Americans are getting more therapy than ever -- and spending more. Here's why.
Together, the pandemic and Zoom have seeded an online therapy boom. Therapists say they have never been busier.
The share of young adults ages 18 to 34 who sought counseling rose swiftly in the pandemic years, from 12% in 2019 to 18.4% in 2022, the most recent figure available from federal researchers. The share of all adults seeking counseling rose from 9.5% to 12.6%.
In a midpandemic industry survey by the American Psychological Association, 68% of psychologists said they had longer wait lists than before COVID-19 arrived. And 2 in 3 said they could not accept new patients.
“A significant portion of our psychologists are reporting that they are working harder than they were before, that they have longer waiting lists than before the pandemic, and there is some concern around burnout as well,” said Vaile Wright, senior director for health care innovation at the psychologists' organization.
Americans are spending more on online therapy
Spending on mental health services also rose, climbing by more than half, 53%, from March 2020 to August 2022, according to RAND Corp. research on millions of workers insured by their employers.
Americans are spending more on therapy because they are getting more of it. The ease of online therapy allows patients to seek treatment pretty much when they wish. The RAND study found that telehealth visits increased tenfold during the pandemic. Overall use of mental health services rose by 39%.
One reason for the online therapy boom, experts say, is that mental health care has never been so accessible. Services that once required a car trip or bus ride – and that were beyond the reach of some rural Americans – are suddenly one click away. Another reason is a societal epidemic of anxiety, depression and loneliness, especially among younger Americans, a trend fed by the pandemic itself.
Some patients are spending more on mental health care than they can afford. In a 2022 survey of 1,000 therapy patients by the health and wellness site Verywell Mind, one-third of patients said they had canceled sessions because of excessive out-of-pocket costs, which averaged $178 a month. Two in five said they had cut down on sessions to save money.
Online therapy has transformed the mental health industry. Nearly 100% of providers now offer telehealth to their patients, industry surveys have found, up from basically zero in the pre-pandemic era.
"We have been doing this for a while. We know it works well," said Dr. Shabana Khan, chair of the American Psychiatric Association's Telepsychiatry Committee. "I think a good clinician is a good clinician, no matter how they provide the care."
More than half of all therapy sessions are telehealth
More than half of all therapy sessions now take place online or over the telephone, compared with about 20% just before the pandemic, according to a 2024 study of telehealth visits in the U.S. Department of Veterans Affairs.
Investors steered $4.8 billion to new companies offering online mental health services in 2021 alone, the Wall Street Journal reported, citing data from the research and investment firm Rock Health. The backers saw an opportunity, both in the pandemic-era surge in depression and anxiety and in the sudden dearth of face-to-face therapy to treat it.
Online therapy has spread to schools. At least 16 of the nation’s 20 largest school districts now offer online therapy to students, in contracts with providers worth more than $70 million, according to a December analysis by the Associated Press.
Online therapy has blurred the lines between work and Me Time for therapists, just as it has for workers in countless other professions.
“People are busy. I know that waiting lists are huge,” said Michele Kerulis, clinical associate professor of counseling at Northwestern University.
'I had to start telling people no'
Consider Jonathan Abramowitz, a clinical psychologist at the University of North Carolina and an expert on obsessive-compulsive disorder.
Patients used to fly in to see Abramowitz from all over, often staying near the Chapel Hill campus for weeks of intensive sessions.
When the pandemic arrived, Abramowitz started seeing the same patients remotely.
Once patients learned they could meet the specialist via Zoom, he said, “It started exploding, and I had to start telling people no.”
Telework has freed thousands of therapists from commuting to an office, and from finding matching socks. But Zoom can only go so far to stretch the industry’s reach.
“You’re not creating more hours in the day,” Wright said. “You’re not creating more therapists.”
Online therapy is a potential game changer
Online therapy is a potential game changer for millions of Americans who once lacked access to a therapist for myriad reasons: They had no transportation, lived far from the nearest therapist, couldn’t get permission to leave a job, or struggled with child care.
“People who live in rural areas, maybe they’re driving four hours for a one-hour session,” Abramowitz said. “There were these therapy deserts. You don’t have that anymore.”
Online therapy may be drawing more people into the mental health profession.
Federal data show a modest increase in the number of marriage and family therapists during the pandemic years, from 59,050 in 2019 to 63,340 in 2023. The number of clinical and counseling psychologists rose from 58,100 in 2021 to 71,730 in 2023. (In the latter profession, comparable figures for earlier years aren’t available.)
Mental health experts don’t really know how much of the surge in therapy is because of Zoom. Even before the rise of telehealth, the nation seemed to be in the grips of a mental health crisis.
Gallup polling finds a steady increase in the share of Americans being treated for depression, from 10.5% in 2015 to 17.8% in 2023. Much of the increase, but not all of it, came in the pandemic years.
“COVID threw a lot of people for a loop,” Abramowitz said.
Online therapy works just fine, most of the time
Research suggests online therapy works just fine for many patients. One meta-analysis, conducted before the pandemic, found remote therapy as effective as face-to-face treatment for many disorders.
But Zoom is not for everyone. And some patients don’t like it.
“I have worked with folks who say, ‘Nope, I have to see you in person,’” Abramowitz said.
Face-to-face therapy generally unfolds in a safe space, behind closed doors, often soundproofed. Virtual therapy, by contrast, can happen anywhere. Some patients struggle to find the right setting.
“I’ve had people walk outside to take their sessions with me,” said Kerulis, who serves adolescent clients, some with roommates. “They’ll find a park bench, but then there are people walking by.”
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Not all online therapy is created equal.
Industry leaders question the quality of online therapy offered by some of the new for-profit companies, which appeal to potential patients with testimonials from such celebrities as Simone Biles and Michael Phelps.
“There are fundamental questions about what these companies are doing and whether they are reaching people who really need help,” said Dr. John Torous, former chair of the American Psychiatric Association’s Health Information Technology Committee, speaking in an investigative report by KFF Health News.
“They may be doing wonderful work,” Torous said, “but it’s hard to know when we don’t have that data.”