What do you think of when you hear the word “Therapy”? For a long time, “therapy” meant going into an office and sitting opposite a therapist on a couch. Nowadays, just as many people may think of text messages, zoom calls, and journaling prompts.
While neither of these perceptions is right or wrong (mental health counseling is a diverse field), there has been a definite trend towards online, tech-driven mental health solutions.
With a rise in mental health apps, online-only counseling businesses, and text messaging counseling, the focus has shifted from counselor to technology.
Although not a new field—BetterHelp and Talkspace have been around since 2013 and 2012, respectively—the tech-driven mental health world saw a boom during the pandemic, when most people were forced from therapy offices altogether.
But is this trend a good one? Is technology-driven mental health the right solution to our cascading mental health problem? The answer may be more complicated than a simple yes or no.
What is text therapy?
Text therapy, also known as text-based therapy or messaging therapy, is a form of online therapy that enables individuals to communicate with mental health professionals through texting, live chat rooms, messaging, or e-journaling.
This mode of therapy offers the convenience of being able to connect with a therapist asynchronously, meaning individuals can reach out for support and guidance via SMS or messaging in an app at any time, without the need to wait for a scheduled appointment. Text therapy can be particularly beneficial for addressing mild stress or anxiety symptoms, relationship issues, problems with friends or family, and other temporary or mild crises and distress. Some text therapy services may also include the option for live video sessions as part of a subscription model.
However, it’s essential to consider the potential drawbacks and limitations, including the absence of face-to-face interactions and the need for immediate support during a crisis situation.
What is subscription-based mental health therapy?
In traditional therapy, you pay a flat fee for every session you have. An hour therapy session can cost between $120-$200 without insurance, but since most insurances cover mental health therapy, you only end up paying between $30-$50.
Subscription-based mental health is different. With this model, you pay an upfront fee every week or month (most plans are monthly). This fee is between $200-$500, depending on what tier of plan you choose.
Subscription-based plans can be canceled at any time, but you usually cannot get a refund once you pay the monthly fee. Also, because of the unique nature of subscription-based plans, insurance companies won’t always cover it.
Cost of text-based therapy
The two biggest text messaging therapies are BetterHelp and TalkSpace. BetterHelp charges $60-$90/week. You are billed monthly (around 240-360/week) and they don’t accept insurance. What you get for this subscription varies on the therapist and the tiered plan you choose. Some offer live sessions, which you can have up to 4 a month. The bulk of BetterHelp takes place on the live text messaging. There is a focus on worksheets and digital coping skills, which could be helpful to some clients.
Talkspace costs between $276 – $436 and does accept insurance. There are three tiers of plans: messaging, video and messaging, and video, messaging, and workshops
While text messaging and subscription-based services such as these may be useful to some people, if you have in-network benefits through insurance, other more traditional therapies may be cheaper. (Copays with insurance tend to be between $30-$50 for online or in-person traditional talk therapy.) However, if you haven’t found much success in traditional talk therapies or don’t have insurance, these services may benefit you.
Is text therapy effective?
Text-based therapy is still a relatively new field, with its popularity only growing during the pandemic. Research for its efficacy is mixed—partly because it is still a relatively new field— although more studies point towards a positive effect.
- One meta-analysis found mixed reviews for anxiety and depression, with good effectiveness for substance abuse and psychiatric conditions.
- A 2020 study found people with depression and anxiety experienced fewer symptoms once they engaged in text messaging therapy.
- A 2022 study found that text messaging therapy may reduce thoughts of suicide.
However, individual reports vary. People tend to either love this method or hate it. Think for yourself if it’s more important to speak to a focused therapist once a week or to have them available for texting throughout the week.
Pros and cons of text-messaging therapy
There are many pros and cons to text messaging and subscription-based mental health plans. Consider them all carefully as you decide what is the best choice for you.
Pros:
- Convenience and Accessibility: Text-messaging therapy provides the flexibility to connect with a therapist from the comfort of your own space whenever you want, without the constraints of a traditional office visit or scheduled session time. This level of accessibility can be especially beneficial for individuals with busy schedules, those who live in remote areas, or who can’t commit to a weekly therapy appointment.
- Asynchronous Communication: Text therapy allows for asynchronous communication, meaning you can reach out to your therapist at any time, providing a sense of ongoing support and the opportunity to express your thoughts and feelings as they arise.
(Pro tip: Make sure you check when your therapist is available to respond to messages and how often they will check the app. Some plans only guarantee 1 hour of texting time with your therapist, spread out throughout the week.)
- Comfort and Privacy: Engaging in therapy through text messages may offer a sense of comfort and privacy, allowing individuals to express themselves more openly and candidly.
Cons:
- Limitations of Non-Verbal Cues: Text-based communication lacks the nuances of verbal and non-verbal cues, which are an integral part of traditional therapy. This may lead to potential misunderstandings or challenges in fully understanding the emotions behind the text.
- Urgent Situations: In emergency or crisis situations that require immediate intervention, text messaging therapy may not provide the timely support needed compared to in-person or live video sessions.
Pro tip: Text messaging services are not a crisis service unless they specifically say so. The 988 mental health hotline or the Crisis Text Line (text HOME to 741741) are more equipped to handle emergencies but will call ambulatory services if there is immediate danger to yourself or others.
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- Technology Dependency: Engaging in text therapy relies on stable internet connections and functioning devices, which may pose challenges for individuals with limited access to technology or those who prefer face-to-face interactions.
- No proper exit plan: An “exit plan” is what therapists call their plan to transition their clients out of therapy. When you start therapy, you have a set of goals to accomplish. The therapists work with you until you meet those goals, and then begin to transition you out of therapy. Subscription-based plans are less likely to actively transition you out of therapy and therefore can create codependency on the services.
- Less personable: A common complaint with subscription-based mental health care services is that therapists feel more detached. Although the idea that you can text your therapist throughout the day is appealing, many people say they receive generic or short responses.
Online therapy vs in-person therapy vs subscription text mental health
Studies have found online therapy to be just as effective as in-person therapy, but most of these studies are only for online telehealth sessions. Telehealth therapy sessions are structured the same way as in-person therapy sessions: usually an hour of face-to-face with a licensed professional once a week. The only difference is online therapy is conducted over a video platform.
There are some extra considerations with online therapy. Nonverbal cues may be harder to read, so some people don’t feel as connected to their therapist. (Your therapist should always keep their video on; it’s just good practice!) Technological errors and malfunctions are always a possibility as well.
For in-person or virtual therapy (in which you have the standard one-hour therapy session over video conferencing) try the reputable Lifebulb Counseling and Therapy or Thriveworks, both companies that have been around for many years and are known for their quality (human) therapists.
At the end of the day, the most important thing is that you’re taking care of your mental health. Whatever plan works for you to achieve your goals is the right option for you.
