At iCouch, we very frequently get asked by experienced and new therapists how to start an online therapy practice. This post is to provide a very simple answer to that question. If you want to read a more detailed post about how to add it to your existing practice, please read our post How to add online counseling to your existing therapy practice. But, for the sake of simplicity, here’s a summary of the steps you’ll need to take. This post doesn’t go into the “why” just the “how.”

How to start an online therapy practice

  1. Find a suitable technology platform. While of course, we recommend iCouch, the important thing is that you use a HIPAA compliant video conferencing system. This doesn’t have to be expensive and doesn’t require special equipment, just a computer with a web cam. By the way, for American practitioners, Skype is not HIPAA compliant!
  2. Advertise! This doesn’t mean actually spending money on ads, this does mean letting people know you are available for online sessions. For example, on your business card, you can add “online video sessions available.” You should also include this on your therapist website as well as mentioning it to any in-person referral sources you have.
  3. Start doing it. This could be as simple as asking one of your existing in-person clients (especially those that tend to miss appointments,) if they might want to occasionally do an online counseling session instead of coming to the office. You could even offer a small discount as an incentive. It’s great to have your first online session with an existing client because it lowers your stress since you already have a rapport with the patient.
  4. Keep doing it. As you gain more confidence in treating patients using online video, you can expand that option to more and more clients. There is certainly always a place for in person therapy, but as a supplement, especially for the mobility-impaired, the chronically absent, or for routine follow up appointments, online therapy can’t be beaten. Remember, a session online is far better than no session at all.

While at iCouch, we strongly believe in the clinical efficacy of the online modality, we always advise our practitioners to stay within their own comfort level. You should never use an online modality if you don’t feel it’s in the best interest of your patient. Technology should never trump the requirement to always do what’s best for the patient! Online counseling/therapy is definitely the way of the future, but it isn’t necessarily the best choice for every client. As a practitioner, you’re in charge; it’s up to you. Don’t be pressured into offering online treatment if you aren’t yet comfortable with it. However, don’t be afraid to give it a try!

You can try iCouch for free right now. Please have a look and sign up! It’s a great way to easily add online therapy to your practice (it’s also great for improving your in-person practice as well.) Learn more here.

Published by Brian Dear

Brian is the cofounder and CEO of iCouch, Inc. He has an extensive background in software engineering, inbound marketing and mental health practice management.

Join the Conversation


  1. Hi Brian, thanks for the info. I am wondering if you have more information on crossing state lines. For example, I am licensed in the state of Colorado and have a potential client in NY that wants to receive therapy online. I am an LCSW. Do you have any insight on this?

  2. Hello. I am very interested in starting my own counceling with a possibility to expands services.
    How do l set up payments?
    I do not think that l would like to use insurance companies at all

  3. Here is a curious question. I’m not sure if you have encountered this one before? I am a non-citizen licensed to practice therapy in one the US states and might return to my home country at some point. In that case, I will not have US work authorization but a US license and can possibly maintain a US address and do the CE credits online to keep my license. In this scenario, if I want to set up an online practice and see clients from my home country, am I able to do this? Will insurances pay? Can I do self-pay? Even if I bill clients half the amount that I would from here, it would be cool. What are your thoughts? And what would be the case if an American citizen wants to do online therapy while living in another country for a couple of years with a valid American professional license.

  4. HI Brian,I have a Masters degree in Christian Counseling and Bachelors in Theology.Do I need any specific licenses to start a “Pastoral Counseling Online Ministry?

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