Online Therapy Review Methodology

Every year, we help 150 million people who come to Verywell Mind seeking answers to their health questions. As part of that mission, we aim to provide you with thorough and unbiased reviews of products and services that can improve your health and well-being.

To accomplish this task when it comes to online therapy companies, we researched and reviewed 55 companies currently in operation in order to determine which ones are the best at providing quality care to their users.  We fairly and thoroughly reviewed each company against its competitors by taking a data-centered approach, collecting key information about each one before expertly assessing their capabilities. We also separately evaluated 27 online therapist directories (you can read our methodology for assessing those companies here). Our team of subject matter experts included Amy Marschall, PsyD, Nic Hardy, PhD, and mental health editor Hannah Owens, LMSW.

Selecting Our Companies

Last year, we evaluated 33 different online therapy companies. However, we were aware that we had missed several newer online therapy companies, as well as some telehealth companies that offered virtual therapy. So the first step of our research process was for our editors to make a comprehensive list of all the online therapy companies we’d either heard of through word-of-mouth or discovered while conducting our research, either through internet ads, news articles, or Google keyword searches. We also asked our team of subject matter experts to weigh in. "Online therapy has been growing in popularity, especially since the pandemic," says Owens. "And research has shown that online therapy can be just as effective as in-person therapy for many therapy seekers."

From there, we narrowed down the list of companies from 80 to 55 by eliminating companies that had received excessively negative reviews last year (we decided we shouldn't waste resources re-reviewing and testing companies that had discriminatory practices or that scored very poorly with users), companies whose services felt beyond the scope of this project (such as those offering psychedelics), companies with broken websites, companies that only offered peer support rather than online therapy, and companies that were too small to provide virtual therapy at scale.

Data Collection

Our data collection for this project involved three components:

1. Company research
2. User survey
3. Testing

Company Research

We began our research into these 55 online therapy companies by sending each a company questionnaire with 76 questions. These questions covered the companies' founding, services offered, hiring practices, pricing, and therapists' expertise. This gave the companies' spokespeople a chance to tell us about themselves, answer any specific questions we had, and share what they felt set the company apart from the competition. 

Unfortunately, only 21 companies chose to respond to our questionnaire directly.

However, in order to ensure that we collected the same amount of information about all companies, we then did our own data collection on each company, with the help of a team of health reporters.

Our team not only looked for the answers to those initial 76 questions but some additional ones we had too. This allowed us to not only fact-check the answers provided by the companies themselves but also give us insight into how easy it would be for a therapy seeker to find answers to their questions as well. It also allowed us to do some reputational research into each company, as well as evaluate the company's terms of use and privacy policies.

Once this research was collected, we shared it with our panel of subject matter experts in order to get their professional assessment.

User Survey

We surveyed 105 users from each of the 55 businesses in order to gain insight into the experiences of therapy seekers across the country that had used the platforms.

We asked them 92 questions about their experience with each company. This survey included questions on:

• How they heard about the company and what they were seeking help for
• What factors were important in their search for online therapy
• The platform's ease of use and customer service
• How they felt about therapist qualifications, diversity, cultural sensitivity, and overall level of care
• Whether they were able to use their health insurance benefits for their therapy at the company
• Their assessment of the company's overall services, affordability, and value for money
• What they wished the company did better

In addition, if the company offered medication management, we asked users about the company's prescribing practices.

We also asked the users if they planned to continue services with the company or recommend it to others. If they had tried multiple online therapy services in the past, we also asked them to tell us how they felt this company's services compared.

Testing

As a final step in our evaluation of each company, we had our writers sign up to test the services for at least one month when we were able to do so. We tested 43 of the 55 companies—and in some cases, where the company offered multiple forms of therapy (i.e., individual therapy and couples therapy), we tested the companies more than once so we could assess each of those services independently.

We were unable to directly test 12 of the companies. Some of these were companies we ethically felt we could not test because they were primarily medication management or psychiatry services, so we could not test getting a prescription. Others were companies that wouldn't allow us because their services are restricted to specific demographics (for example, Ginger is only open to employees while Mantra Health is only open to university students). In a few cases, though, we attempted to sign up for the company but despite several months of waiting to begin services, we were never matched with a therapist to trial the service.

All of our testers were asked to test the same features (i.e., trial each communication method with their therapist) and attempt to do the same things, such as switch therapists halfway through their trial month. These notes were shared with our panel of experts and used as part of our scoring. One of the testers for each company also wrote the reviews we published on Verywell Mind.

Scoring Features

Once data collection was complete, we scored each company on nine key areas:

1. Company reputation
2. Company reach
3. User satisfaction
4. User friendliness and convenience
5. Pricing and insurance
6. Types of therapy services offered
7. Therapist qualifications
8. Cultural sensitivity
9. Privacy policies

Company Reputation

The 55 companies we evaluated were a mix of established names in the field and relative newcomers. As part of our research, we evaluated whether the company had an overall positive reputation by not only asking our survey respondents how they felt about the company but also by looking at how the company is covered in the media. Does it have a generally positive reputation? Or has the company been involved in scandals, investigations, or other negative press coverage?

A company's perceived reputation is a big reason why a potential therapy seeker may be eager or apprehensive about trying a company's mental health services and so we felt strongly that it should be evaluated.

Company Reach

Since 2020, more people are seeking mental health care, especially for anxiety or depression—and this has made it increasingly difficult for people to find a therapist that is both available and appropriate for their needs. This is especially true if you live in a therapy desert, (i.e., a location where there is a shortage of mental health professionals), such as Mississippi or South Carolina, the wo states with the lowest number of therapists in the United States. They have only 11.9 and 13 therapists per 100,000 people, respectively, compared to Washington, D.C., with 173.3 and Vermont with 100.5 per 100,000 people.

So if an online therapy company is able to provide therapy virtually to therapy seekers in therapy deserts or states where there is a lot of demand for mental health care, we considered this to be a huge plus for the company.

User Satisfaction

Many online therapy companies, particularly the bigger ones, have very effective advertising and marketing campaigns to attract customers, but this doesn’t necessarily translate into happy customers.

So, in order to effectively gauge each service’s effectiveness, we relied heavily on our user survey results and our testers to evaluate the company's ability to deliver quality mental health care.

For example, we looked at how our users rated the service overall.

Our survey asked users to rate whether the services were excellent, very good, good, average, or poor. If more people than average scored a company as excellent, very good, or good, we reflected this in our final star rating scores. If more than the average number of users said the company was poor, we also reflected this in the final score. 

We also looked at how likely a user was to recommend a service to others.

There’s no greater compliment than recommending a company to others, so we asked users to tell us whether they were very likely, likely, neutral, unlikely, or very unlikely to recommend the company to someone like them who was looking for therapy. If more people than average said they were very likely or likely to recommend the company to others, this was reflected in our final star rating scores. If more than the average number of users said they were unlikely or very unlikely to recommend the company, we took away points in their star rating score. 

We also looked at whether the users felt their therapist met their mental health needs, how likely they were to still be seeing the therapist in six or 12 months, and whether they felt they would return to this company should they need a new or different therapist again. We also took into account our testers' experiences and whether those testers said they would have stayed with the company after their trial period.

In addition, we evaluated what our survey respondents said they liked best and disliked about the company, and what they thought the company could improve. If the users had tried other online therapy companies in the past, we also asked them about how they felt this company compared.

User Friendliness

Like it or not, businesses are often judged based on first impressions. So, if a company has an out-of-date or poorly designed website, a potential client might have misgivings about signing up. If a company had a website that loaded slowly, had older resources, didn’t answer key questions about price or what its services entailed, or generally was difficult to navigate, it tended to score poorly in this category.

We also evaluated the sign-up process: Did the company have a thorough intake process? How did it match users to therapy seekers? Did the sign-up process take unnecessarily long? Companies that had confusing or misleading sign-up processes tended to score lower in this category, as did companies that withheld prices until the very end. In addition, companies with insensitive intake questionnaires also were flagged in this category. "The intake process can be imperative when looking for a provider who meets your needs," says Owens. "If the company does not gather enough information about you before recommending or matching you with a therapist, this could result in a poor choice of therapist and make it necessary for you to switch providers. At best, this can be a hassle, and at worst, it can discourage you from continuing to seek services."

We also evaluated the strength of customer service, looking to see if companies had customer service helplines or chat functions for clients who had questions or problems with the sign-up process. 

Companies that prominently displayed therapist bios and qualifications on their websites were rated higher, as this helped clients feel more comfortable signing up for the service. Similarly, companies that allowed clients to choose their therapist during sign-up or easily switch therapists were also rated higher in this category. 

We also rewarded companies that took the matching process seriously between client and therapist. Those companies that had personalized matching services or detailed intake questionnaires generally scored higher.

Once sign-up was completed, we also evaluated whether the process remained intuitive, scoring companies with dedicated customer service lines or easy functionality more highly. For example, companies that made it easy to add, change, or cancel services were ranked higher.

We also evaluated the communication options offered by the company, as there are many different ways to participate in online therapy, including:

• Live chat
• Video call
• Phone call
• Audio messages
• Messaging
• Journaling

While some users may only want to connect on their smartphones, others may prefer using a full-sized laptop to communicate. Those with slow internet connections may also prefer phone support rather than video messaging. As a result, we tended to score companies that have a wide range of communication methods better than those that had fewer. 

That said, companies didn’t just score well in this category if they had a lot of options—those communication methods had to be high quality. As a result, we asked our surveyed users to rate the quality of each method, such as how reliable the video calls were or how quickly and thoughtfully their therapist responded to messages, and took this into account when determining final scores. Similarly, companies that offered longer video or phone sessions also tended to score higher because this allows for more in-depth therapeutic work. 

Pricing and Insurance

Most online therapy companies strive to make mental health services more affordable than traditional, in-person therapy—and by and large, almost all 55 companies we reviewed achieved this goal.

Still, there was a pretty substantial range of prices across companies, ranging from $60 to over $600 a month if a client were to see a therapist weekly. 

In general, the companies we examined kept prices low by structuring their businesses based on two different payment models:

• Subscription model: Usually, a monthly subscription plan comes with a certain number of live therapy sessions and offers messaging with your therapist between sessions.
• Pay-per-session model: A pay-per-session lets you book as many or as few sessions with your therapist as you like.

The subscription model is, by and large, substantially more affordable than traditional in-person therapy. However, because it’s a subscription, you are locked into a monthly commitment that requires you to decide upfront how many live sessions you want with your therapist in a month or if you prefer to communicate with your therapist entirely in messaging form. 

To evaluate subscription-based companies, we considered whether a company offers more than one subscription option, what the monthly price tag is, and whether those subscriptions offer good value for money by providing clients with enough therapy time to actually make a difference for their mental health. We also rewarded companies in our scoring if they offer clients free trials or discounted first months so that you can feel confident in your subscription purchase. 

The pay-per-session online therapy model is closer to the way traditional therapy is set up. The advantage is that it allows you more flexibility in the amount you want to spend in a given month because you can book sessions as often as you want. However, if you want weekly sessions with a therapist, the price per month is almost always higher than with a subscription. Thus, if a company had this model, we gave higher marks if it offers variable pricing, which allows a client to pay more or less depending on how much experience or training their therapist has. We also rewarded companies in our scoring if they offer financial assistance to those who need it. 

As part of our price scoring, we also took into account whether a company accepts health insurance because if a company is in-network on your health plan, you can save substantially on out-of-pocket costs. 

Finally, if a company offers access to a psychiatrist or medication management, we took into consideration whether the costs associated with these services were part of your monthly price or you had to pay extra, as well as if they include copays and shipping costs.

Types of Therapy Offered

Not everyone benefits from the same type of therapy, which is why companies that offer a range of different types of modalities increase the chances that you’ll find something that works for you. Traditionally, online therapy has been a little more limited in terms of the types of treatments it offers; group therapy, family therapy, or certain psychotherapy techniques are often less common. 

However, as online therapy companies grow and strive to improve, many have dramatically expanded their services in order to be a one-stop shop for all your needs, whether that’s individual therapy, couples therapy, teen counseling, psychiatry, medication management, or group therapy. Others, meanwhile, focus on being the best at providing one type of therapy. 

As a result, we scored companies highly if they offer a wide range of different services, as long as we could verify that all of those services were high quality and beneficial to mental health.

This meant rewarding companies that prioritize quality talk therapy, ensuring that session lengths are long enough to do real therapeutic work and that the video call platform is high quality. If a company offered subscriptions with unlimited messaging, they only scored highly if clients were guaranteed timely responses from their therapists.

If medication management or psychiatry was offered, it meant evaluating whether diagnoses could be made, which conditions are treated, and what medications could be safely prescribed. 

To avoid unfairly penalizing companies because they chose to specialize in one or two types of treatment, we rewarded companies that outperformed their competition when they focused on one type of service, whether that was couples therapy, teen therapy, or psychiatry, and received higher user satisfaction ratings than those companies that took a more generalized approach. 

Therapist Qualifications

Most of the users we surveyed said that therapist qualifications were one of the most important factors across the board in choosing an online therapy company. As a result, we carefully evaluated the qualifications of the staff employed by each company. Companies that ensured that all their therapists were licensed and had at least a master’s degree were rewarded, as were those that had diverse staffs with a range of specialized training. Meanwhile, companies that had staffs made up mostly of trained listeners, life coaches, or counselors scored lower.  

In addition, companies scored higher if they responded to our questionnaire and gave us detailed information about how they vetted therapists or board-certified doctors before hiring them. (We also rewarded companies that included this information on their websites too.) We also considered staff turnover and attrition rates because quality treatment requires that clients have continuity of care. 

We carefully considered how our surveyed users evaluated their experience with their therapists. We scored companies higher if they did a good job matching their therapists to clients and if users wanted to stay with their therapist instead of repeatedly switching. Our testers played a big role in this evaluation too: Did they find their therapists to be attentive during sessions? Did the therapist seem distracted?

As part of this category, we looked at how well a company knows its audience and serves its needs. So, for example, if a company was set up to serve marginalized communities or first responders, we evaluated how well they actually did this to ensure it wasn't just a marketing approach.

Cultural Sensitivity

Companies that prioritize underserved communities stood out to us in particular because the mental health field has long had a diversity problem. In the U.S., only about 4% of mental health providers identify as Black, 4% as Asian, and 6% as Latinx. We wanted to ensure that we were reviewing the companies that would be most useful to our readers, regardless of where they live or how they identify. 

As a result, companies with diverse therapist rosters and companies with social justice mission statements tended to score well in this category.

We also rewarded companies that put in the effort to match users to therapists based on therapy seekers' preferences regarding sexual orientation, gender identity, religion, and racial or cultural background.

"People from marginalized communities have long faced discrimination and trauma at the hands of the mental health care system," explains Owens. "Finding a therapist who understands your identities and background can be affirming and can break the cycle of abuse."

Privacy Policies

When you’re signing up for an online service, particularly one where medical data will be collected about you, privacy and security are very important considerations. In other words, can a company keep your private information and data safe and secure?

Unfortunately, lots of the companies we evaluated were vague about how they protect their clients’ private information. 

As a result, companies that were transparent on their websites and in their apps about how they keep private information safe generally scored higher in our ratings, as long as their measures seemed adequate. We also rewarded companies that were HIPAA-compliant or that required privacy training for their staff. 

"Many online therapy companies openly admit that they sell their clients' personal information to third parties for advertising purposes," says Owens. "It's important to educate yourself on a company's privacy practices before committing to that service."

Our Team