Octave Online Therapy Review

Online therapy has grown in recent years, largely due to the COVID-19 pandemic. After our collective culture began to adopt virtual meetings in lieu of in-person gatherings, the mental health industry followed suit. In turn, many virtual therapy platforms have been created to meet the rising demand for accessible care. 

However, physically accessing services isn’t the only hindrance to accessible care. Finances also stand as a major obstacle when it comes to receiving psychotherapy. According to our 2022 Cost of Therapy Survey, 71% of people use their insurance to access therapy, but they are left with an average of $178 in out-of-pocket expenses every month. As of 2020, the median household income in the United States was $67,521. Depending on the number of individuals in the household and keeping in mind our nation’s rising cost of living, $178 a month may be cost-prohibitive for some. 

This is where Octave’s online therapy services come in. Octave is a psychotherapy company that aims to make mental health care sustainable for both therapy seekers and therapy providers by accepting employer-sponsored insurance plans and offering competitive compensation packages for therapists. 

We reviewed Octave by surveying 105 Octave clients on their experiences, researching the company’s history and practices, using its services, interviewing an Octave therapist, and asking our subject matter expert to weigh in with their impressions of the service. Read on to find out how the company stacks up against its competitors. 

What Is Octave?

Octave is a therapy practice that was founded in 2018 by Sandeep Acharya. It initially aimed to offer attainable therapy through insurance coverage. However, the COVID-19 pandemic led Acharya to pivot this plan, turning the company into a digital-focused mental health organization. 

Octave aims to set itself apart by accepting health insurance and maintaining a focus on providing quality care. Attempting to find a therapist through one’s insurance company is typically arduous, with many insurance companies giving you a long list of in-network providers that you have to call individually—a process that takes up quite a bit of time and can lead to a lot of dead ends. 

When we surveyed Octave users, overall cost and acceptance of insurance was a considerable selling point. Twenty-nine percent of folks surveyed chose Octave due to its overall cost, while 23% chose it because it accepts insurance. This isn’t without limitations, however. Octave only accepts a few insurance plans—so while it is great for some with very specific health insurance plans, it inevitably isn’t an option for many. 

What Services Does Octave Offer?

Octave offers individual, couples, family, and group therapy. It also provides workshops focused on mental health skill-building that licensed psychotherapists lead. It has providers who are licensed clinical social workers, psychologists, and licensed marriage and family therapists, as well as licensed professional counselors. Its services are available in California, Connecticut, Florida, New Jersey, New York, Texas, and Washington D.C. While the company has physical offices in San Francisco, Oakland, Los Angeles, and New York, all services are virtual until further notice due to COVID-19. 

Those with a marginalized identity may feel especially seen—Octave includes providers who are members of marginalized communities and specialize in racial trauma, LGBTQ+ issues, and trans issues. 

Other provider specialties include:

• ADHD
• Anxiety
• Bipolar disorder
• Burnout
• Chronic illness
• Depression
• Eating disorders
• Family conflict
• Grief
• Immigration
• Domestic violence
• Life transitions
• OCD
• Panic
• Personality disorders
• Phobias 
• Pregnancy
• Self-harm
• Sexual trauma
• Sleep
• Stress
• Substance use
• Trauma
• Women's issues 

The types of therapy used are incredibly diverse—from cognitive behavioral therapy (CBT) to eye movement desensitization and reprocessing (EMDR) to acceptance and commitment therapy (ACT); there is something for everyone. If you prefer your sessions to be in a language other than English, Octave may also be a great option—there are 20 different provider language options.

How Much Does Octave Cost?

Octave’s session fees are based on the type of service rendered and location of the client. Individual therapy ranges from $170 to $250 per session, couples or family therapy ranges from $190 to $275 per session, and group therapy averages about $75 per session. To provide a more specific estimate, Octave offers a cost estimator. You simply enter your insurance provider and state of residence to receive a specific estimate of your cost per visit. 

Unfortunately, you are not given an exact session cost until you have been matched with a provider. I found this very off-putting—finances can be a crucial factor in finding care. 

Does Octave Take Insurance? 

Yes, as noted above, one of Octave’s most significant selling points is that its therapists accept insurance; however, they only accept a few plans. 

Octave is only in-network with employer-sponsored plans, which is a considerable limitation. 

The insurance plans accepted also depend on what state you live in. For example, in California, Octave accepts Anthem Blue Cross of California and Health Net and Managed Health Network (MHN). In New York, it is in-network with United Healthcare UMR plan for Mount Sinai employees. Octave accepts Aetna regardless of the state. It does not accept Medicaid or Medicare. While we love the spirit of Octave accepting insurance as a form of making therapy accessible, it definitely falls short of this mission here. 

Navigating the Octave Website

The Octave homepage feels warm and easy to navigate, thanks to its neutral color palette and strengths-focused language. It features the tagline, “Mental health, built around you,” next to an image of a stylish therapy office. 

The landing page has a call-to-action inviting you to start the therapy process, making it easy to move forward with services. There is also information on why people should choose Octave, including insurance, a statistic citing a 37% reduction in depressive symptoms over three months with its therapists, and a structured assessment leading to a personalized treatment plan. 

It is worth noting that this emphasis on symptom reduction within three months can be misleading. Many conditions, like post-traumatic stress disorder (PTSD), may see some relief within three months, but it can ultimately take years to reach lasting relief. 

One of our subject matter experts, Hannah Owens, LMSW, also noticed the potential confusion this brings up. 

“Octave mentions multiple times on its homepage that it is goal-oriented, but does not explain what this means or what this would look like in therapy,” she says. This lack of clarity may lead potential clients to expect a “quick fix” when entering therapy.

Octave’s website also features a blog with well-written content on mental health topics, including mindfulness, addiction, cultural humility, boundaries, and burnout. The articles are research-driven, and some feature insight from Octave therapists. 

There aren’t any accessibility features on the landing page, which I found disappointing. It would have been great to see options to change the screen’s colors or receive audio of the webpage contents for those who are visually impaired. In addition, I would have appreciated options to translate the page into different languages, especially since the service has providers who speak languages other than English. 

How Do You Sign Up for Therapy at Octave?

Signing up for therapy at Octave is straightforward. 

After clicking on the “get started” button on the landing page, you are taken to a page that gives you a quick overview of what to expect during the sign-up process. It lists four steps: 

1. Gather basic information.
2. Complete a questionnaire about the care you’re seeking.
3. Answer some questions about your mental health background.
4. Get matched with a provider.

The intake questionnaire includes questions about identity, past experiences in therapy, areas of concern, and the main reason for seeking treatment. It asks if your partner is seeing an Octave therapist as well to ensure you’re not matched with the same therapist as them. I loved this detail. As a psychotherapist reviewing this company, it made me feel confident that Octave takes its ethical obligations seriously. 

Octave doesn’t offer a private user portal, which I found a bit frustrating. After completing the intake questionnaires and signing off on the informed consent, I wanted to be able to access them for future reference. This is good practice so both the client and therapist can track how their symptoms and issues have shifted since beginning therapy. However, I was unable to do so without a patient portal. 

Once you complete your questionnaire, an Octave care navigator will be your point of contact for the rest of the process, from billing and scheduling to matching and switching therapists. 

Matching With a Therapist

On Octave’s homepage, you can head over to the navigation bar in the upper right-hand corner and click “Meet the Team” to see a complete list of their providers. 

However, when clicking on each provider, it stood out to me that I could not select one as my therapist. Instead, Octave will matches each client with a therapist based on intake information. While I appreciated having the ability to get a preview of the types of therapists available, it did seem odd that there wasn’t an option for me to request a session directly from their bio page—or at the very least, request a specific therapist at the end of my intake form. 

While the matching process can take seven to 10 business days, I was pleasantly surprised to find that I was matched with a provider within 48 hours. I found the therapist I matched with to be a great fit—they met all the qualifications I had listed, and even their temperament was a good match for my personality. 

At this point, I was taken aback by how easy Octave made finding a qualified therapist. And I am not the only one. Forty-seven percent of Octave therapy seekers found finding a therapist very easy. Thirty percent found the process easy, and another 20% found it to be neither easy nor difficult but relatively neutral. 

According to a current Octave therapist who requested to remain anonymous when I interviewed them, Octave's matching service is unique because it doesn’t rely on an algorithm. Instead, the company has its care navigators match each client with a therapist. 

That being said, this therapist was disappointed that there isn’t greater transparency regarding the number of clients seeking providers. Transparency like this among providers allows them to see how many clients have signed up for the platform and are awaiting a match. This could help create a deeper sense of trust and enable therapists to see how in demand their specific set of qualifications and experience is. 

How Do Therapy Sessions Work at Octave?

All therapy at Octave takes place over live video session. 

Once you're matched with a provider, you are sent an appointment confirmation email with a link to your session. Octave didn’t provide me with my therapist’s email or phone number, though my therapist did give me a call shortly after the care navigator confirmed my session to say hello and let me know I was welcome to reach out to them with any questions. I did text them a scheduling question—I received a response the same day, and then they followed up over email. 

You receive two email reminders about your appointment: One is sent two days before your appointment, the other is sent two hours before the appointment. 

According to its website, sessions are typically about 45 minutes long but may vary by provider. In my experience, my therapist asked if I was open to extending our sessions by about 10 minutes to include an ending mindfulness exercise. They did not charge me for the extra time, which was a nice touch. 

What Happens If I Miss a Session at Octave?

Octave’s cancellation policy is standard—if you cancel or miss a session with less than 24 hours notice, you will be charged a $100 cancellation fee to your credit card on file. 

Switching Therapists at Octave

If you do not like the therapist you are matched with, you can request a change; but to switch, you must reach out to an Octave care navigator. They will then alert your current therapist about the requested switch. 

In my case, after my therapist was alerted, they sent me a text requesting any feedback that triggered the shift. While it is wonderful they wanted feedback, I imagine an experience like this could negatively impact someone who struggles with boundaries or people-pleasing. It also may be a bit overwhelming for a therapy newcomer.

The switching process felt clunky because once you request to switch therapists, you are back to waiting for them to match you with a new provider. In my case, after my request to switch, there was a two-week wait to see someone new who met my requested criteria. 

While Octave’s care navigators were very kind and thorough, there was something that felt a bit impersonal about coordinating scheduling, billing, and therapist changes through them. Each time I reached out to a care navigator with a general billing or scheduling question, I would later receive an automated email asking me to rate my customer support experience, which, frankly, was too reminiscent of retail customer service practices. 

Pausing or Canceling Therapy at Octave

Canceling therapy at Octave is very simple. You can let a care navigator know that you do not want to continue therapy and request they cancel your sessions. However, you must cancel therapy at least 24 hours before your next session to avoid any late cancellation fees. You can pause sessions by letting your therapist know. They will hold off on booking you for any additional sessions. Let the care navigator know that you are pausing sessions, too.

Quality of Care and User Satisfaction

I found my provider at Octave to have an innate gift for developing rapport and providing feedback immediately. This is a particularly challenging task and as a therapist myself, I admired their ability to connect with what I was sharing and share their insights without knowing much about me. In fact, I found their style to be so wonderful, I provided their information to a friend who was seeking therapy. Additionally, they identify as a person of color, and while their racial identity is different than mine, they were comfortable in swiftly acknowledging how my racial experience impacts my daily life. BIPOC folks are not homogenous, and there are many cultural differences. My provider’s ability to account for my cultural experience without overidentifying with me is yet another example of their clinical talent. 

I don’t think my experience with my therapist is unique to me either. Therapist qualifications are universally impressive at Octave. While each provider is unique, they are all fully licensed and have an eclectic offering of therapy modalities. In addition, the majority of Octave therapy users we surveyed found their therapist’s qualifications to be above average: 26% considered their therapist’s qualifications excellent, 30% considered them very good, and 19% considered them good. It is worth noting that 1% found the therapist qualifications to be poor and 9% found them to be terrible and unprofessional. 

The therapist I spoke with also confirmed that Octave pays better than Path Mental Health, Cyti Psychological, BetterHelp, AbleTo, Two Chairs, and Talkspace. I found this promising, since a well-compensated therapist is less likely to be burnt out and see an excessive amount of clients to make ends meet. Decreasing burnout can decrease therapist turnover. Therapist turnover can be highly disruptive to patient care, so the fact that Octave is compensating its therapists well is promising not just for providers, but for patients too.  

This all being said, Octave—like all online therapy providers—may have limitations when it comes to treating individuals who need a higher level of care. For example, those experiencing suicidal thoughts or severe panic may not be a fit for online therapy. 

Privacy Policies

Octave’s privacy policies are written in layman's terms and clearly state how your private data may be used. Octave does collect the data you share whenever you choose to use their services. That said, any confidential health data is processed in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA). 

Octave may share all other data with its affiliates and new parties associated with any potential corporate restructuring. While it is always unsettling to consider how my data may be shared, I do feel it is reasonable for data to be shared in the event of a company restructuring. It isn’t clear if the company would let clients know if their data was going to be shared beforehand and I believe doing so would be fantastic for general transparency and trust. Despite this concern, I found this to be a rather typical privacy policy statement. 

Octave vs. Its Competitors

One of Octave’s direct competitors is Two Chairs. Two Chairs matches Octave regarding out-of-network individual therapy pricing—sessions start at $205 at both companies. However, Two Chairs is only in-network with Kaiser Permanente, leading to Octave having a slight edge when it comes to insurance options. 

When it comes to therapist diversity, Octave also has the edge. Forty-seven percent of Two Chairs’ clients rated therapist diversity as very good or excellent. Meanwhile, Octave scored slightly higher at 53%. 

However, 72% of Two Chairs clients were likely to recommend them to others, which is 6% more than Octave clients who would recommend the platform. 

One big difference between the two companies is the therapist matching process. Octave matches clients with a provider, while Two Chairs requires you to attend a matching appointment. This difference comes down to personal preference—some therapy seekers may want to meet with a clinician for a matching appointment, while others might enjoy simply being matched. 

One major difference between Octave and Two Chairs is in the types of therapy they provide. Octave offers individual, couples, family, and group therapy. Two Chairs currently only provides individual therapy. 

Octave is much smaller when compared to prominent telehealth companies like BetterHelp, Brightside, and Talkspace. It has fewer providers and doesn't offer subscription services. Some clients may prefer the intimate feel of Octave and the ability to pay by session while others might like the idea of a subscription service and a wealth of providers. 

Final Verdict

Octave is a mental health platform with solid services, but also some pitfalls. It is a great fit for those who have one of the employer-sponsored mental health plans Octave accepts. The staff of highly qualified providers with diverse identities is a somewhat unique quality compared to typical insurance-funded therapy experiences. But, those seeing an Octave provider out-of-network may find this service financially inaccessible. A single session at Octave can cost more than the total average monthly out-of-pocket cost.  

Despite the downsides, Octave clients are generally satisfied. Sixty percent of users found its services to be good or very good, and 23% of users found services to be average. Thirty-nine percent of clients said all their needs were satisfied with their Octave therapist. Another 42% said most of their needs were met. 

For those experiencing intensive mental health symptoms, paying for services out-of-pocket, or in the midst of a crisis, Octave isn’t the best fit, but I would feel comfortable referring therapy seekers to Octave if they were in-network with one of the company’s insurance providers and were seeking more generalized mental health support. Current clients seem to share these sentiments—66% of Octave users were either likely or highly likely to recommend this platform to others. 

Methodology

To fairly and accurately review the best online therapy programs, we sent questionnaires to 55 companies and surveyed 105 current users of each platform. This allowed us to directly compare services offered by gathering qualitative and quantitative data about each company and its users’ experiences.

Specifically, we evaluated each company on the following factors: website usability, the sign-up and therapist matching processes, therapist qualifications, types of therapy offered, the service's quality of care, client-therapist communication options, session length, subscription offerings, client privacy protections, average cost and value for money, whether it accepts insurance, how easy it is to change therapists, overall user satisfaction, and the likelihood that clients would recommend them.

We also signed up for the companies in order to get a sense of how this process worked, how easy to use the platform is, and how therapy takes place at the company. Then, we interviewed one therapist we found who either currently works for this company and worked with three subject matter experts to get their expert analysis on how suited this company is to provide quality care to therapy seekers.