Text Therapy: Can A Therapist Improve Mental Health?

These days, we can do just about anything from our phones: check email, text messages, send pictures to a friend, and pay bills from anywhere. And now our phones are playing a role in mental health treatment and therapy, such as through online text therapy.

Yes, there are apps for mindfulness, stress management, and even ones to help with medication management and timing. But can our cell phones be a source of real, life-changing therapy and mental health support with text? And does it work? If you haven't heard of texting therapy, it's real, and many people are beginning to discover that text message therapy can be effective in managing certain mental health conditions.

Text therapy – mental health treatment over text

It is not a crisis text line, meant for mental health crisis situations, but a line of communication for making progress in weekly sessions over time, and at your own pace. Depending on the therapy platform you choose, you may be able to use features like text therapy between therapy sessions.

It's not quite like live video options such as Zoom or Skype offered by other online therapy platforms but gives you the experience of meeting with doctors or psychologists on your schedule. With the rise of telehealth through online therapy providers, and most mobile plans offering unlimited messaging, more people are using text therapy to address any number of mental health conditions, from anxiety to eating disorders. For many people, text messaging a therapist feels less vulnerable than speaking face-to-face.

Advantages of text therapy

There are many advantages to using text therapy. How important these text therapy advantages are will vary based on each person. One possible advantage is that you may find that this kind of virtual therapy is covered by your benefits. Or, for some others who find a service that doesn’t accept insurance, it is often offered for a lower cost.  

Here is a brief overview of the advantages of text counseling:

• Comfort of receiving text therapy from your house
• Time to process your responses
• Feeling safe while participating in text counseling
• Ease of typing out your feelings
• Feeling like there's less judgment in each session

Comfort of talking from your home

Sometimes actually making it to an appointment can be difficult for people. There are many reasons why this is true for counselors and their clients. It could be that someone lives with social anxiety and doesn't want to have to sit in front of a stranger to talk about their symptoms. Others may have a very busy schedule between their work life and home life, and don't have the time to get in one more appointment each week; or, they have small children at home that they are unable to find a sitter for, and can't leave them home alone. Still, others live in areas that don’t have a high population of licensed mental health professionals available for support. All of these are examples of why some people prefer messaging for a counseling session over in-person counseling. 

Text therapy gives a person the chance to communicate with a licensed therapist from the comfort of their own home or whatever location is convenient for them rather than meeting their therapist in an office for in-person therapy. Everyone has their reasons for seeking mental health care, and now some methods work for anyone.

Time to process your responses

When you are sitting in front of a therapist for an in-person session, and you know that the clock is ticking and you only have 30 or 60 minutes total for a weekly live session, it may feel like the pressure is on. This can make it very difficult to process information and honestly answer the questions being posed to you. 

When you are using messaging for text therapy, you can take the time that you need to think through the questions you are being asked. It allows you the time to process and think of things that you might have missed if you were sitting face-to-face, making communication easier for some individuals. The information provided could be key in helping the therapist to know what steps need to be taken to help you achieve your goals. Text-based therapy may allow for more insightful responses to your therapist’s questions and comments.

Some things are easier to say through messages

Some people communicate better with written words than they do verbally. Writing things down and taking time to think about the therapist's responses can make a difference in helping people to process and respond to information. It can help allow them to reflect on their memories and situations and to come to revelations of things that could have been done differently. You can also message your therapist at any time. They may not be able to respond immediately, but you can get the words down. 

Easily look back at the conversation

During an in-person session, the therapist usually takes notes throughout your time together. However, you as the patient do not usually take notes about what's being said in the conversation. Later in the day, after your session has concluded, you may have questions about the conversation you had. If you don't have notes, you are unable to look back at that information. 

Text therapy and messaging your therapist allow you to see the conversation that you were having. It allows you to look back through the live chat sessions and their provided information so you can reprocess it through a new lens if needed. This can be a significant benefit of text therapy platforms.

Less judgment

Some people report feeling less judged when talking over messaging than they might chatting in person for individual therapy or standing up in front of a support group. Your therapist should never be judging you, no matter what type of therapy you're doing, but the patient could feel judgment because they are navigating many difficult emotions such as shame and guilt. 

Just the thought that they might be judged harshly can make some people clam up during a session. When these same people are talking with a therapist through text therapy— whether it be messaging or chat, they may be less worried about judgment and can tell more openly. It can be much easier to type out your thoughts and feelings in a live chat setting, rather than speaking to your therapist in person or through a video conference.

Comfort and safety with text therapy

Counseling sessions and even support groups tend to stretch people outside of their comfort zone. Most people aren't naturally comfortable talking about their feelings and emotions with strangers. However, messaging provides an opportunity for a greater level of comfort and safety than you may find in more traditional therapy– whether that’s individual or group counseling. Patients know that no one sees them on the text therapy platform, which can help them to feel more comfortable being open. 

Some people may also prefer messaging because they don't want to be seen going in and out of the sessions. This is often due to the stigmas surrounding mental health and can keep many people from getting the help that they need.

The limitations of text therapy

Messaging and text-based counseling isn't going to be the right approach or mental health treatment for every situation. For example, if you enjoy group therapy, support groups, or video sessions, a text therapy service might not be the right fit. 

There are also some limitations on what type of mental health challenges can be properly treated through therapist messages. It can help many people navigate through things like anxiety, depression, grief, and relationship problems. The therapist that you choose will help you determine if text therapy is right for you or if in-person therapy or another type of traditional counseling might be a better fit. 

Potential limitations of text therapy:

It's important to note that text therapy may not be available for you 24/7. If you're looking for immediate support, contact the Crisis Text Line by texting "DESERVE" TO 741-741. You can also visit the Get Help Now resource page for more emergency services contact numbers, like the National Domestic Violence Hotline at 1-800-799-7233. 

You cannot receive a prescription

Some mental health challenges will require the use of medication to help alleviate symptoms. Therapists generally can't prescribe medications through text therapy. For this type of mental healthcare, a person must visit a medical doctor or have in-person counseling with a psychiatrist. Sometimes these providers may also be able to provide prescriptions over online video sessions.

Tone of voice is hard to replace

Sometimes your mental health provider can pick up on things that their patients are trying to communicate simply by hearing their voices during face-to-face therapy or even through audio messaging and video chat. It might not be the words that they are saying, but how they are saying them. Messaging removes a therapist's ability to pick up on subtle cues. All that they have to go off of are the actual words that the patient is typing into each message. They are unable to detect changes in emotion in their voice.

Nonverbal cues are lost

Therapists are also able to pick up on non-verbal cues when they are meeting for in-person counseling or video sessions. This could be as simple as reading their body language when they enter the room or seeing their posture change as they start talking about a different situation. For example, you may appear aloof over when you message your therapist but your body language may show your true emotions, of feeling closed off or vulnerable. This context is nearly impossible to discern from text conversations alone.

Efficacy of text therapy: Can texting really work?

As outlined in this article, certain technologies are increasingly being used in a few online counseling platforms as tools for mental health services– like video chat and text therapy platforms. Medically reviewed and peer-reviewed studies have shown that messaging is a valuable component of online therapy and counseling programs when addressing an array of mental illnesses and mental health issues. 

According to one study, messaging with a provider through text-based therapy can help lead to better outcomes by increasing engagement with therapeutic exercises, and reinforcing the skills learned in video therapy sessions or personal sessions. 

Overall, peer-reviewed studies point toward the fact that messaging can help facilitate and complement an overall mental health approach. Some therapists and therapy services offer the ability to message your therapist anytime, and they will get back to you when they can even outside of sessions.

What to look for

If you are interested in beginning messaging with a therapist, be they a crisis counselor, grief counselor, or another specialty, you'll have to find a provider offering messaging services. There are several platforms, such as BetterHelp, that can provide you with a list of people who can help. Many also have online forms and other tools that help you match up with a therapist for your situation, including if you are looking for sliding scale therapy if cost is a concern for you. BetterHelp even offers text messaging options. In the same way, TalkSpace offers online text with therapists to help people progress toward their goals. With online counseling, you're not limiting yourself to seeing a mental health professional in your state-you're open to seeing anyone who's licensed to work with you.

You may feel much more comfortable checking yourself to see the therapist's credentials that you might be working with. And, if the first person that you were matched up with doesn't feel like a good fit for you as you go through your first session, it's okay to stop working with them. This doesn't necessarily mean that messaging isn't a good option for you; it just means that the individual therapist was not a good fit.

Online therapy and mental health support with BetterHelp

As mentioned above, internet-based sessions, video counseling, and text therapy services are efficient ways of helping to manage symptoms arising out of several different mental health issues. If you’re concerned about safety, online therapy sessions through a therapy platform like BetterHelp can be completely unknown. Along with the ability to easily communicate with your therapist through text, you’ll be able to schedule sessions on your time. You won’t have to wait months for an appointment with one of our licensed therapists, or contact support staff just to schedule a time—just go online or through the BetterHelp app to quickly make or modify an online session. You can even use the app to easily switch therapists if your current therapist isn’t the right fit for you.