover it. 

But what if you didn’t “click” with the expert? “It’s an important consideration since your relationship with your therapist is the best predictor of how you’ll do in therapy,” Collier said.  

“Give it a few sessions. If you still don’t think your therapist is a good fit, it’s okay to change clinicians. Many telehealth platforms allow you to do that pretty easily.” 

Heidi Godman is executive editor of Harvard Health Letter. 

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