How telehealth video therapy improves access
Summary
Clinicians are asking, “Will therapy become fully virtual?” as telehealth continues to expand and clients increasingly seek flexible, online options.
The future of online counseling depends on balancing technology, clinical best practices, and client needs to maintain strong therapeutic connections.
Use secure, HIPAA-compliant platforms, check licensing guidelines, and document telehealth sessions to ensure quality care.
Evaluate each client’s situation to determine if in-person sessions are necessary for interventions like EMDR, crisis management, or working with children.
Stay informed about policy and insurance changes, including ACA and telehealth coverage, which will influence access and the growth of virtual mental health care.
The COVID-19 pandemic shifted how therapists deliver care. Clinicians initially questioned telehealth, asking: what about therapeutic connection?
But therapists adapted, and virtual treatment has become the norm for many clinicians. Clinicians have also seen technological advances that make their jobs much easier.
Many therapists are wondering what the future of online counseling may look like and whether therapy will become fully virtual.
It’s important to consider the very real impact impending policy changes may have on mental health care for millions of Americans.
How therapy has changed
Virtual treatment rose dramatically during the pandemic, but will therapy become fully virtual? The answer is probably not.
According to the Centers for Disease Control and Prevention, there was a staggering 154 percent increase in telehealth services during the last week of March 2020, compared to the same period in 2019.
While clinicians are no longer limited to telehealth, many still prefer its flexibility and convenience. Others have opted for a hybrid practice, and some have returned to purely in-person treatment.
How to maintain quality virtually
As with any client interaction, there are ways to maintain quality virtually and promote the therapeutic connection with a few simple steps, including:
Consider guidelines: Check your licensing board's guidelines for telehealth practice standards, and undertake the necessary telehealth and digital competency classes, especially on cybersecurity and ethics.
Assess fit: Ensure telehealth is appropriate for your client and check that their insurance covers telehealth sessions.
Prioritize secure, high-quality technology: Use appropriate equipment, such as a computer or tablet, headphones, safe, high-speed internet access, and an encrypted, HIPAA-compliant telehealth platform. Ensure devices are fully charged, and all notifications are turned off.
Document the session: Note that the session was conducted via telehealth, ask the client to confirm they are in a private location (and located in the state in which you are licensed), and all other relevant session information that you would usually record in a session note. Ensure you have a signed informed consent for telehealth from the client in their file.
Maintain clinical boundaries: Provide therapy in a private space. Some clinicians might use a screen background to obscure their home.
Promote the therapeutic relationship: Encourage the client to create a therapeutic environment for themselves, in a private room, with headphones, a drink or snack, and no distractions. Ask for clarification when you cannot assess body language, be more explicit in your reflections, and empathize where appropriate.
Use therapeutic tools and safety protocols: Confirm the client's location during the appointment, identify their emergency contact, perform a risk assessment, and use validated tools when indicated.
How to ensure accessibility for clients
Check with the client or their parents if they have access to a private room that could be used for therapy, free from interruption, and a suitable device.
Suggest the client download the EHR and other software, test their device, and complete the relevant consent forms before the session. Show the client what it looks like during their in-person session and give them the contact information of someone who can help if they run into technical difficulties.
When is in-person necessary?
As clinicians weigh these situations, the question of whether therapy will become fully virtual becomes more pressing.
In some cases—like EMDR therapy, crises, or working with children—telehealth may not fully replace in-person sessions.
Instances when in-person therapy is necessary include:
The client is opting for a particular method of bilateral stimulation.
Suicidal ideation is present.
Using an interactive intervention or modality, such as art therapy or somatic experiencing work.
The client is experiencing dissociation and increased risk factors.
Insurance may not cover telehealth sessions.
The client prefers in-person sessions.
The client is a child, adolescent, or family unit.
The client doesn’t have access to a private space.
Clinical outcomes decline with telehealth.
What about crisis management?
It can be more beneficial to be in the same room as the client during a crisis, as you may have greater access to resources and be better able to de-escalate.
However, you can still provide crisis management during telehealth.
Depending on the severity of the crisis, clinicians will want to confirm:
The client's location
Emergency contact details
Risk assessment, including access to lethal means
Medication information
If necessary, a safety plan with coping strategies, contacts, follow-up steps, and local resources
Then document the session, speak to your supervisor, and follow up with the client and any other necessary parties to ensure their safety.
What does the future of online counseling look like?
With advances in AI, EHRs, and virtual platforms, the debate over the future of online counseling and whether therapy will become fully virtual is more relevant than ever. These tools streamline administrative tasks and enhance flexibility for both therapists and clients.
More recently, despite some legitimate ethical and privacy concerns, providers are increasingly using AI-assisted note-taking.
Just as virtual therapy offers convenience and saves time, AI and EHRs streamline administrative tasks by handling billing and documentation—two major time-consuming tasks for therapists.
There are costs and benefits to how clinicians deliver therapy and perform essential functions, as with any business model. There remains a high demand for therapists, both in person and via telehealth.
However, there are other broader considerations that shape demand and service delivery, such as health insurance. Currently, most payers continue to allow virtual visits. Medicare and Medicaid cover telehealth, though requirements around in-person visits for mental health services have been subject to ongoing extensions and policy changes.
Policy changes and insurance coverage will play a major role in the future of online counseling, affecting accessibility, affordability, and the mix of in-person and virtual sessions.
A leading policy analysis from the Kaiser Family Foundation (KFF) shows that marketplace coverage has grown from 11.4 million in 2020 to 24.3 million in 2025. This expansion has given millions of Americans vital access to mental health care.
According to KFF, one in six Marketplace enrollees had a mental health diagnosis in 2022, although they estimate current figures are higher. Further, in a recent survey, enrollees reported their mental health is “fair” or “poor.”
The proposed policy changes to the ACA could have a significant impact on the mental health of millions of Americans. By raising premiums by an estimated 26%, enrollees will see their monthly premiums more than double, on average, increasing out-of-pocket costs by about 114%.
As insurance becomes unaffordable, KFF estimates that 8.2 million Americans may lose coverage and become uninsured by 2034. The broader impact could mean less coverage and less access to mental healthcare.
Virtual therapy appears to be here to stay in various online and hybrid forms, though whether therapy will become fully virtual still depends on technology, policy, and client need.
Sources
American Psychological Association. Calkins, H. (2022). Telehealth is here to stay. Psychologists should equip themselves to offer it.
Kaiser Family Foundation. Cox, C. (2025). ACA Insurers Are Raising Premiums by an Estimated 26%, but Most Enrollees Could See Sharper Increases in What They Pay. Kaiser Family Foundation.
Research in Psychotherapy: Psychopathology, Process and Outcome. Giordano, C., Ambrosiano, I., Graffeo, M. T., Di Caro, A., Gullo, S. (2022). The transition to online psychotherapy during the pandemic: a qualitative study on patients' perspectives. 25(3), 638.
Centers for Disease Control and Prevention. Koonin, L., Hoots, B., Tsang, C., Leroy, Z., Farris, K., et al. (2020), Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020.
Kaiser Family Foundation. Panchal, N., Rae, M., & Lo, J. (2025). How might changes to the ACA Marketplace impact enrollees with mental health conditions?
U.S. Department of Health & Human Services. (2025). Telehealth policy updates.
Wake Forest University. (2025). Telehealth Mental Health: The Future of Counseling.
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