It's a video call from your couch. Here's everything else you should know.
Online therapy is therapy. The 'online' part is just where you sit.
By the Digital Therapy Solutions team · Editorially reviewed · DTS Research Team · March 2026
What a typical session looks like — the actual mechanics
If you've never done online therapy before, the process probably feels abstract. Here's exactly what happens, step by step, from the moment you decide to try it.
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1Sign up on a platform
This usually takes 10 to 15 minutes. You'll fill out a questionnaire about what's bringing you in, what you're hoping to get out of therapy, any preferences about your therapist (gender, specialty, particular approach), and insurance information if you have it. Nothing invasive — just enough for the platform to understand your needs.
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2Get matched with a therapist
Depending on the platform, this can happen the same day or within a few days. Some platforms use algorithms; others have coordinators who read your intake and make a manual match. Either way, you're being paired with someone based on your stated needs and preferences.
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3Schedule a session
Most platforms offer real-time scheduling through an app or web portal. You pick a time that works for you. Sessions are typically offered from early morning through evening, and many platforms have evening and weekend availability.
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4The session itself
You'll spend 45 to 55 minutes in a video call (or phone call, if you prefer) with your therapist. You're in your space — your home, your car, wherever you feel comfortable. They're in theirs. It's just a conversation, structured like any in-person therapy session.
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5Between sessions
Depending on the platform, you might have access to unlimited messaging with your therapist, worksheets, journaling tools, or other resources. Some platforms offer these as supplements; others include them as standard.
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6Payment
You're typically billed weekly or monthly. If you have insurance, the platform handles the claims process on your behalf. You pay your copay (if applicable), and they handle the rest.
That's it. Nothing mysterious. If you've ever done a video call with a friend or colleague, you already know what the technology part feels like. The difference is that the person on the other end is trained to help you work through what's on your mind.
Video vs. phone vs. messaging — what's the difference
Not every session needs to be a video call. Platforms typically offer three formats. Here's the honest breakdown of when each one makes sense.
Video
The closest thing to in-person therapy. You see each other. Nonverbal communication matters — your therapist is reading your body language, your pace, how present you seem — and you're reading theirs. Most of the research on online therapy effectiveness is based on video sessions. For most people and most conditions, video is the standard choice.
Phone
Audio-only calls for days when you don't want to be on camera. Some people find it easier than video — there's less self-consciousness about how you look. The trade-off is that your therapist has less nonverbal information. But for many conditions and many people, phone sessions are just as effective.
Messaging therapy is useful as a supplement. As a replacement for live sessions, the evidence base is thinner — understand what you're choosing before committing to it as your only format.
Async messaging is available on platforms like BetterHelp. You write to your therapist when something comes up, and they respond once or twice daily. It's not real-time. This isn't a replacement for live sessions for most conditions — the research on async messaging therapy is much more limited compared to live formats.
| Format | What it's like | Best for | Not ideal for |
|---|---|---|---|
| Video | Real-time, face-to-face via webcam | Most conditions, building rapport | Poor internet connections |
| Phone | Real-time, voice only | Camera anxiety, accessibility | Complex trauma, severe conditions |
| Messaging | Async text exchange | Supplement to live sessions | Crisis support, acute symptoms |
How therapist matching works
This is usually where the anxiety kicks in: "What if I get the wrong therapist?" Fair question. Here's how most platforms approach it.
When you sign up, you fill out a questionnaire about your presenting concerns, what you're hoping to work on, and your preferences — therapist gender, specialty, therapeutic approach. The platform then uses an algorithm, a human coordinator, or some combination of both to match you with a therapist from their network.
You are never locked in. If the match doesn't feel right, you can request a different therapist. The relationship matters more than the credentials on the wall — if it doesn't click, that's important information, not failure.
Some platforms (like BetterHelp) auto-match you — fastest, least control on your end. Others let you browse therapist profiles and self-select who you want to work with. Both approaches work; it just depends on whether you want speed or more agency in the selection.
What does online therapy cost
This is the number-one question people ask, and for good reason. Therapy should be affordable. Here's what you're actually looking at.
Without insurance
Online-Therapy.com and Calmerry typically run $45 to $80 per week. BetterHelp and Talkspace are on the higher end at $69 to $109 per week. Many platforms offer sliding scale options or need-based discounts — BetterHelp has a formal financial assistance program.
With insurance
If you have coverage, most online therapy platforms work with major insurers. A typical copay is $20 to $50 per session — similar to what you'd pay in-person. Talkspace accepts Aetna, BCBS, Cigna, and UnitedHealthcare, among others. The platform handles the insurance claim; you pay your copay.
For a detailed breakdown of costs and platform-by-platform comparisons, check out our full cost guide. If you want to know specifically how your insurance covers online therapy, we've put together guides for Aetna, BCBS, Cigna, and UnitedHealthcare.
Is online therapy as effective as in-person?
This is the skeptic's question, and it's the right one to ask. If you're considering online therapy instead of in-person, you want to know it actually works.
If you're dealing with something that needs professional help but isn't a crisis, online therapy works. If you're in acute crisis, call 988 — that's what it's for.
References: Luo et al. (2020), J Med Internet Research; Andersson et al. (2014), World Psychiatry; APA (2023) Telehealth Guidance; Bouchard et al. (2021), Frontiers in Psychiatry.
When you're ready
You've read this far, which means you now know more than most people who sign up for online therapy. You understand the mechanics, the formats, the costs, and what the research actually says.
The next step isn't signing up for a platform. It's finding the right fit — for your specific situation, your insurance, your schedule, the way you prefer to work.
About Our Editorial Process
DTS Research Team Editorial
Anxiety Disorders · CBT · Telehealth Research
Every recommendation on this page was independently researched, cross-referenced against current clinical literature, and verified for accuracy by the DTS editorial team. Platforms are re-evaluated monthly.
We're not therapists — we're researchers who spent hundreds of hours comparing these platforms so you don't have to. This article is for informational purposes only. For professional guidance, please consult a licensed mental health provider. Pricing is based on our most recent research and may vary.