Something shifted in 2023. More people started therapy from their couches than ever before, and the platforms that delivered it got better — or at least louder. Worth adding: it wasn't dramatic. It was quiet. I keep hearing the same question from friends, coworkers, even my barber: "Is online therapy actually worth it, or is it just another subscription you forget to cancel?
Here's the short answer: it depends. But the longer answer is worth reading.
What Is Online Mental Health Practice in 2023
Let's just say it plainly. Online mental health practice is any mental health service delivered through a screen — video call, messaging app, phone session, or asynchronous platform. Teletherapy is the big umbrella term. But in 2023, it got a lot messier and more interesting than just Zoom sessions with your therapist Simple as that..
Registered nurses have been playing a bigger role here than most people realize. RNs in mental health don't replace psychologists or psychiatrists. Plus, they screen, they assess, they triage, they provide psychoeducation, and they connect people to the right level of care. They do something different. And increasingly, they're doing all of that remotely.
The Rise of Asynchronous Care
Here's something most people miss: not every good mental health interaction needs to happen in real time. Platforms like BetterHelp, Talkspace, and a growing number of nurse-led apps started offering text-based or asynchronous therapy in 2023. You send a message. Your provider responds when they can. Plus, you reflect between replies. On top of that, it's not for everyone. But for people who can't fit a 50-minute video call into their week, it's genuinely useful Practical, not theoretical..
Platform-Based vs. Private Practice
There's a real divide here. Some nurses and therapists work through large platforms that handle scheduling, billing, and marketing. Which means others run their own private virtual practices. The experience for the patient is wildly different depending on which model they end up in. More on that later It's one of those things that adds up..
Why It Matters
Why does this shift matter? Because access is still broken The details matter here..
In the US, roughly half of all counties don't have a single psychiatrist. Severity worsens. In real terms, by the time the appointment finally arrives, motivation drops. And for people with anxiety, depression, or trauma, waiting itself becomes a barrier. Wait times for traditional in-person therapy can stretch weeks or months. Rural areas are worse. People give up.
Online mental health practice in 2023 addressed that gap in a way that felt permanent rather than temporary. Because of that, cOVID pushed everything digital in 2020 and 2021. But 2023 is when it stopped being a workaround and started being a legitimate model. Insurance companies adjusted. And licensing boards loosened interstate rules in some states. And patients started choosing telehealth even when in-person options were available.
Real talk: for a lot of people, logging into a session from their bedroom feels safer than sitting in a waiting room. That's not weakness. That's self-awareness.
How It Works
So how does this actually function when you're sitting on the patient side? And what does it look like from the provider side — especially for an RN?
Finding a Provider
Most people start by searching. BetterHelp and Talkspace still dominate the ad space, but there are nurse-led startups, community health platforms, and sliding-scale options that show up on Google if you know what to look for. The short version is: look for someone licensed in your state, read a few bios, and pay attention to what they actually specialize in. "General therapist" can mean a lot of things That alone is useful..
The First Session
First sessions online tend to follow a similar rhythm. intake forms beforehand, a video call that runs 45 to 60 minutes, and a conversation that covers your history, current symptoms, goals, and what kind of support you're looking for. The provider — whether that's an RN, LPC, LMFT, or psychologist — is trying to figure out one thing: what level of care do you need right now?
That's where the nurse's role gets interesting. RNs doing mental health screening online often use validated tools — PHQ-9 for depression, GAD-7 for anxiety, PCL-5 for PTSD. They can flag risk factors like suicidal ideation or substance use and make referrals accordingly. Consider this: they're not diagnosing in the way a psychiatrist does. They're assessing and connecting.
People argue about this. Here's where I land on it.
Ongoing Sessions
After the first session, things vary. Some people do weekly video calls. Some get a mix of live and asynchronous messaging. Some use apps between sessions for mood tracking or CBT exercises. The best providers I've seen online don't just show up on camera and ask "how was your week." They use the platform to stay present. Check-ins, worksheets, short voice memos — it matters.
Billing and Insurance
This is where people get confused. Not all online therapy is covered the same way. And if you're paying out of pocket, expect to spend somewhere between $60 and $200 per session depending on the provider and platform. Some don't. Some platforms accept insurance. Some states require the provider to be licensed there, even for telehealth. Sliding scale options exist but you have to ask for them.
Common Mistakes
Honestly, this is the section I wish more articles included Not complicated — just consistent..
Picking Based on Price Alone
Cheap therapy that doesn't click is more expensive than slightly pricier therapy that actually works. Here's the thing — i've seen people bounce between three different online providers in two months because they chose the cheapest option each time. That's not saving money. That's burning through it.
Assuming Asynchronous Means "Easy"
Text-based therapy can be powerful. But it also requires you to be disciplined about writing your thoughts out. If you're not someone who processes well through writing, it'll feel surface-level no matter how skilled the provider is Nothing fancy..
Ignoring the Provider's Credentials
Not all "therapists" online are created equal. Some platforms let you filter by degree or specialty. Think about it: use those filters. An RN with mental health training is not the same as an unlicensed wellness coach calling themselves a therapist. Know the difference The details matter here..
Real talk — this step gets skipped all the time Worth keeping that in mind..
Expecting Instant Results
This one sounds obvious. But people still show up to their third session expecting to feel "fixed.That's why " Therapy isn't a software update. It's more like learning to play an instrument. Some days you practice and notice nothing. Then one Tuesday everything clicks Small thing, real impact. Which is the point..
Practical Tips
If you're considering online mental health care in 2023 or beyond, here's what I'd actually tell a friend.
Start with your needs, not the platform. If you need someone to help you manage panic attacks, find someone who specializes in anxiety — not someone who lists twelve modalities in their bio and hopes one sticks Turns out it matters..
Ask about their approach to crisis. Also, this matters more than people think. Does the provider have a plan? That said, if something goes wrong — a panic attack mid-session, a sudden suicidal thought — what happens? Can they connect you to emergency resources in real time? Good online providers have this figured out Simple, but easy to overlook. Which is the point..
Try one provider for at least four sessions before deciding it's not working. Four sessions gives both of you enough context to actually evaluate the fit.
And if you're a nurse considering this space — whether you're already in mental health or looking to pivot — know that there's real demand. Psychiatric mental health nursing, both in-person and remote, is growing. Consider this: the skills overlap more than people think: assessment, therapeutic communication, motivational interviewing, crisis intervention. You don't need a second degree to start. You need to be willing to learn the digital side of things, which is mostly just logistics.
FAQ
FAQ
Q: Can online therapy really be as effective as in-person?
A: Research consistently shows that for many conditions—especially anxiety, depression, and PTSD—online therapy can be as effective as in-person care, and sometimes even more so due to increased accessibility and reduced stigma. The key is matching the modality (video, phone, text) to your preferences and the clinician’s competence in delivering care remotely Simple, but easy to overlook..
Q: What if I don’t like my therapist after four sessions?
A: That’s completely normal—and common. Therapeutic fit is deeply personal. If you’ve given it a fair shot and still feel stuck, it’s okay to end the relationship respectfully and seek someone else. A good provider will support your search for a better match; a great one will even help you transition smoothly Which is the point..
Q: Are online sessions confidential?
A: Reputable platforms use HIPAA-compliant, encrypted video and messaging systems—just like secure portals in hospitals or clinics. Always verify that a provider uses a platform certified for telehealth in your state. Avoid services that rely solely on personal email or unsecured messaging apps.
Q: Can I use insurance?
A: Increasingly, yes. Many national and regional teletherapy platforms now accept major insurance plans, and even if they don’t, some offer superbill receipts for out-of-network reimbursement. Check your plan’s telehealth coverage before signing up—some insurers still treat online care as “elective.”
Q: What if I need medication?
A: Some teletherapy platforms integrate psychiatric services, allowing you to consult with a prescriber (like a PMHNP or psychiatrist) alongside your therapist. If your provider doesn’t offer this, they should be able to refer you to a trusted partner. Never start or stop psychiatric medication without professional guidance.
Q: Is this just for “mild” issues?
A: Not at all. While online therapy is great for prevention and early intervention, it’s increasingly used for complex, chronic conditions—especially when combined with in-person care when needed. Many people use it to maintain gains after intensive outpatient or residential treatment.
Q: What if I’m not tech-savvy?
A: Most platforms are designed with simplicity in mind—many require only a smartphone or laptop and a stable internet connection. Providers often offer tech support, and some even provide orientation sessions. If digital barriers feel overwhelming, ask about hybrid options (e.g., phone-only sessions) or in-person follow-ups.
Q: How do I know if I’m ready for online therapy?
A: Ask yourself: Do I have a private, quiet space where I won’t be interrupted? Am I emotionally stable enough to engage deeply—even when it’s uncomfortable? Do I trust that I can build rapport remotely? If most answers are yes, you’re likely ready. If not, that’s okay—therapy can wait until conditions support it That alone is useful..
Final Thought
Online mental health care isn’t a replacement for all in-person services, nor is it a magic fix. But when approached with intention, discernment, and realistic expectations, it can be one of the most empowering steps toward well-being—especially for those who’ve fallen through the cracks of traditional systems. The goal isn’t just to access care, but to connect with it: with yourself, with a skilled guide, and with the possibility of lasting change And it works..
