The Ultimate Guide To Building An Online Therapy PracticeCommercial & Office
Stay-at-home orders have turned lives upside down across the globe. People are finding themselves without work, working from home for the first time, or worried about friends and loved ones getting sick.
For therapists and counselors, that means demand for their services are at an all-time high. BetterHelp, an online counseling service, reported that the number of new members who joined in February 2020 due to “concerns of stress and anxiety” was more than double than the previous year’s numbers.
However, many people don’t feel comfortable coming into an office to meet with a therapist. This poses challenges for the industry, which historically has relied on in-person interaction to provide a safe space and comprehensive mental health care.
Enter teletherapy. While the service first emerged around twenty years ago, it’s surged in popularity lately due to the rise of online counseling services and teletherapy providers.
Now, as their clients seek to access mental health care while practicing social distancing, traditional therapists are transitioning their services to online, and recently licensed therapists are having to build their practice online for the first time.
If that describes your situation, read on. We’ve put together this soup-to-nuts guide to help you build your online therapy practice with confidence, no matter your level of tech-savvy.
In-Person Therapy vs Online Therapy
There’s no question. Online therapy feels very different than in-person therapy. But it may have more benefits than you think. Below we review the pros and cons of online therapy vs. in-person therapy.
Pros of online therapy
- Your client base is no longer restricted by geography. Your online therapy practice can serve clients who live close to your office, as well as anywhere in your city — or your state! Depending on the licensing laws, you may even be able to counsel patients who live out-of-state.
- You’ll have fewer missed appointments or cancellations. One of the hurdles to therapy is simply getting there. When all your client has to do is hop on the internet, it’s a lot easier to make sure they make their appointment.
- Online therapy is more accessible. Clients don’t need to have a car to see you; they just need internet access or a phone. Online therapy also helps make therapy more accessible to those who live in more remote areas, have mobility issues, or are housebound.
- Online therapy reduces your overhead. When you offer teletherapy, you can meet with clients from a secure space in your home, reducing the need to rent a separate office space—and pay for the utilities and insurance to match.
- It’s more approachable for those who are wary of therapy, or have social anxiety. Some people find it less nerve-wracking to meet over the phone or video conference than in-person. As for those who worry they’ll run into someone they know in your waiting room, that’s not a problem with teletherapy.
- Teletherapy is becoming more popular. There’s a reason you’ve seen online counseling companies like BetterHelp and TalkSpace pop up in recent years: people like it, especially if they’re younger. A survey of 3,500 insured adults found that millennials were “far more likely” to be interested in telemedicine than previous generations.
Most importantly, a growing number of studies demonstrate that online therapy can be just as effective as face-to-face therapy.
Cons of online therapy
For all its positives, online therapy isn’t without its downsides. Here’s what you need to know.
- It’s not always covered by insurance. While most states require insurers to cover online therapy the same as traditional therapy, not all do.
- It can require additional licensing. If you plan to market your online therapy practice to clients who live in another state, you may need to be licensed in their state as well as your own.
- Teletherapy poses more challenges to maintain privacy and confidentiality. Perhaps unsurprisingly, you have to hop through a few more hurdles to make sure your online therapy practice is HIPAA-compliant. We’ll discuss how to accomplish this in the following sections.
- You’ll miss out on key visual and audio cues. With online therapy, human contact is limited. It’s harder to pick up on body language when you’re not in the same room — all the more so if video chat isn’t available or the internet connection is spotty. You may not be able to see if your client is crossing their arms or legs.
- Teletherapy is not suitable for all cases. While some types of online therapy can be just as effective as face-to-face therapy, as with online cognitive behavior therapy for anxiety, it’s not as effective in more severe cases which require close supervision and direct treatment. Online therapy can be a good extra resource for these individuals, but in-person treatment with a therapist or at a mental health care facility is more appropriate for ensuring they don’t hurt themselves or others. Likewise, some types of therapy simply can’t be done as well or at all over the internet, like animal or art therapy.
Prepare your online therapy service
For many therapists, the pros of teletherapy outweigh the cons. If you agree, let’s dig into how to set up your online therapy practice. We recommend following the steps below, whether you plan on offering teletherapy exclusively, or adding teletherapy to your existing list of services.
Step 1: Research your state licensure laws for online therapy
Generally, if you’re licensed to provide in-person psychology services, you can also provide online treatment. Depending on where you’re licensed, your state may have additional requirements for teletherapy, such as an additional patient consent form.
Things get trickier if you plan on providing teletherapy to clients who live out of state. Many states allow out-of-state-licensed therapists to provide teletherapy on a temporary basis.
For longer-term treatments, the rules vary by state. Some, like Florida, allow you to provide teletherapy as long as you are registered in Florida and pay a fee. Others require additional consent forms. Others, like Texas, require you to undergo additional training.
To ensure compliance with the state licensure laws for your state (and any others where your clients live), the American Psychological Association offers the following advice:
- Refer to your state legislature’s website for their telehealth laws. Check their website on a regular basis to stay up-to-date.
- Refer to your state licensing board for additional policies specifically related to online therapy. You can find yours through the Association of State and Provincial Psychology Boards.
- Review your malpractice insurance policy to confirm that online therapy is covered. Typically, in-state teletherapy is covered, but that’s not always the case for out-of-state.
Note: During the COVID-19 crisis, many states have passed temporary provisions which loosen these restrictions, allowing individuals licensed in another state to provide teletherapy. The American Association for Marriage and Family Therapy provides an overview with links to each state’s rules.
Step 2: Figure out insurance and billing
Billing clients isn’t all that different with online therapy. You can bill clients the same fee as you would if they were seeing you in-person. You are providing the same service, just not in the same place. Of course, you may also decide to charge your telehealth clients more or less for online treatment.
If you plan on accepting insurance, the good news is that most insurance providers cover telehealth services, and they reimburse these the same as in-office visits. You can thank your state’s parity laws for that.
However, that’s a generalization, not a guarantee. Double check with each insurance provider to confirm, and avoid giving your clients an unpleasant surprise. For example, Medicaid recommends covering telemedicine, but allows states to make their own rules. Currently, in response to the COVID-19 crisis, individuals can use Medicare to pay for telehealth, but it’s unclear how permanent that policy is. Prior to March 2020, Medicare only covered teletherapy under certain conditions.
Fortunately, there are resources that make tracking down this information a bit easier. The Center for Connected Health Policy provides a clickable, interactive map where you can filter by state and specific coverage conditions to view the telehealth laws.
Should you accept insurance or private pay for your online therapy business? That’s up to you. While accepting insurance requires more paperwork, eats into your pay, and takes longer to process, many newer therapists find insurance is helpful for growing their client base, as it provides them with a mark of credibility and a large referral network.
More established therapists may prefer private-pay, as they can earn more, spend less time on paperwork, and receive payment quicker. However, there’s no built-in client referral network with a private-pay option, so you’ll need to build your practice using online marketing. Don’t worry; we’ve dedicated the last section of this guide to this topic!
Step 3: Prepare your client intake forms
Online therapy requires a few different forms. These include:
- Informed consent: A majority of states require separate written and/or verbal consent for online therapy. Again, the CCHPCA’s map tool is helpful here! Choose “Consent” as your filter to see what’s required in your state. Both the Telebehavioral Health Institute and the American Telemedicine Association offer templated telemedicine forms you can download for free.
- No-show policy: Update your no-show policy to include missed teletherapy appointments, or create a separate policy for teletherapy. Your time is your money, and you want clients to take these appointments as seriously as they would an in-person appointment. A no-show policy can help with that.
- Billing and insurance: If anything will be changing for your billing, make sure to update these forms as well.
Step 4: Make things secure
It’s critical that your online therapy services be just as secure and private as your in-person practice. To achieve this, you’ll need to ensure you’re using the right tools and maintaining HIPAA compliance.
- Use HIPAA-compliant video conferencing software. We’ll review options in a later section.
- Use a private internet network with password protection. For additional assurance, wired internet connections can be more stable than wireless ones.
- Install security updates on your computer when they become available. If you’re using web conferencing software, also keep your internet browsers (e.g. Google Chrome) updated regularly.
- Keep client forms in a secure place. Fortunately, electronic intake forms reduce the risk of a paper trail. You can upload these to a HIPAA-compliant cloud storage provider. DropBox, Carbonite, and Google Drive all offer data encryption options.
Set up your online therapy office
One of the benefits of online therapy is that it permits you to practice from nearly anywhere, as long as you have a private space and a strong Wi-Fi connection.
However, you’ll want to ensure that your online therapy office is set up to allow you, and your client, to focus on the therapy. Even if you rent office space for in-person appointments, there are a few changes you may need to make to make sure it’s fit for virtual therapy sessions as well.
Follow these teletherapy best practices.
Create a private space
Wherever you will be holding your online therapy sessions, make certain that the space is private and secure. No one else should be able to hear the conversation between you and your client. Wearing headphones can help with this.
If you’ll be offering online counseling from your home, make sure it’s a private room where other household members can't hear or see you. Use a separate room and make it clear that they can’t enter whenever you are “in session.”
Noise and other distractions can encourage your client’s mind to wander, so focus on making your office quiet. If offering online therapy from your home, make sure that doorbells, TVs in other rooms, or even noises from a construction crew outside won’t be heard by your client during the call.
Visuals can be distracting, too. Wear an outfit similar to what you would wear if you were meeting your client in person. Solid colors and minimal patterns can be less distracting on camera.
Remember that your client will have a limited view of your online therapy office. Set up your camera in an area of your office where your face is fully lit and in frame. Additional lights can warm up your appearance, but avoid being backlit. Face lights toward you, or position your computer between yourself and a window. You want your client to be able to see your face so you can maintain eye contact.
Ensure a strong Wi-Fi connection
You want your client to trust that they have your full attention, and that you are listening to them. A dropped call or shoddy internet connection can shatter that trust and frustrate your client (and you!).
Invest in a high speed internet connection. For the highest video quality, most conferencing platforms recommend upload and download speeds of 3.0 Mbps or more. If you’re not sure of your internet speed, Google offers a free speed test that takes less than 30 seconds to run.
Remember that your upload and download speeds can be affected by other devices on your internet network, such as smart home devices, or online gaming or streaming services your family members may be using. Reduce the use of these devices during your appointments, and close internet browsers on your computer.
Find the right online therapy software
Since you’ll be meeting with clients remotely, you’ll need a way to actually host your appointment with them, as well as a way to bill and receive payments remotely. Let’s discuss your teletherapy software options.
HIPAA-compliant teletherapy platform
You can speak to your clients over the phone, but you’ll miss out on all the visual cues available with video conferencing. That's why it’s better to use a platform with video conferencing capabilities. However, not all video chat software is HIPAA compliant (Skype and FaceTime, for instance, are not).
Zoom is a popular video conferencing platform that’s used for all kinds of virtual meetings, from 2 to 500 participants. While it’s not designed for therapy, it offers much of the features you’ll want. Importantly, it’s HIPAA-compliant and all data submitted over a video call is encrypted.
Highlights for online therapists:
- To keep meetings as secure as possible, make sure to set up a separate meeting link for each patient. Do NOT use the same link for all of your patients. You can password protect meetings for extra privacy.
- You can also record your meetings to reference later, but make sure you receive your patient’s consent before doing so.
- You can integrate Zoom with your calendar software like Outlook or Google Calendar for easy appointment scheduling.
- Zoom has a waiting room feature, which keeps your clients in a virtual “lobby” until you’re ready to invite them into the meeting. This feature is great for marriage or family therapists who meet with multiple clients at once.
Pricing: Zoom offers a free plan, which allows for unlimited one-on-one meetings. Couples and family therapists should note there is a 40-minute limit on meetings with more than 2 participants on the free plan. Paid plans allow for unlimited group meetings, and include more features. Zoom also offers special plans for healthcare organizations, which may be a better fit for group practices. Save with these Zoom promo codes.
Unlike Zoom, TheraNest is designed from top-to-bottom as an online practice management software for psychologists, therapists, and more. You can set up an account as a solo or group practice. Everything is HIPAA-compliant. LIke Zoom, mobile apps are available on Android and iOS for clients who don’t have a personal computer.
Highlights for online therapists:
- TheraNest allows you to issue multiple invoices at once using the Batch Payments feature, file claims electronically, bill insurance, and store and charge credit cards.
- You can customize client intake forms, and store them securely.
- TheraNest includes a built-in calendar, with automated appointment reminders via email, phome, and text. Clients can even schedule their own appointments through an integrated Client Portal.
Pricing: TheraNest charges a set monthly rate based on the number of clients using the platform, between $1.14 and $1.30 per client. Annual plans are available at an additional discount. Save with these TheraNest promo codes.
HIPAA-compliant payment platform
How will you bill your clients? If you go with TheraNest, billing is included as part of the platform. If you choose Zoom, you’ll need a separate HIPAA-compliant billing software.
Square is a popular, user-friendly option that’s HIPAA-friendly (you can view their Business Associate Agreement here). You can design branded invoices for your online therapy business and set up recurring payments to make your life easier.
With Square’s appointment scheduling software, you can ask clients to prepay when booking their appointment. You can also charge cancellation fees for no-shows, and send appointment reminders through the platform.
Counseling EMR software
Operating any business requires some form of record-keeping, but this is especially important for online mental health practices. You’ll need EMR software to manage and organize your patients’ electronic medical records.
Again, since TheraNest is a comprehensive counseling software, it has EMR functionality built-in. You can create, manage, and store client intake forms, invoices, insurance claims, counseling note templates, and more.
You can also store documents securely with Dropbox and maintain HIPAA compliance by signing an electronic BAA.
Other counseling EMR software options include Kareo, TherapyNotes, Counsol, and TheraPlatform.
Finally, you need a way to schedule your appointments! You can always do this manually, but many therapists find it more expedient to use tools that integrate with their other teletherapy software.
Zoom integrates with Google Calendar, Office 365, and Exchange, so when you create a meeting, it will be automatically added to your calendar.
Calendly is a popular scheduling software that integrates with Zoom, along with other calendar and conferencing software. You simply program your availability into Calendly, and set the length of time for individual appointments. Then, clients can book a new appointment during the time slots you have available. Calendly offers a free plan, along with 14-day trials for their paid plans. Save with these Calendly promo codes.
TheraNest’s scheduling is built in. You can create appointments with individuals or groups, and display client initials to maintain anonymity. It syncs with Google Calendar and Apple iCal, and automatically sends appointment reminders via phone, email, or text, and tracks attendance. You can set up recurring appointments as well.
Create your online therapy website
A website is essential for any business today, and all the more so for online businesses like an online counseling practice!
For online therapists, your website is the online “home” of your business. It’s where new clients can learn about your services, and contact you to set up an appointment. It’s also your main asset for marketing your online therapy business, which we’ll cover in the following section.
Making a website doesn’t have to be hard. In fact, thanks to the variety of website builders you have to choose from, it’s easy, and dare we say it — maybe even a bit fun! Below we walk you through what you need to do to build your website.
Register a custom domain name
The first thing you’ll need to set up your online therapy website is a domain name. The domain name is the address of your website. It’s what people type into their internet browser to access your website. Knoji.com is the domain name of this website.
Online therapists can take a few different routes when it comes to choosing their domain name. You can make your domain name match the official name of your business, such as sarasonlinetherapy.com. Or, you can use keywords that potential clients may use to find your business.
We’ll talk more about keywords in the marketing section, but they’re basically a fancy marketing term for the phrases people type into Google when they’re looking for something. For therapists, keywords include phrases like “online counseling” and “teletherapist.”
If you’ll be meeting with people in a defined area, such as your city or state, you can also use local keywords like “online therapy los angeles.” In that scenario, your domain name could be something like losangelesonlinetherapy.com.
Once you have an idea of your dream domain name, think of a few backup options. You can then check to see if they’re available with a domain registrar like:
If possible, select a .com version of your domain. These are the most commonly used, and they’re what potential clients will be more likely to type in.
Most domain names run from $10 to $25 per year. Don’t buy your domain name just yet, though, as you may be able to get a deal if you bundle it with your web hosting platform.
Choose your website hosting platform
Your domain name is how people access your website on the internet. The web hosting provider provides the server space that hosts your website files, and enables your website to exist. Many web hosts include a free domain for your first year of hosting.
Back in the day, building a website essentially required you to be a professional coder. Thankfully, that’s no longer the case! Anyone can build a website, thanks to easy-peasy website builders.
If you’ve heard of SquareSpace or Wix, then you know what a website builder is. These offer pre-designed website templates you can use, all of which are completely customizable. That means you can drag and drop different elements around, switch out the stock images, and replace the default copy with your own. The templates are mobile-friendly out-of-the-box, and the web host takes care of updating them to meet web best practices, so that’s one less thing for you to have to worry about!
Many website builders offer website themes designed for different types of businesses, including a default template you can use for each page on your website. Depending on the website builder you choose, there may even be a theme (or several) designed specifically for therapists!
Check out these Wix templates for online psychologists and therapy centers:
As you can see, you can click on any of the elements and edit them, all while maintaining a website that looks professional, features a color palette that’s calming to potential clients, and functions like a well-oiled machine!
Here are some of our favorite website builders:
We recommend browsing these sites to find a template you like. Then, you can choose a plan based on your budget. Typically, website builder pricing varies from $5 to $20 a month, depending on the features you use. A beginner or basic plan is suitable for most online therapists and counseling businesses.
Design your website
The beauty of using a pre-built therapist website template is that you can count on it having everything you need. If you decide to go with another template, though, we recommend sticking to the default font and color choices. These have been pre-selected based on web design best practices, and a rogue color can make your website look off.
That takes care of the design. As for the meat of your website, every online counseling website includes at least these four pages:
- A home page. This is the client’s first introduction to your online therapy practice. Feature a professional photo of yourself, along with other calming imagery. Provide an overview of your services, with links to the other pages on your website.
- An About page. Here you can go into more detail about your approach to therapy, and list your credentials. Give clients an idea of what they can expect from an online therapy session with you.
- A Services page. Here you can list your services, and what types of therapy you offer. Explain the typical length of sessions, pricing, and software you use to conduct online therapy.
- Contact page. Finally, offer clients ways to get in touch with you via email, phone, or web form. Direct them to 911 for emergencies, and provide other helpful resources.
Market your online therapy practice
We’ve reached the last step of starting your online therapy practice: marketing yourself and your services! Get started with these tips.
Submit your information to online counselor directories
Add your listing to online directories. If you’re accepting insurance, make sure that all of your information is accurate, and include your website and phone number in their provider directory.
Beyond insurance, there are many trusted online directories patients use to find therapists. Create a listing for your business on Psychology Today, ZocDoc, and Good Therapy. There is often a listing fee, but it is worth it! (Plus, you can save with these promo codes for Psychology Today and ZocDoc).
If you have an office space you rent, you can also list your therapy practice on Google My Business and Yelp.
Ask your clients to review you on these websites, too. Listings with better ratings and more reviews are prioritized. Then, you can embed your positive reviews on your online therapy website to build trust with potential clients.
Plan out your content marketing
Another way to catch the attention of prospective clients is through content marketing. This includes everything related to content, from starting a podcast or blog to being written up in your local newspaper.
If you choose to start a podcast or blog, research topics that are relevant to the type of therapy you practice. You can do this using SEO tools to search for those keywords we mentioned earlier. These tools allow you to enter in a phrase like “couples counseling” and see what phrases people use to find therapists like you.
For example, from searching “couples counseling” on SEMRush, we can see that people have questions about whether couples counseling works, how much it costs, and how to prepare for an appointment. Every one of these keywords could be addressed in a blog post or podcast episode.
In addition to blogging on your own website, you can also submit guest posts to other websites to help your clients find you. Psychology Today accepts guest articles.
Consider therapists in your personal network, as well. If you refer clients to each other, there’s likely an opportunity for you to share your expertise on each other’s websites, too, via a blog post. Alternately, you can share each other’s websites and contact information as part of a broader online therapy resources page.
You don’t have to limit your marketing content to words. You can get creative with visuals, too. You could design an infographic for Pinterest that shares the top tips for clients new to online therapy. Free design tools like Canva make this process easy. Just like building your website, you can use their premade infographic templates.
Market your practice on social media
Once you start blogging, it’s up to you to get those posts out there. Set up a profile for your teletherapy practice on social media channels like Facebook, Instagram, and Twitter. You can share links to your blogs, or copy and paste short snippets or tips from them, like @sitwithwhit does:
You can also use social media to provide relief in another way, while boosting your visibility on the platform and increasing your followers (and number of potential clients). For example, some therapists share calming quotes or advice. This sort of inspirational content fits right in on Instagram, and it helps clients get a feel for your therapy style.
Here are some examples from @lizlistens:
When filling out your social media profiles, make sure to include your website, the types of services you offer, and ways to get in touch with you. Use hashtags to increase your reach!
Note: When advertising your therapy services on social media, it’s strongly advised that you use a separate account from your personal one.
Advertise your online therapy practice
Once you get the hang of keywords, you can start using them as part of your online advertising strategy.
Google Ads is a powerful tool you can use to promote your online therapy practice. You can bid on keywords relevant to your services, such as “young adult counseling” or “cognitive behavioral therapist irvine ca” in order to appear at the top of the search results.
Once you enter a few keywords, Google will suggest others that may be relevant to you:
Brighter Vision offers an excellent guide for therapists getting started with Google Ads.
You can also advertise your services on social media. Almost all social media platforms, including Instagram and Facebook, offer a variety of ad formats, from videos to sponsored posts.
Of course, advertising costs money. You can save with these promo codes:
There’s a lot to starting a teletherapy practice, but it’s definitely doable. You do so much to help others, so we’ve put together this guide to help you. We hope it makes things easier. Use it to develop your online counseling business plan, and get started today!