What makes for a good online therapy platform? What are some of the key differences between systems? When you’re looking to add online therapy to your behavioral health practice, you’ll (rightfully) have a lot of questions. This article will help you learn how to cut through the marketing hype and understand the elements of a HIPAA-compliant video conferencing system that matter most.

The 5 most important considerations for online therapy software

  • The client experience
  • Your experience
  • Security
  • Price
  • Technical behavior during less-than-optimal conditions

The client experience

This is the most important consideration aside from security. You’re in the people business. You serve the public. As you certainly know, the public has a diverse cast of characters, some technically astute, others easily frustrated, and still others who are befuddled by what digital natives might consider “simple.”

When choosing a system for online counseling, therapy or coaching, it’s vital that you consider the ease of use for the first time user. As a practitioner that would use the system all the time, the quirks of a particular platform are generally manageable — you get used to how it works and thus, your notice the difficulties much less than a client might.

Around iCouch, we have a disdain for requiring anyone to download or install anything. That disdain stems from years and years of experience. Let’s take Zoom for instance (which isn’t HIPAA compliant, but still very popular,) Zoom requires users to download a plugin, install it and then use that to have a video session. Seems “simple” enough right? However, if you’ve spent any time helping people with technology, you’d know that something so “simple” isn’t always so. It increases friction. That friction means that it’s harder for clients to use the system. If it’s harder, that means it’s more frustrating, more difficult, and thus makes the therapy “harder” to participate in.

Downloading something like Zoom can create barriers to your clients. Additionally, many online counseling platforms require an iOS or Android app download. This is problematic for a few reasons:

  1. App downloads aren’t particularly private, for example, if you download Tinder, that app is in your app download history, even when the app is deleted. Downloading a “Therapy Video Conference” app means that the client is going to have a record of that download in their account — an account that is often shared with family members.
  2. App downloads require visiting the App Store or Google Play. While we have strong confidence in Apple’s privacy policies, do your clients really want Google knowing they downloaded a therapy app? There is also the friction involved with downloading an app. They have to visit the store, search for the app, download it, sign into it, etc.
  3. Shared devices — if someone is using an iPad for instance, they’d have to download the app and it would be visible and available to anyone who uses that iPad. In many families, iPads are shared.

Your experience with an online therapy platform

While optimizing for the client experience is paramount, your experience matters as well. Are you easily able to organize your sessions? Do you have a unique room for each client or is it something shared where every client accesses your session in the same place, at the same link, etc. Do you have to set up an account for each of your clients or can they use the system without being “in” the system. These are important considerations. How easy it it for you to manage your therapy practice and online sessions?


Did you know Skype is not HIPAA compliant? FaceTime, despite us loving FaceTime for our personal life, is also not HIPAA compliant. Though if you’re going to ignore compliance issues, FaceTime is far more secure than Skype.

The other aspect of security has to do with recording. Zoom allows recording, which itself isn’t bad, but if a practitioner is recording a session on Zoom, there is a serious risk when it comes to compliance and security. Imagine if client sessions were released to the public in the event of a data breach! That would destroy the public’s trust in online behavioral health modalities as well as cost you potentially $10,000 or more per violation of HIPAA. Even if you have client permission, are you willing to trust your session security to a company that hasn’t signed a Business Associates Agreement?

Those using Facebook Messenger are swimming in even more dangerous waters. Did you know that Facebook gave access to private messages to Netflix and Spotify? Using Facebook for any part of your clinical activities is extremely negligent. In fact, it could be considered willful negligence given that Facebook’s privacy issues are widespread and well-known.

Using a dedicated, purpose-built system for your online behavioral health practice is the best way to ensure security. Even if you are outside the US where HIPAA doesn’t apply, the privacy risks of using “consumer” video systems outweigh the advantages.


HIPAA-compliant video conferencing has historically been very expensive. However, if you are a solo or small group practice, the costs of such systems exceed the amount of revenue online sessions might provide. On the other end of the spectrum, there’s “free.” However, with free systems, there is always a catch. Whether or not the catch is worth it to you is your decision, but you get what you pay for is as true now as when that phrase was first uttered. So, avoid “free” but also don’t spend hundreds of dollars per month. You know your pricing thresholds — but just remember, expensive isn’t always better and free never is. If you’ve ever worked with Epic EHR systems, you’ll know that expensive software doesn’t make it good or easy to use!

Technical behavior during less-than-optimal conditions

This is the one criterium that you aren’t going to see on many vendor sites. What technical behavior during less-than-optimal conditions actually means is the performance and usability of a system when you don’t have the greatest internet, you don’t have perfect devices or when you’re in less-than-perfect conditions.

For example, some systems will cut out, freeze or otherwise stop working when internet connections drop too low. Other systems might look like High Definition when you’re on a fiber broadband connection, but they turn into a freezing mess when you use the system under the conditions faced by many of your clients. Performance over cellular is particularly troublesome.

How well does your system work when things aren’t perfect? This might be one of the most important things to consider — if your client can’t hear you, you aren’t doing much good are you?

How iCouch fares as an online therapy platform

We aren’t perfect, nobody is! However, the iCouch system was designed around the five criteria. Other systems might be better at one specific, but very few get all of them right.

  1. The client experience — iCouch has a one click system for clients. What that means is that if they have the link to their session, they just click it and they are in the session. No downloads required. As long as their computer or device is relatively recent (i.e. within the past 5 years,) it’ll work. They don’t need to even sign in to an account — if they have the link, they can join the session. It’s about as low friction as it can get. Of course, occasionally there are issues relating to things like the client hasn’t allowed microphone access, but the vast majority of clients that use iCouch for videos sessions simply click-and-go.
  2. Your experience — You can easily create rooms for clients, do group sessions and you don’t have to invite or add a client in order for them to connect. You just send them the link and they’re good to go. Of course, your system does have complete practice management as part of the software, so you could do things like send clients forms, create appointment reminders, take clinical notes or start a text-based chat. But, to use video, you don’t have to do any of that. It’s there if you want it, but it isn’t required at all. With iCouch, group sessions are as simple as sharing the link with all of the participants. They all click, they all join.
  3. Security — every part of the iCouch system is HIPAA compliant. We’ve been in this business a long time and we’re pretty good at keeping your information secure, however, to use video, you don’t even have to enter any protected health information at all — if there’s a link, there’s a session.
  4. Price — our video and messaging plan is $25 per month. We think that’s a fair price; it isn’t free, but it’s far from budget-crushing. If you did just a couple of sessions per month, it is affordable for most practices. Our full-featured practice management plan is $40 per month which includes video as well as all of the other practice management stuff such as scheduling, clinical notes and credit card payments.
  5. Technical behavior during less-than-optimal conditions — this is where our system really shines. We engineered the system to “gracefully degrade.” What that means is that we prioritize audio quality over everything else. You’ll always get pristine audio, regardless of bandwidth and video quality is scaled to match the available connection speed. That means that if the connection gets bad during a session, the audio will stay perfect and the video will reduce in quality until the bandwidth improves. Our system also works with relatively low bandwidth as well. Of course faster connections give you amazing quality for both audio and video, but we built our system around the reality that most internet connections aren’t perfect.

Do you have any questions about online therapy platforms? Feel free to ask us in the comments below! If you’re interested in trying iCouch for free, sign up for the full-featured trial!

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.

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