Buzz
Mental illness affects everyone differently, and for many, there are times when anxiety or depression symptoms intensify. One moment, I might be typing calmly, and the next, emotions begin to seep in. (I imagine it like the elderly couple in Titanic, lying in bed as water floods the room, aware of their impending fate...which, admittedly, doesn’t help with the depression.)
Despite having access to therapy and medication, there are moments when everything feels unbearable, and I wish I could message my therapist instantly (though I don’t). Occasionally, I turn to free online text or chat therapy services, and whether it’s a licensed therapist or an AI chatbot, it has provided relief.
But what about scheduling regular therapy sessions via text or chat? Is this approach effective or advisable? Could it be a viable option for those experiencing mental health challenges for the first time during the pandemic and trying to navigate this unfamiliar terrain? We consulted several mental health professionals to explore this further.
What does text- and chat-based therapy entail?
To begin with, the term 'therapy' can have various interpretations. In this context, we’re referring to conversations with a trained professional (or a computer) about your mental well-being. Rather than meeting a therapist in person or via teletherapy, clients and therapists communicate through text or online chat. We’ll explore both scenarios: text/chat-based therapy with a licensed human therapist and sessions where the 'therapist' is an AI-powered chatbot.
What advantages might it offer?
Before discussing the risks and limitations of this therapy format, let’s examine some of its potential benefits.
Ease of access and convenience
The primary advantage of text- and chat-based therapy, whether with human therapists or chatbots, lies in its accessibility. “Text-based therapy can extend its reach to more individuals by eliminating barriers related to time, cost, and location,” explains Dr. Sabrina Romanoff, a clinical psychologist at Lenox Hill Hospital in New York City, in an interview with Mytour.
This is particularly relevant during the pandemic, as it eliminates the need to leave your home or search for a local therapist who accepts your insurance, offers sliding-scale fees, and is open to new clients. Regardless of the pandemic, this approach is invaluable for those residing in areas where therapy services are scarce. Additionally, as Romanoff highlights, chatbot-based services are available 24/7, providing support whenever needed.
Cost-Effectiveness
Text- and chat-based therapy offers an affordable avenue for mental health support, especially for those who might otherwise struggle with the costs. “Apps and chat services are relatively low-cost, often featuring modest monthly fees or unlimited messaging options,” notes Dr. Scott Guerin, a developmental psychologist and adjunct professor at Kean University, in a discussion with Mytour. “In contrast, traditional live sessions can be expensive, even with insurance copays.”
Introduction to Therapy
For those curious about therapy and wanting to explore what such conversations entail, text- and chat-based therapy offers a practical starting point. “It serves as a gateway for individuals to test the waters of therapy, potentially inspiring them to pursue more traditional methods,” Romanoff explains.
Some individuals find writing or typing more comfortable
In today’s world, texting, emailing, or chatting online has become the standard mode of communication for many. Even if you didn’t grow up expressing emotions through text, you might now find it more natural than speaking on the phone. For some, phone calls can even trigger anxiety, making text-based therapy a preferable alternative.
Similarly, Romanoff notes that some people process their emotions more effectively through writing or typing. However, she suggests that if this method resonates with you, maintaining a journal might yield even greater benefits.
What are the potential risks or limitations?
When deciding on matters related to your mental or physical health, it’s crucial to evaluate the potential advantages and disadvantages of your options to determine the best choice. The risks and limitations of text- and chat-based therapy aren’t meant to discourage you but to provide important considerations as you make your decision.
Creating a tailored care plan
Before beginning in-person therapy, you’ll typically undergo an intake evaluation. This helps both you and the mental health professional identify key areas of focus and develop a personalized care plan suited to your needs.
“There are numerous therapy approaches, and the best way to determine which one suits you is by consulting a mental health professional who can assess your needs,” says Dr. Georgia Gaveras, co-founder and chief psychiatrist at Talkiatry, in an interview with Mytour. “While chat-based services might work for some, they may not be sufficient for others.”
Absence of facial expressions and vocal tone
Similar to other forms of written communication, text- and chat-based therapy can lead to misunderstandings, as it lacks the ability to convey facial expressions and tone.
“It’s essential to recognize that, despite the prevalence of digital communication, 70 to 93 percent of in-person communication is non-verbal,” Guerin explains. “Observing a client’s body language, facial expressions, gestures, and eye contact provides clinicians with invaluable insights as they evaluate the client, understand their concerns, and formulate a treatment plan.”
The absence of these non-verbal signals can be especially challenging when a person’s words don’t align with their true feelings, as Romanoff notes. This discrepancy often arises when patients withhold critical information—something therapists are more likely to detect in face-to-face interactions than through text. “This is particularly relevant for high-risk groups, such as those dealing with suicidal thoughts, abuse, or substance dependency.”
Gaveras also highlights that therapists rely on more than just facial expressions and tone to evaluate a patient’s condition. “For instance, if you injured your arm but the doctor couldn’t see it, diagnosing the severity would be nearly impossible,” she says. “In psychiatry, we gain significant insights from body language and facial cues. These help us assess self-care habits, signs of anxiety like nail-biting, or emotional states such as tearfulness.”
The impact extends to the person receiving therapy as well. “Whether during a scheduled session or an emergency contact, the way something is expressed is just as important as the content itself. This nuance is often lost in text-based communication, especially when relying solely on AI,” Gaveras adds.
For instance, a person with anxiety who tends to catastrophize might interpret a period at the end of a message from their therapist as aggressive (even though it’s unlikely), potentially heightening their anxiety and making them worry about whether they’ve upset the therapist or chatbot (try not to judge if you haven’t experienced this).
Genuineness
Romanoff also raises concerns about authenticity. “In face-to-face therapy, we urge patients to practice free association—expressing thoughts without filters or the editing that typically accompanies other forms of communication,” she explains. “Texting, however, erects barriers. The process of crafting a response, typing it, and seeing it on screen within the context of the conversation often leads to self-editing and censoring, leaving little room for genuine, unfiltered reactions compared to spoken communication.”
The absence of human interaction
When using AI-powered chatbots for therapy, you not only face the challenges mentioned above but also the inherent limitations of interacting with a machine rather than a human. “Starting therapy requires significant vulnerability and effort,” Romanoff notes. “Stepping into the role of a patient is no simple task.”
For many, therapy involves sharing deeply personal and painful experiences from their past—things they may not have even confided in their closest loved ones. Different individuals seek different outcomes from therapy. For some, disclosing their innermost fears and secrets to a computer program rather than a human therapist might feel less daunting. Others might find the act of simply releasing their thoughts to be the most therapeutic aspect, regardless of who—or what—is on the receiving end.
However, for others, the human connection—even through text or chat—is an essential component of the therapeutic process. “Feeling fully seen, heard, and supported while enduring emotional pain in the presence of another person is one of the most healing and reassuring elements of therapy,” Romanoff states. “There’s a significant loss when therapy shifts from human interaction to engagement with robots, as robots cannot truly empathize with our experiences in the way we need.”
Delays in communication
For some, the effectiveness of text- or chat-based therapy may be hindered by communication delays, which Romanoff notes can interrupt the therapeutic process. “A key factor in therapy’s effectiveness is the emotional intensity that accompanies spoken words, which is absent in text-based interactions,” she explains.
While many expect text-based therapy to mimic a real-time conversation, Romanoff points out that it often feels more like an email exchange. “The extended gaps between responses dilute the emotional tone and immediacy that were present when the message was initially sent,” she says. “As a result, the recipient interprets the response through a different emotional state and perspective, which can alter its impact.”
Trust is essential
Given concerns about data and privacy, it’s natural to feel cautious—or even skeptical—about therapy that requires you to trust the identity and qualifications of the person (or bot) on the other end.
“From an ethical standpoint, anyone entering a therapeutic relationship should feel assured that the environment is safe and their privacy is safeguarded,” Gaveras emphasizes. “Chat-based services must prioritize and deliver the highest level of security for their clients.” This underscores the importance of researching a site or provider thoroughly before making a choice (more on that shortly).
Does text- and chat-based therapy work?
By now, it’s clear that the effectiveness of this approach depends on an individual’s unique needs and how they prefer to express themselves and engage with the therapeutic process.
Guerin notes that text- and chat-based therapy can be effective for individuals with mild symptoms or those who have completed intensive counseling and now use it for maintenance or support. Gaveras adds that it can also serve as a helpful supplement for those already engaged in traditional therapy, particularly for treatments targeting anxiety or obsessive-compulsive disorder (OCD).
However, Guerin emphasizes that this approach isn’t suitable for everyone. “I don’t believe this type of therapy is appropriate for individuals with severe or chronic issues, those with a history of hospitalization for behavioral or emotional challenges, or people who rely on regular medication to maintain stability,” he explains.
Romanoff highlights that this is particularly concerning for individuals with complex diagnoses or symptoms who choose chatbot therapy. This is because such services often rely on cognitive behavioral therapy (CBT) techniques, which may not be ideal for everyone.
“These treatments are typically manual-driven and work best for individuals with straightforward, ‘cookie-cutter’ clinical profiles,” she says. “This includes those without preexisting conditions, co-occurring disorders, or complicated cases. In reality, no one fits such a simplistic mold, which is where the complexity and value of therapy lie. This limitation of CBT becomes even more pronounced in online settings.”
Ultimately, Gaveras remains hopeful about the potential of text- and chat-based therapy but stresses the need for further research. “While existing studies on these services have been limited in size and scope, the results are encouraging,” she says. “This is an area that warrants deeper exploration.”
How to choose a text- or chat-based therapy provider
If you’re considering text- or chat-based therapy but unsure how to find a provider that meets your needs, Guerin shares these recommendations:
Choose a provider that employs licensed therapists with a master’s degree or PhD. Ensure they are associated with a reputable organization and verify their academic credentials from an accredited institution.
Select a service or provider with expertise in addressing your specific concerns—such as depression, anxiety, or sleep disorders—and experience working with individuals similar to you, whether they are younger, older, students, retirees, etc.
Familiarize yourself with how the service operates, including interaction schedules, whether monthly plans are capped or unlimited, pricing, and session duration.
Avoid providers that require long-term contracts or significant financial commitments.
Ensure the provider has a clear confidentiality policy, including HIPAA compliance, and guarantees that your information won’t be misused or shared without consent. Protecting your privacy is essential.
Check how they handle serious issues. Do they provide emergency phone consultations or crisis support? What resources are available for someone experiencing thoughts of self-harm or harm to others?
Similar to in-person therapy, finding the right text- or chat-based service may require some experimentation and adjustment.
For more insights on mental health and online therapy, explore content from G/O Media’s partner.
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