How Does Text Therapy Work? A Guide To Messaging-Based Mental Health Support

Text therapy works by allowing you to exchange messages back and forth with a licensed mental health professional, either in real time or over the course of a few days as your therapist responds when able. It can be part of broader online therapy services, and it gives many people a more comfortable way to open up. Our phones are increasingly playing a role in mental health treatment and therapy, and many people are discovering that texting therapy with licensed therapists can be an effective way to get support for certain mental health concerns.

What is text therapy?

Text therapy refers to text-based counseling that lets clients communicate with a licensed therapist through messaging interfaces, such as chat messages, online chat rooms, or asynchronous messages sent via a phone or computer. These services are often offered through a subscription model, which can be a convenient and flexible form of care for many individuals.

It's worth noting that text therapy is different from a crisis text line, which is meant for mental health crisis situations. Instead, text therapy can be a line of communication for making progress over time and at your own pace. It's also distinct from AI mental health chatbots. With text therapy, you communicate with a real, licensed human therapist, not an automated tool.

This type of therapy can be part of a broader online therapy experience, which may also offer video, audio, or live chat sessions. With that foundation in mind, it can help to understand what the process actually looks like day to day.

How text therapy works

Text therapy often involves typing messages back and forth with your therapist during your session time. Rather than speaking out loud, you can simply type out your thoughts and communicate in written form, which can be more comfortable for some people. Your therapist may offer suggestions and coping skills to help you regulate your emotions and stay grounded.

With a platform that offers text-based therapy sessions such as BetterHelp, users can also take advantage of asynchronous messaging outside of sessions. That means they can send messages to their therapist outside of sessions using in-app messaging, and their therapists will respond when they are able. These communications may allow for regular check-ins and the ability to express yourself during a stressful moment.

Synchronous vs. asynchronous messaging

Understanding the two main formats of text therapy can help you decide what might work best for your needs. Here is how the two types of therapy message exchanges tend to differ:

When your therapist responds

One common question involves how quickly a therapist replies to messages. With asynchronous messaging, therapists often respond as soon as they are able rather than immediately, so it can help to set realistic expectations. This approach still allows you to get your thoughts down in the moment and receive thoughtful responses later.

What a text therapy session looks like

Picture opening an app and typing out what has been on your mind, then reading your therapist's reflections and follow-up questions a few moments later. You might describe a recent situation, share how you responded, and then receive gentle guidance or coping tools in return. The exchange is a written conversation, giving you space to reflect between messages and revisit anything that stands out. Once you understand the mechanics, it can be helpful to explore why so many people appreciate this format.

Benefits of text therapy

There can be many advantages to using text therapy, and how meaningful each one feels will vary from person to person. Below is a brief overview of some potential benefits of text counseling:

• The comfort of receiving support from your own home
• Flexibility that doesn't always require scheduling a formal session
• Time to process your responses before replying
• A greater sense of ease while participating
• The simplicity of typing out your feelings
• A sense that there may be less judgment in each session
• A possible cost-saving alternative, particularly when it's offered through a subscription model

Time to think and process

Sitting in front of a therapist while the clock ticks during a 30- or 60-minute session can sometimes make it feel like the pressure is on. That kind of pressure can make it difficult to process information and answer questions honestly. When you use text messaging, you can take a bit more time to process the questions you're being asked. This can allow you to think through things you might have missed face-to-face, which may lead to more insightful responses for your therapist to work with.

A written record of your sessions

During an in-person session, a therapist may take notes throughout your time together, but you as the client typically don't. Later in the day, you may have questions about the conversation you had, and without notes, it can be hard to look back. Text therapy provides a written record you can revisit, so you can reprocess the information through a new lens later if needed.

Communicating from a comfortable space

Getting to an in-person therapy appointment can be difficult for some people. Someone might experience social anxiety symptoms and prefer not to sit in front of a stranger, while others live in areas without a high number of licensed therapists nearby. Text therapy gives a person the chance to connect with a licensed therapist from home or wherever is convenient.

Some people may also prefer messaging because they don't want to be seen going in and out of in-office sessions, often due to the stigmas surrounding mental health that can keep many people from getting the help they need. If this resonates with you, it may be worth exploring online options when you feel ready.

Feeling less judgment

Some people report feeling less judged when talking over text than chatting in person or speaking up in a support group. Your therapist typically won't judge you, no matter the format, but the client could still feel judgment because they're navigating difficult emotions like shame and guilt.

Just the thought of being judged harshly can make some people clam up during a session. When these same people communicate through text therapy, they may worry less about judgment and can open up more freely.

Text therapy vs. in-person therapy

Both text therapy and in-person therapy can offer real value to many people, and the right choice for you often depends on your needs and preferences. The table below highlights some of the key differences between the two approaches to help you decide.

What can text therapy help with?

For many people, texting a therapist feels less vulnerable than speaking face-to-face. One longitudinal observational study of individuals with PTSD suggests that symptoms like avoidance and guilt can pose a significant barrier to seeking therapy, but text-based care may feel more approachable in cases like these. In other words, text therapy options can sometimes be the difference between a person receiving care and not receiving care.

Text therapy may help many people navigate a range of concerns. Some common areas it can support include:

• Anxiety
• Depression
• Grief
• Relationship problems

The therapist you choose can help you determine whether text therapy is a good fit or whether in-person therapy or another approach might serve you better.

What text therapy is not

Text therapy is not a crisis service, and it may not be available around the clock. If you're looking for immediate support, you can contact emergency services, dial 988, or reach the Crisis Text Line by texting "HOME" to 741-741. You can also visit the Get Help Now resource page for more emergency contact numbers, such as the National Domestic Violence Hotline at 1-800-799-7233.

Certain technologies are increasingly being used in online therapy platforms as tools for mental health services, and messaging can be a valuable part of that care, but it isn't right for every situation.

Considering the role of nonverbal communication

Sometimes a mental health provider can pick up on things a client is trying to communicate simply by hearing their voice or noticing body language. In text-based sessions, a therapist has only the words a client types to work with, which means subtle shifts in tone or emotion may be harder to detect. Nonverbal cues, like a change in posture, can also be nearly impossible to read through messages alone. Even with these limitations, research offers encouraging insights into how effective text therapy can be.

How effective is text-based therapy?

Some studies suggest text therapy can be effective for many people. One study of asynchronous mobile-enabled text psychotherapy indicates evidence for the effectiveness of the intervention, with nearly half of participants experiencing clinically significant symptom remission. Some peer-reviewed studies like this point toward messaging being a valuable component of an overall mental health approach, though more research is needed regarding when additional services may be helpful.

Is text therapy right for you?

Text-based therapy may be a good match for certain people and preferences. It can be worth considering if any of the following describe you:

• You have a busy schedule and value flexibility
• You experience social anxiety and prefer not to meet face-to-face
• You communicate more comfortably through writing than speaking
• You live in a rural area with limited access to local providers
• You're familiar with technology and prefer written communication

Options to consider if you're seeking psychiatric care

When it comes to medication, therapy through text is a separate service from psychiatric care. BetterHelp now offers psychiatry services through Uplift, which may include medication management when clinically appropriate, as determined by a licensed psychiatric provider following a full clinical evaluation.

Psychiatry is an additional care option available alongside therapy and can be part of a holistic mental health care experience. Not everyone needs or benefits from medication, and medication decisions are personalized.

Medication availability and coverage may vary by member location, clinical appropriateness, and individual pharmacy/insurance benefits. Prescribing decisions are made by the treating clinicians. We do not guarantee that any specific medication will be prescribed or covered by a member's insurance plan.

Cost of text therapy

Cost can vary depending on the online therapy company you choose. A BetterHelp subscription typically ranges from $70 to $100 per week, based on factors like your location, referral source, your preferences, any applicable discounts, and therapist availability. A BetterHelp subscription includes weekly sessions with a licensed therapist, which can take place via video, audio, or live texting, along with access to a suite of digital tools like journal prompts and group sessions.

In select states, some providers on BetterHelp may be in-network with certain health plans, and co-pays average about $23/session for eligible members. Coverage varies by plan, provider, and therapist availability, so it can help to check your in-network status on the BetterHelp site. Financial assistance may also be available to qualifying individuals.

How to get started with text therapy

Starting with text therapy can be simple. With BetterHelp, for example, you'll need to simply complete a brief intake questionnaire and sign up for a subscription, and then you can get matched with a suitable therapist. From there, you can schedule your first session and begin.

If your first match isn't a good fit, BetterHelp allows you to switch therapists as needed at no additional cost, and most users are matched with a therapist within 48 hours. When you're ready, you can take the first step and explore your options.

Exploring online therapy with BetterHelp

Online therapy through a platform like BetterHelp can bring flexibility and accessibility to mental health care, with text therapy as one potential part of that experience. Sessions can take place via video, phone, or live texting, and you can also message your therapist between sessions using in-app messaging

BetterHelp also now offers psychiatry services through Uplift as an additional care option available alongside therapy, expanding access to licensed psychiatric providers who can support a holistic mental health care experience. This kind of accessibility is one reason many people find online care worth exploring.

Research on online therapy's effectiveness

Research suggests that, in many cases, online and in-person therapy can both be effective for relationship and mental health concerns. It's worth remembering that the mode of delivery isn't the only factor in therapy effectiveness, since dedication and commitment from the client and the therapist's experience can also play a role.