In times of increased interest and demand for online healthcare services, more people have turned to online therapy via mental health apps and text messaging. Patient convenience and affordability benefits aside, is text therapy effective and should your practice offer it?

The demand for text therapy is largely driven by millennials, who have been texting since the mid-90s (the first text was sent in 1992). Following the introduction of the iPhone in 2007, texting has become mainstream, with millennials texting 70 times per day on average.

Is Text Messaging Therapy Effective?

According to Ron Taffel, PhD., “I finally embraced the clinical relevance of texts as a real time record of dysregulation and potential healing that could strengthen the vitality of treatment.”

Early research on the topic also suggests that some patients have and could benefit from text therapy. One recent study evaluated anxious and depressed patients who engaged in daily text messaging with licensed clinicians. Nearly 70 percent experienced improvement or recovery.

Another study focused on patients with more serious forms of mental illness. Ninety four percent of patients surveyed said text messaging as a therapeutic service made them feel better.

The Pros & Cons of Text Messaging for Clinicians

As with any form of psychotherapy, text therapy may be a good fit for some patients and not appropriate for others. When deciding whether to offer text therapy in your practice, consider the following pros and cons.


1). The demand for AND acceptance of telehealth services is high. In a poll of 5,000+ adults conducted by CynergisTek in June 2020, fifty-four percent of respondents said they had used telehealth services in the past month. Of that 54 percent, seventy three percent said they’d continue to use telehealth services post-pandemic. Millennials and Gen Xers were the most enthusiastic (at 81 percent and 79 percent respectively).

As for text messaging specifically, Aetna reports a Morning Consult poll of 2,200 adults and 500 frontline healthcare workers (conducted April 28-May 3, 2020) revealed that 48 percent of respondents would be willing to receive mental health care via text message or mobile application.

2). Since it’s more affordable, text therapy gives more patients access to care. In-person therapy is cost prohibitive for many people, and in the past, that meant going without care. Text therapy is much more affordable, allowing clinicians to help more patients. For example, CarePaths Online Therapy with text messaging costs $40/week.

3). Text therapy is convenient for both the patient and clinician. Patients don’t need to wait for their next in-person visit to seek help, and clinicians with a smartphone can respond from any location. However, therapists must be sure to set expectations up front. Patients need to know how soon they can expect to receive a response.

4). The privacy afforded by text therapy brings comfort to many patients. Some patients don’t want other people to know they “see” a therapist. Since text messaging is so discreet, it’s easy to reach out to a therapist on the patient’s terms.


1). Some patients have concerns about security risks. In the CynergisTek poll, forty eight percent of respondents said they would be unlikely to use telehealth services again if protected health information was compromised during a security breach. Choosing a mental health app or text messaging tool with encryption and one that is HIPAA compliant—like CarePaths EHR —is key for behavioral health clinicians.

2). Switching from in-person to text-based therapy takes practice. If you’re new to text message therapy it may take time to figure out what works best for you and each individual patient. For example, a study of text based counseling with patients ages 23 and under suggests that patients may “benefit from the texting as long as the counselor responds promptly and in long, dense, expressive messages. The number of messages exchanged is not as important as the total length of the texting session.”

3). Lack of visual cues. During in-person therapy, mental health professionals learn a lot about a patient’s mental state through his or her body language, facial expressions and other visual cues. The therapist won’t have access to those clues and will need to rely on the tone of the written text and the patient’s ability to express themselves via the written word. Some patients have difficulty conveying their thoughts via text.

If you are considering an online counseling tool for your practice and need additional information about CarePaths EHR, schedule a free demo today!