Online mental health care: What you need to know

It is very likely that you will google yourself into a discrete psychotherapy session with an online service provider before you physically set foot in a psychotherapist’s office.

This is not alarming, considering that a lot of the goods and services that we seek can be purchased online. Psychotherapy is one such service. Businesses that understand this have started providing online counseling and psychotherapy services. But they are doing so poorly, and the cost will be borne by their clients who will be caught at their most vulnerable moments.

Online counseling/therapy works much like in-person counseling/therapy, but ignores a mutual physical presence of client and counselor or therapist. This is a huge loss, but one that can be compensated for by a skilled and trained professional. However, on almost all the websites that I have come across off late, and there is a growing number, the “therapists” and “counselors” listed did not seem to have the necessary skills and training, nor adequate education and experience.

Please do not seek therapy or counseling from such “professionals.”

In trying to write this article, I kept wondering if it was alright that such services, or rather businesses, are making their way into the market. After all, they are doing something in a space where no one else is doing anything. They are providing affordable and accessible mental health care. But as I said this to myself, I realized that this line of reasoning was flawed because had they actually been providing “mental health care,” this problem would not have presented itself. They are actually not providing mental health care at all. Unfortunately, they have developed a number of phrases that convince you that they are. Here’s what you’ll read and mistake for psychotherapy: empathetic listening, here for you, your friend always (I’m making these up to avoid calling out the real “businesses” at this stage).

Good mental health care is more than just a caring conversation. It involves a professional who has trained rigorously in therapeutic techniques, who has undergone a severe examination of their own problems, who follows the structure and ethics of psychotherapy.

Patient conversations and advice-giving by well intentioned people do not make for psychotherapy.

Consider a nervous breakdown, a confession to doing something illegal, a desire to harm themselves or someone else. Now imagine all this being received by a young, early 20s “professional” on the other line, fresh out of a master’s program, with little or no training.

Consider how a “fresher” with insufficient training and no supervision receives a call about conflicted sexuality, domestic or other abuse, substance problems, and other ailments such as, say, depression, obsessive-compulsive disorder – diagnosed or not. How will this information be received and dealt with? How will they “help?” Is there a system in place that will ensure that they recognize and declare their lack of competence, if necessary, and refer you to a trained therapist?

Consider how the person listening to you is processing your very private information. What rule is ensuring that they aren’t speaking to 10-15 different people a day? The best counselors or therapists can nary do more than 5-7 a day, by which time they’re emotionally drained, and unable to be effective therapists. And how are they managing all this emotional baggage within themselves?

And lastly, consider how your information is being kept private? Who has access to it and is this with your permission? Is your conversation being recorded in anyway? Is the software being used to communicate with you encrypted? Will your information be shared with other parties for market research and targeted advertising?

I’m concerned therefore that the promise being made of providing quality care is not the service being offered.

Since there are no laws governing who can provide such services and a glaring lack of public awareness about mental health care, this space is easy for a business to occupy. The potential for financial success is huge. But the fact that our country’s education and training systems are not ready to provide mental health care for a population this size, does not provide license to businesses to fill that gap with freshers or people with inadequate education, training, experience and supervision.

With this in mind, I do believe that businesses providing mental health care services online can and should make money, but without compromising on the quality of care. There are several existing models of providing affordable mental health care that can be adopted to cater to different economic sections of society. The core of any business capitalizing on mental health care should firmly and only be care for the clients’ (read: target audience’s) mental health.

In the meantime, as a potential user, please remember that therapy and counseling go much beyond patient listening. There are techniques that professionals train in that enable them to help you make sense of your situation and empower you to resolve the problem yourself. They are also trained to understand and assimilate psychiatric diagnoses and medication into your therapy. If you’re seeking help for mental health concerns from an online channel, then please ask with confidence for the education and experience of your service provider. Ask them to explain their process. Please also check how long they hope to see you for (therapy is a finite process for most) and what are the takeaways that you can hope you gain from the process.

They owe you a guarantee of the best care that they can provide, which includes their own education, training and ongoing supervision.

There is nothing wrong with using technology to reach people; in fact, it is to be encouraged. Nor is there a problem with monetizing the provision of mental health care. But there is certainly an issue with substituting and selling conversations for professional care.


My thanks to Arpita Bohra for helping me think through this article.

 PS: I have no gains, financial or otherwise, to be had from the success or failure of any healthcare businesses.

1 comment

  1. Very interesting and well written! I think there is so much of truth in what you are saying, and people should be empowered and educated to make decisions about the care they receive be it online or offline.

    Thank you for bringing this issue out into the open!

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