Is Online Therapy Legit? How It Works, Effectiveness, and State Licensing Explained
Online therapy has become far more common over the past several years, especially after the COVID-19 pandemic required many providers and clients to move online. What began as a necessity has since become a meaningful option for people seeking flexibility, accessibility, or comfort in their mental health care.
But questions remain: Is online therapy effective? Is it secure? And how does state licensing work if you or your therapist are located in different states?
What online therapy is — and how it works
Virtual therapy involves meeting with a licensed mental health provider through a secure online platform, most often via video and sometimes by phone. Sessions are typically similar to in-person therapy in length, structure, approach, and cost. Many insurance plans cover virtual therapy in the same way they cover in-person sessions.
Research shows that virtual therapy can be just as effective as in-person therapy for many concerns, including anxiety, depression, stress, and adjustment-related issues.
What virtual therapy isn’t is a shortcut or a watered-down version of care. When provided by a licensed clinician, it follows the same ethical, professional, and clinical standards as in-person therapy.
Online therapy vs. therapy apps and AI-tools
It’s important to distinguish between virtual therapy with a licensed provider and app-based mental health platforms or AI-driven tools.
Virtual therapy involves working directly with a licensed professional who is trained to assess, diagnose, and treat mental health concerns and who tailors care to the individual.
App-based programs and AI tools may offer general education, coaching, or symptom tracking, but they are not a substitute for therapy and typically lack the relational component that research shows is central to effective treatment.
Some people find these tools helpful as supplements, but they are different from working with a therapist.
How state licensing works in online therapy
One of the most common sources of confusion is licensing.
In the United States, mental health professionals are licensed by individual states. That means a therapist must generally be licensed in the state where the client is physically located at the time of the session.
Virtual therapy does not remove state licensing requirements. Even if you and your therapist are meeting online, the same laws apply.
This is why things can get complicated if someone moves, travels frequently, or lives part-time in different states. The question isn’t whether therapy is online or in person. The question is: where is the client located during the session, and is the provider authorized to practice there?
Some clinicians hold independent licenses in multiple states. Others may participate in interstate agreements that allow them to practice across participating states.
Different mental health professions have developed their own versions of these agreements. For example, psychologists participate in one type of compact, while social workers and counselors may participate in others depending on their profession and state laws.
What Is PSYPACT and how does it affect online therapy?
PSYPACT (the Psychology Interjurisdictional Compact) is one example of an interstate agreement. It allows licensed psychologists who have obtained specific PSYPACT credentials to provide teletherapy across participating states. Currently, more than 40 states are part of this compact.
If a psychologist is both independently licensed in their home state and authorized through PSYPACT, they may be able to provide teletherapy to clients located in other participating states.
This can significantly expand access to consistent care for people who:
Move between states
Travel frequently for work
Attend college in a different state
Split time between two locations
PSYPACT does not apply to all therapists. It applies specifically to licensed psychologists who have completed the required credentialing process.
Other professions may have separate compacts or multi-state licensing options, but those rules vary by profession and state.
If continuity of care across state lines is important to you, it’s reasonable to ask a provider:
What state(s) are you licensed in?
Are you authorized to provide telehealth in the state where I’ll be located?
What happens if I move or travel for an extended period?
Clear answers to these questions help avoid disruptions in care.
Who online therapy works best for
Virtual therapy can be a great fit for people who value flexibility or have changing schedules or locations. This can include:
Adults who travel frequently for work
Parents who need to stay home due to childcare responsibilities
Busy professionals who need to fit therapy into the workday
College students living away from home
Individuals who feel more comfortable opening up in their own space
Most people who benefit from virtual therapy are generally comfortable with technology and able to engage through conversation without relying heavily on physical cues.
Virtual therapy may be more challenging for individuals who need a high level of in-person structure, who have significant difficulty attending to a screen, or who have communication needs that are better supported in person. These are important considerations to talk through with a provider.
Common concerns about online therapy
Privacy is one of the most common concerns — and an important one to consider. Before starting virtual therapy, it’s worth thinking about whether you have access to a space that feels private and relatively free from interruption. This might be at home, in a dorm room, or during a break at work.
Other practical considerations include:
Internet reliability and device access
Potential distractions from pets, roommates, or family members
Whether sitting for a full session feels manageable
How comfortable you feel discussing personal topics online
Some people also worry that nonverbal cues are missed in virtual sessions. This can be a valid concern, and it’s something that can be discussed openly with a provider. Many therapists adapt their approach to ensure connection and attunement in the virtual setting, but it’s important to consider how much this matters for you personally.
How to know if online therapy is the right fit
Choosing the right fit in virtual therapy involves many of the same considerations as in-person care — feeling understood, respected, and supported — with a few additional logistical factors layered in.
The best approach is often to reflect on what helps you feel safe and engaged, ask questions during an initial consultation, and notice how the interaction feels.
Virtual therapy isn’t the right choice for everyone, but for many people, it offers a flexible and effective way to access meaningful support.
If you’re still unsure what to look for, you can read more about finding the right therapist in my blog, How Do I Know If a Therapist Is the Right Fit for Me (or My Teen)?