You have finally made up your mind to go to therapy. Then the second decision hits: do you sit in a waiting room with strangers, or do you just… log in from your couch? For most people today, that second option isn’t a compromise; it’s the preferred choice. However, it has its own set of questions. What platform will it be based on? Are special equipment required? Will a therapist actually be able to help you through a screen the way they would in person?
It’s totally normal if you’ve never done therapy before or you have, but not on the internet. This guide will address all of the above and will create an understanding of how telehealth therapy works from start to finish, what will happen during the first appointment, and questions that most people are too nervous to ask before logging on.
What Is Telehealth Therapy, Exactly?
Telehealth therapy, also known as “teletherapy,” “online therapy,” or “virtual counseling,” is the provision of mental health services remotely, via video conferencing, phone calls, or secure messages, instead of in-person appointments. It applies the same therapeutic techniques as traditional therapy based on evidence, such as CBT (cognitive behavioral therapy), DBT (dialectical behavior therapy), and psychodynamic therapy, but does so through the medium of virtual reality.
According to the Journal of Affective Disorders, the American Psychological Association, and other journals, Telehealth therapy has been shown to yield similar results as in-person therapy for many conditions including anxiety, stress, depression, and more. The format shifted completely in usage during the Covid-19 pandemic, and it’s since become a mainstream and clinically accepted method, not to replace, but a viable and acceptable method of delivery.
Why People Choose Telehealth Over In-Person Therapy
Knowing the appeal helps explain why telehealth has remained popular, long after the conditions that popularized it:
- Accessibility: No commute, no sitting in traffic or waiting room, which is important for those with a balance of work, caregiving or limited mobility.
- You may not be limited to those in the same area you can match with a provider based on specialty and fit, not location (same state because of licensure requirements).
- Familiarity: When many clients are in a familiar place, they may be less anxious to begin their first session and open up earlier.
- Consistency Sessions do not involve leaving home, so there is less chance of missed sessions because of the weather, transportation problems, or minor illness.
- For others, privacy is a factor that means they may be less inhibited by the stigma that can prevent people from seeking treatment in the first place, given a lack of physical waiting room.
But none of this is to say that telehealth is always “better” than face-to-face care, it just eliminates a few of the logistical hurdles that can stop people from seeking and maintaining treatment.
Before Your First Session: Scheduling and Setup
Choosing a Therapist and Booking
Most telehealth counselling platforms also let one check therapist profiles and narrow down to their specialty, and book directly on the website (anxiety, trauma, couples counselling, grief, stress management etc.). Many practices, like Lovely Day Counseling, will provide a brief intake call or consultation first, allowing you to ask questions and determine if this therapist’s approach is a good fit for you prior to committing to a full session.
Completing Intake Paperwork
You’ll likely complete intake forms that include information about your health history, concerns you are seeking resolution for, emergency contact details, and consent forms before the first session, usually via a secure client portal. This happens in all therapy (face-to-face or virtual), but with telehealth it typically happens electronically prior to the session, which can save time during the real therapy.
Technical Requirements
Most platforms require only a few basics:
- A stable internet connection
- A device with a camera and microphone (laptop, tablet, or smartphone)
- A private, quiet space where you won’t be interrupted
- Headphones, if you want an added layer of privacy
Reputable providers use HIPAA-compliant video platforms, meaning the software meets federal privacy and security standards for protected health information. This is worth confirming with any provider you’re considering, since not all general-purpose video call tools meet this bar.
Creating the Right Environment
A small but often overlooked part of preparation is the physical space itself. Having a door that can close, letting people know in your house that you don’t need to be interrupted and trying out your camera and audio a couple of minutes in advance can help to alleviate anxiety about the first session meaningfully. Some clients also prefer to have water at their fingertips and a notebook to make some notes during or after the conversation.
What Actually Happens During the First Session
It Starts With an Intake Assessment
The initial session is different from the continuous sessions. Instead of immediately getting into problem solving, most therapists will use the first session which is sometimes referred to as an intake session or initial assessment to learn more about your background, what you are worried about, and where you would like to go. Expect questions about:
- What brought you to therapy right now
- Relevant history (family, medical, relationship, work)
- Current symptoms and how long they’ve been present
- Past experiences with therapy or medication, if any
- What you’re hoping to get out of treatment
This is not a test – there are no right or wrong answers. The idea is for the therapist to learn enough about your situation so that they would be able to adapt an approach to best fit your situation, and not to follow a generic approach.
Building Therapeutic Rapport Remotely
A typical question is if therapeutic rapport, the trust and bond between client and therapist, can be established through video conferencing as well as in person. In terms of clinical research, this has been reassuring: a comparison of therapeutic alliance scores from in-person to telehealth modalities has shown no significant difference in the majority of studies. Many clients say it’s easier to open up in a familiar comfortable setting, rather than in an unfamiliar office setting.
However, regardless, rapport building is a process that is either a session or two. Don’t expect the first session to be super intense, it’s just natural that it is a bit more of a trial, that’s how it should be, and it doesn’t mean it’s not working.
Discussing Confidentiality and Its Limits
Therapists must take the time to discuss confidentiality and its legal boundaries early in the therapy (usually during the first session). This is in line with the exceptions that would be allowed in a face-to-face therapy: risk of harm to self or others; suspected abuse of a minor or vulnerable person. Additionally, therapists will typically verify where you are physically when you’re in session with them, because therapists need to be licensed in the state they are practicing in, which is the state you are in during the session in the U.S.
How Telehealth Compares to In-Person Therapy
A good question; what do you lose in translation from office to screen? The truth is that, on most fronts, talk therapy has little effect. Verbal communication, tone, and the therapeutic conversation itself translate directly. Mostly logistical changes a therapist can’t see your body language as easily, and some specialized interventions (such as some somatic or exposure-based techniques) may be adjusted online.
With most individuals seeking help for stress, anxiety, depression, life changes or relationship issues, such differences don’t really matter. Telehealth-trained therapists adapt their approaches accordingly and with many clients, the form is sometimes more effective, after a period of getting used to the experience.
After the First Session: What Comes Next
After the initial intake, the majority of therapists will provide some general idea of how often sessions will be held (typically once or twice per week to begin with), what the therapeutic approach will be, and some initial goals. This treatment plan is not set in stone and will change as the therapy continues and as the therapist learns the best, so this is a natural process.
Also, the right fit can sometimes be more of a trial and error. If the initial session doesn’t seem like a good fit, most good platforms will make it easy to change therapists without having to begin the intake process again – client comfort and fit is more important than finishing out of obligation with the first therapist assigned.
Getting Started With Telehealth Therapy
Now that telehealth therapy has become a well-known and proven method to get mental health help, it provides even more convenience than in-person therapy in terms of location, comfort, and scheduling. The first session is predictable, with an intake form completed prior to the session, an assessment conversation and confidentiality/disposition, and all done securely via a HIPAA compliant platform.
Lovely Day Counseling provides online counseling sessions that strive to do just this – deliver accessible, structured, first-session counseling and matching with a licensed therapist who fits your style of counseling. Scheduling an initial consultation is a low-pressure option to figure out what taking the first step toward therapy looks like.