The State of Online Mental Health Practice in 2023: What Actually Works
The therapy room went digital almost overnight. And honestly? By 2023, online mental health practice wasn't just a pandemic workaround — it had become the new normal. Millions of people now attend therapy from their couch, their car, or their office during lunch break. A lot of them prefer it that way.
If you're a mental health professional figuring out how to build or grow an online practice, there's good news and hard news. The demand is massive. Worth adding: the competition is too. And the rules have changed And that's really what it comes down to. But it adds up..
Here's what actually matters in 2023.
What Online Mental Health Practice Actually Means in 2023
Let's get specific. When we talk about online mental health practice, we're covering a few different things:
Telehealth therapy — live video sessions with clients, the most common format. This is what most people mean when they say "online therapy."
Asynchronous care — text-based therapy, messaging platforms, app-based check-ins. Some clients never see their therapist's face. They text, they get responses. It's controversial, but it's growing.
Hybrid models — some in-person, some online. Many practices now offer both, letting clients choose based on what they need that week.
Digital mental health tools — apps, worksheets, guided meditations, AI-powered chatbots. Some therapists recommend these as adjuncts to care. Others build entire businesses around them.
The common thread? Technology is the delivery method. Everything else — the therapeutic relationship, the clinical work, the ethics — still applies.
Why the Shift Stuck
People often ask why online practice didn't fade once lockdowns ended. Here's the thing — it solved problems that were already there.
Clients who lived far from specialists can now access them. Working parents can squeeze in a 3 PM session without commuting. In real terms, people with social anxiety find video less intimidating than a waiting room. Rural communities — historically underserved — finally have options It's one of those things that adds up..
The convenience factor is real. But it's not just about ease. Research now shows that for many conditions, online therapy works about as well as in-person. The outcomes are comparable. Consider this: that evidence base didn't exist in 2019. Now it does Took long enough..
Why It Matters — For Clients and Practitioners Alike
If you're a therapist considering an online practice (or trying to figure out how to make yours work better), the stakes are higher than you might think.
The market exploded. Teladoc, BetterHelp, Talkspace — these platforms raised billions and brought therapy to people who'd never considered it. They've also normalized the idea that therapy can happen on a screen. That's opened the door for private practitioners too. More people are willing to try online therapy now. That's a rising tide.
But the competition is brutal. Every therapist with a webcam is now competing not just with the therapist down the street, but with the app, the online platform, and the coach who calls themselves a "therapist" on Instagram. Differentiation matters more than ever That's the part that actually makes a difference..
Regulations are still catching up. Licensing across state lines, HIPAA compliance, informed consent for telehealth — the rules exist, but they're inconsistent and change often. What worked last year might need updating this year That's the whole idea..
Burnout is a real risk. Online practice can blur boundaries. Your living room is your office. Your phone is always there. Some therapists find this harder to manage than a physical practice with set hours Surprisingly effective..
What Clients Actually Want
Here's what most guides get wrong: they focus on what therapists want from online practice, not what clients need.
Clients want:
- Convenience — easy scheduling, minimal friction, sessions that fit their life
- Privacy — discrete, secure, no running into neighbors in a waiting room
- Choice — ability to switch therapists if it's not a good fit, without the awkwardness of in-person
- Affordability — online often costs less, and clients know it
- Connection — they still want to feel seen, heard, and understood. The screen doesn't change that.
How to Build (or Strengthen) an Online Mental Health Practice
Let's get practical. Whether you're starting from scratch or trying to level up an existing online practice, here's what actually works Nothing fancy..
Step 1: Get the Basics Right
Before you market a single client, lock down the fundamentals:
- Licensing — Know the rules for your state. If you want to see clients in other states, you need to be licensed there (or use an interstate compact, if your state participates). This isn't optional. It's the law.
- HIPAA compliance — Use HIPAA-compliant video platforms. Regular Zoom or FaceTime won't cut it. Look at platforms like SimplePractice, TherapyNotes, or Doxy.me that are built for healthcare.
- Informed consent — Your consent forms need to cover telehealth specifically. Include things like: What happens if the technology fails? How do you handle emergencies remotely? What are the limits of online therapy?
- Professional liability insurance — Make sure your policy covers telehealth. Most do now, but double-check.
Step 2: Set Up Your Space (Yes, Really)
Worth mentioning: most underrated aspects of online practice is your physical setup.
Your background matters. Clients notice whether your space looks professional, cluttered, or distracting. You don't need a full studio — a clean, neutral background with good lighting goes a long way.
Sound matters more. Echo, background noise, poor audio quality — these undermine the therapeutic relationship more than most therapists realize. A decent microphone and some acoustic tweaks (even a simple curtain behind you) can make sessions feel completely different.
And here's the thing most people skip: test your tech before every session. Know how to troubleshoot if something freezes. Plus, have a backup plan. Nothing kills the therapeutic vibe like you fumbling with settings while a client waits.
Step 3: Market Without Being "That Person"
Marketing for therapists is tricky. You want to reach people who need help, but you don't want to come across as salesy or desperate. Here's what works:
Content that actually helps. Blog posts, videos, social media posts that answer real questions people have. Not "Book a session with me" — but "Here's what anxiety actually feels like, and here's when it might be time to talk to someone."
Google Business Profile. If you want local clients (even for online practice), this is essential. Show up in local searches.
Referrals. The most reliable source of clients for most therapists. Make it easy for current clients to refer others. Stay in touch with professionals who might refer (doctors, HR departments, school counselors).
Directories. Psychology Today is the big one. Keep your profile updated, professional, and specific. Don't just list your credentials — explain who you work with and how.
Step 4: Build the Relationship Differently
Online therapy isn't just in-person therapy through a screen. The dynamic is different. Some things to consider:
Eye contact is harder. Looking at the camera (not the screen) simulates eye contact, but it means you can't see yourself. This takes practice Worth keeping that in mind. That alone is useful..
Reading body language is harder. You're seeing less of the client. Pay attention to what's visible — hand movements, changes in lighting (are they in a different room?), voice tone shifts.
Silence feels different. In person, silence has a physical presence. On video, it can feel awkward or like the call dropped. Some therapists are more comfortable with verbal check-ins: "Take your time — I'm here."
Pacing matters. Some clients talk differently on video. Some overshare because they feel "safer" at a distance. Some hold back. Pay attention and adjust.
Common Mistakes That Hold Therapists Back
After watching hundreds of therapists try to build online practices, certain mistakes come up over and over:
Underpricing. Many therapists new to online practice charge less than they would for in-person, assuming clients won't pay as much. Sometimes that's true. Often it's not. Don't sell yourself short.
Neglecting the business side. Therapists are trained in clinical work, not marketing, billing, or systems. But an online practice is still a business. If you hate that part, either outsource it or accept that your practice will stay small.
Using consumer-grade tools. That free Zoom account might work for coffee with a friend. It's not appropriate for clinical work. Invest in proper platforms.
Ignoring boundaries. When your practice lives on your phone, it's easy to check messages at 10 PM. Or answer emails on vacation. Or feel like you need to be "on" constantly. Set clear hours. Use separate devices or accounts if needed. Protect your downtime.
Failing to adapt clinically. Some therapists try to replicate their in-person approach exactly and wonder why it feels off. Online therapy requires some adjustments — in how you build rapport, how you handle crises, how you read the room (the virtual room) Easy to understand, harder to ignore..
What Actually Works: Practical Tips
A few things I'd recommend if you're serious about building a sustainable online practice:
Start with one platform and master it. Don't try to be everywhere at once. Pick your EHR, your video tool, your scheduling system. Learn them well. Add more only when you need to.
Create systems. Automated intake forms. Template consent documents. A consistent onboarding process. Systems save time and reduce errors.
Collect feedback. Ask clients how it's going. Not just at the end — periodically. Is the video quality good for them? Do they feel the sessions are helpful? You'd be surprised what you learn.
Invest in continuing education. Telehealth-specific training exists. It's worth it. Look for courses that cover the clinical side of online practice, not just the technical side The details matter here..
Plan for the hard days. Technology fails. Internet goes down. Clients have crises remotely. Have protocols. Know what to do when things go wrong.
FAQ
Is online therapy as effective as in-person therapy?
For many conditions, research shows comparable outcomes. Some clients do better online; some do better in person. Depression, anxiety, PTSD — these have been studied fairly well in telehealth formats. The therapeutic relationship matters most, regardless of format.
Do I need special licensing to do telehealth across state lines?
Yes. Here's the thing — you generally need to be licensed in the state where the client is physically located during the session. Some states participate in the Interstate Medical Licensure Compact or similar agreements for other professions, which can speed up the process. Check the rules for your specific license type and the states involved Easy to understand, harder to ignore..
What platform should I use for online therapy sessions?
Look for HIPAA-compliant options designed for healthcare. me, and Zoom for Healthcare are common choices. SimplePractice, TherapyNotes, Doxy.Avoid consumer-grade free tools for clinical work.
How do I handle a client crisis during an online session?
Have a protocol before it happens. Know the client's location (you should have this in your intake). Have local crisis resources ready for wherever your clients are. Know when to call emergency services. Have a backup communication method if the video call drops.
Can I build a full-time practice doing only online therapy?
Absolutely. Also, many therapists do. It requires the same business fundamentals as any private practice — marketing, systems, client retention — but the logistics are different. It can be more flexible and have lower overhead than a traditional practice.
The Bottom Line
Online mental health practice in 2023 isn't a niche anymore. It's a major part of how therapy happens. The therapists who thrive in this space are the ones who treat it as its own discipline — not just a convenient way to do what they've always done.
Get the tech right. And remember: the screen is just the room. Get the business side right. Get the clinical adaptations right. Everything else — the trust, the hard work, the relationship — that's still on you.
