Online therapy is counselling or psychotherapy with a trained professional by chat, voice call or video call, instead of in a clinic. It is also called online counselling or e-therapy. In India, many people get it through their employer or their college, which pays for a set number of sessions. It is one of the services in telemedicine.
Who provides the therapy? Three kinds of professional work on these platforms. A counsellor helps with everyday problems, such as stress, exam anxiety or the end of a relationship. A clinical psychologist assesses and treats mental illness with talking therapies. In India, a clinical psychologist must be registered with the Rehabilitation Council of India (RCI). A psychiatrist is a medical doctor, and is the only one of the three who can prescribe medicines. A good platform first finds out which of these a person needs.
Here is a typical case. A second-year engineering student in Thiruvananthapuram cannot sleep before her exams, and feels panic in the exam hall. Her college has bought a counselling plan from an online therapy platform, under which each student may have six free sessions. One evening, she starts a chat in the app. A counsellor replies within the hour and asks a few questions about her sleep, her mood and her studies. The platform then books her a 50-minute video session with a counsellor whose first language is Malayalam. Over five weekly sessions, she learns to notice and question her anxious thoughts, a method from cognitive behavioural therapy (CBT). She also learns a breathing exercise to use in the exam hall.
Privacy is the main worry for most users. The college receives only numbers, such as how many students used the service and for which broad kinds of problem. It never sees names or what was said. Employers buy the same kind of service through an employee wellbeing platform, and the same rule applies.
The platform must also recognise danger. If a person mentions thoughts of suicide or self-harm, the counsellor follows a set procedure. The counsellor assesses the risk, involves a psychiatrist or a clinical psychologist, and gives the person emergency helplines. The Government of India runs a free national mental health helpline, Tele-MANAS, on 14416.
When a person needs medicine, the platform refers them to a psychiatrist, either in person or by video call through a telemedicine app. Between sessions, some people also use digital therapeutics for mental health, which give them exercises to practise.
How is online therapy different from a mental health app? A self-help app offers exercises, articles and sometimes an AI chat, with no professional involved. Online therapy always involves a trained person who talks with the client. Many people use the two together.