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According to the World Health Organization (WHO), more women are affected by depression than men. This pattern is seen in countries around the world, including the United States.

Cross-national and cross-cultural studies have indicated that the prevalence of depression among women is higher at any given time than among men. This pattern does not seem to have many exceptions.

Why is that? Biological differences between men and women, like hormones, explain part of it. These are examples of sex differences. But social factors between men and women (gender differences) may play a bigger role. For instance, women, in general, experience more stress than men, and research has shown that social stress is a main cause of depression.

But, new research that I’ve conducted with my colleague Maryam Moghani Lankarani suggests that men might be more vulnerable to depression caused by stressful events.

Why are more women depressed than men?

Researchers have defined stress as any major changes to the status quo (existing balance) that may potentially cause mental or emotional strain or tension. These stressful life events can include marriage, divorce, separation, marital reconciliation, personal injury or illness, dismissal from work or retirement.

Men are more likely to have depressive episodes following work difficulties, divorce and separation. Women, on the other hand, are more sensitive to conflict, serious illness or death happening in their close social network. In fact, research suggests that most of the stressful events that cause depression among women are related to their close social network, such as romantic and marital relationships, child-rearing and parenting.

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Research suggests that compared to men, women tend to ruminate (the technical term for “overthinking”) more about stressors and have negative thoughts that cause depression. And at least one study suggests that this explains the gender difference in the prevalence of depression. Rumination can make stress worse, and unfortunately, it is more common among women.

These findings suggest that psychosocial causes of depression may be at least partially gender-specific, and that these disparities are rooted in different life conditions – social inequalities – that men and women experience. And, in general, women tend to experience greater social inequality and social stress, and therefore depression, than men.

The gender gap in depression is largest in countries with highest gender inequalities. Gender difference in burden of depression is highest in the countries where women and men differ more in access to resources and social equity.

And that, oddly, might explain why men might be more susceptible to the depression-inducing effects of stress. They aren’t as used to dealing with it.

Men are more vulnerable to the effects of stress over time

In new research, my colleague Maryam Moghani Lankarani and I found that stressful life events are more likely to predict depression in men than in women.

In fact, men are more susceptible to the depression-inducing effects of each additional stressor over long-term periods.

We looked at data from a nationally representative study that examined how psychological factors affect physical and mental health of individuals over time.

We studied the effects of stressful life events men and women reported at the beginning of the study to their rates of depression 25 years later. We found that the effect of each life stressor on the risk of clinical depression was 50 percent stronger for men than women.

These findings correspond with a study we published in late 2015 that showed white men may be most vulnerable to the effect of stress on depression, possibly because they have a lower exposure to stress compared to any other demographic group.

It’s possible that cumulative exposure to stress may build resilience or habituation to stressors. In other words, people who cope with stress all the time can get used to it.

So the social group exposed to the lowest stressors (living the most privileged life) may at the same time be most vulnerable to each additional stressor. They have not learned to cope with stress as effectively as those who experience it more.

This is potentially the cost of living an easier, and therefore, less stressful life.

Men who experience depression may not seek care

Men may also be vulnerable to the effects of stress because they may perceive depression as a weakness. They may also define talking about emotion, and seeking help for an emotional problem, such as depression, as a weakness. This is especially the case in developing countries where traditional gender roles are more strongly endorsed.

These beliefs strongly shape behaviors of men who are in need of mental health care, and make men vulnerable when stress and emotional problem happens. All these result in men ignoring depression when it develops, and avoiding care when needed, not to look weak.

This also partially explains why more men with depression kill themselves (particularly white men) than women with depression.

Gender influences our risk of depression through various ways. It determines our risk of exposure to adversity. It changes our vulnerability to stress. And it can also determine what resources we’ll be able to access to cope with stress or depression.

A virtual therapy appointment can happen from your kitchen table, parked car, bedroom, or office. That flexibility is meaningful, but it also means the quality of the experience depends on more than clicking a video link. The best practices for virtual therapy help you protect your privacy, feel more present, and build a working relationship with a provider who understands what you need.

Online therapy is not a lesser version of care. For many people, it removes barriers such as transportation, scheduling conflicts, mobility limitations, and the discomfort of walking into an unfamiliar office. Still, it works best when you treat the session as protected time rather than one more task squeezed between errands.

Start With the Right Provider Fit

A therapist can be qualified and compassionate yet still not be the right match for you. Virtual care makes it easier to access professionals with different specialties, approaches, availability, and price points, so take advantage of that range.

Start by thinking about why you are seeking support. You may want help with anxiety, depression, grief, relationship concerns, trauma, life transitions, burnout, or a pattern you cannot quite name. A clear answer is helpful, but you do not need to have everything figured out before reaching out. “I have been overwhelmed for months and I do not know where to start” is a perfectly valid reason to begin therapy.

Ask potential providers about their experience with your concerns, their therapeutic approach, session format, availability, fees, and cancellation policy. If you plan to use insurance, verify coverage directly with your insurer and ask about your expected out-of-pocket cost. Transparency early on prevents financial surprises from getting in the way of care later.

Credentials matter, too. Your provider should be appropriately licensed to practice with clients in the state where you are physically located during sessions. This can be especially relevant if you travel often, attend college in another state, or split time between homes. A carefully vetted matching platform such as TheraConnect can make it easier to find providers whose qualifications and areas of focus align with your needs.

Prepare a Space That Feels Private Enough

You do not need a picture-perfect home office for effective virtual therapy. You do need a place where you can speak honestly without worrying that someone is listening nearby.

If possible, choose a room with a door, use headphones, and let household members know you need uninterrupted time. A fan, white-noise machine, or low background sound outside the room may help if privacy is limited. If home is not private, consider whether you can use a confidential room at work, sit in a parked car in a safe location, or ask your provider about flexible options.

Privacy is not only about who can hear you. Use a personal device when you can, keep your screen out of view of others, and avoid public Wi-Fi for sessions. Password-protect your phone or computer and update the software used for video calls. These small choices reduce the chance that sensitive information is exposed.

Before your first session, test your camera, microphone, internet connection, and device charger. Keep your provider’s office number or support contact available in case the video connection drops. Technology problems happen. Having a backup plan means a brief disruption does not have to derail the appointment.

Treat the Session Like an Appointment, Not Background Noise

One of the most useful best practices for virtual therapy is creating a transition into the session. In an office setting, the commute and waiting room naturally separate therapy from the rest of the day. At home, you may need to create that boundary yourself.

Try to arrive a few minutes early. Get a glass of water, silence notifications, and close unrelated browser tabs. If you have been rushing from work, parenting, or caregiving, take a minute to notice what is happening in your body. A few slow breaths or a short walk around the room can help you shift your attention.

During the session, resist the urge to multitask. Avoid checking email, folding laundry, scrolling, or responding to messages. You do not need to perform perfectly for your therapist, but being as present as possible gives you both more to work with.

It can also help to keep a notebook nearby. Write down topics that come up between appointments, questions you want to ask, or a feeling you want to understand better. You are not required to bring a polished agenda, but a few notes can be useful on days when your mind goes blank after, “How have you been?”

Be Honest About What Is and Is Not Working

Therapy is collaborative. Your provider brings training, perspective, and structure; you bring your lived experience, goals, and honest feedback. The relationship becomes more useful when both people can talk openly about the process itself.

Tell your therapist if you feel confused by an exercise, uncomfortable with a question, unsure about your goals, or dissatisfied with the pace of therapy. You can say, “I think I need more practical tools,” or “I want to spend more time on what happened this week.” That is not being difficult. It is valuable information that helps your provider tailor care.

The same applies to virtual logistics. Maybe video calls make you feel distracted, maybe you need a different appointment time, or maybe you prefer a phone session when your internet is unreliable. Discuss it. There are trade-offs with every format, and the best arrangement is the one that supports consistent, meaningful participation.

A strong therapeutic connection does not mean every session feels comfortable. Some conversations may bring up sadness, anger, uncertainty, or relief. What matters is whether you generally feel respected, heard, and able to be truthful. If that foundation is missing after you have given the relationship a fair chance, it may be time to explore another provider.

Know How Privacy and Safety Work Online

Your therapist should explain confidentiality, informed consent, payment practices, communication boundaries, and what happens in an emergency. Ask questions before you need the answers. For example, find out whether your provider uses a secure telehealth system, how they handle messages between sessions, and what to do if you are in immediate danger.

At the beginning of virtual care, many providers will confirm your current location and an emergency contact. This is standard safety planning, not an invasion of privacy. Because your therapist is not physically in the room, they need enough information to respond appropriately if a serious crisis arises.

Virtual therapy is not always the right level of support for every situation. If you are at immediate risk of harming yourself or someone else, call 911, go to the nearest emergency room, or contact 988 for the Suicide & Crisis Lifeline. If your symptoms are becoming more intense between sessions, tell your provider as soon as possible so you can discuss a safer, more appropriate plan.

Make Space for What Happens After the Call

The end of a virtual session can feel abrupt. One moment you are talking about a painful memory; the next, you are back in the same room where you answer emails or make dinner. Build in a small buffer when you can.

Give yourself five or ten minutes before jumping into another responsibility. Write down a takeaway, step outside, drink water, or simply sit quietly. You do not have to turn every session into homework, but reflection can help you carry the conversation into daily life.

Progress rarely moves in a straight line. Some weeks bring insight; others simply help you get through a hard day with a little more support. Keep showing up, speak honestly, and let the process adjust as your needs change. The right virtual therapy setup should make care feel more reachable, not harder to hold onto.

Mariah Carey recently opened up about her struggle with bipolar disorder.

As an assistant professor of psychiatry, I see her courage as an opportunity to explain bipolar disorder, a mood disorder that includes episodes of elevated mood, as well as episodes of depression.

There are two common types: Bipolar I disorder includes manic episodes in which a person experiences heightened or, at times, an irritable mood, for at least a week. This includes high energy, inflated self-esteem, reduced need for sleep, talkativeness or pressured speech, overspending, reckless risky behavior, racing thoughts, increased goal-directed behavior and a substantially increased sex drive. Symptoms are a clear departure from person’s baseline behavior. A patient in a manic episode may have all or some of these symptoms, none of which are induced by drug use.

Bipolar II disorder includes hypomanic episodes, a mood episode that includes the same symptoms at lower severity for a shorter time (four days at least) and without significant impairment of person’s functioning.

It is important to note the required duration of days to avoid a common mistake: Too often people are labeled with this diagnosis because of emotional instability or changes in mood over the course of hours, as a result of stressful events or other psychiatric conditions. I always make sure patients who believe they have this condition know the definition and substantial sustained nature of the episodes.

Diagnosis is mostly based upon psychiatric interviews and a review of the history of previous episodes or current symptoms, if the patient is experiencing a manic/hypomanic episode at the time of psychiatric examination. Historical data could be based on patient’s report, collateral information from family members, or psychiatric records. A history of a manic or hypomanic episode, not justified by medical conditions or drug use, is enough to make the diagnosis.

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It is also important to know that the majority of the episodes of mood change in a person with bipolar disorder are of the depressed nature and not manic/hypomanic. That is, a person with bipolar disorder usually experiences more depressive episodes than manic ones.

Treatment is vital to prevent future manic or depressive episodes and to reduce the severity of those that emerge. A manic episode can ruin a marriage, a bank account, or a job, or it can even lead to legal consequences.

Treatment usually involves mood stabilizer medications that reduce the chance and severity of future episodes. Mood stabilizers often are the same medications that are used for treatment of epilepsy, and some belong to other categories of psychiatric medications. Reduction of stress and close monitoring of mood by the patient, their family and physician can prevent the emergence of a new episode or its exacerbation.

A college student takes her first therapy session from a parked car between classes. A new parent talks quietly during nap time. A retiree meets with a therapist without arranging a long drive or asking someone for a ride. These are the settings behind many success stories of online therapy – not picture-perfect transformations, but real people making room for support in lives that are already full.

Online therapy is not the right fit for every person or every clinical need. But for many people, virtual care removes barriers that once kept therapy out of reach: distance, scheduling, transportation, cost concerns, and the discomfort of walking into an unfamiliar office. When the therapist, format, and goals align, that easier access can turn into meaningful change.

What Online Therapy Success Can Actually Look Like

The most valuable therapy outcomes are not always dramatic. Someone may not wake up one day feeling permanently free of anxiety, grief, or stress. More often, progress shows up in smaller, sturdier moments: pausing before reacting, setting one honest boundary, sleeping a little better, or recognizing a harmful thought pattern before it takes over the day.

That distinction matters. Therapy is not a performance, and success is not measured by how quickly someone can say they are “fixed.” It is measured by whether care helps them understand themselves, cope more effectively, and make choices that fit the life they want to build.

For online clients, the format itself can be part of the progress. Meeting from a familiar environment may make it easier to open up. Having an appointment without a commute can mean fewer missed sessions. For a person in a rural area, a virtual platform may offer access to a therapist with experience in concerns that local options do not cover.

From Constant Worry to Practical Confidence

Consider a working professional who starts therapy because worry has become the background noise of every day. She is checking email late at night, replaying conversations, and assuming a mistake at work will lead to disaster. She has considered therapy before, but a traditional appointment would require time away from work and a drive across town.

With online sessions, she can meet with a licensed therapist during a break at home. Early conversations focus on understanding her anxiety rather than judging it. Together, they identify the cycle: a stressful thought leads to reassurance-seeking, which brings short-term relief but makes the worry return stronger.

Over time, she practices skills between appointments. She learns to name catastrophic thinking, set a reasonable cutoff for work messages, and sit with uncertainty without immediately trying to erase it. Her anxiety does not vanish. What changes is her relationship to it. She has more confidence that a difficult feeling can be managed without controlling her entire day.

That is a realistic therapy success story: less time trapped in the spiral, more time present in her own life.

When Convenience Makes Consistency Possible

A parent may begin online therapy after realizing that irritability and exhaustion are affecting family life. Finding child care for an in-person appointment feels impossible, and canceling at the last minute creates more guilt. Virtual sessions make it possible to meet after the children are asleep or during a protected window in the workday.

The therapist does not offer a magic solution for the demands of parenting. Instead, the work may center on burnout, communication, self-compassion, and asking for help before resentment builds. The client begins noticing the difference between having a bad day and believing they are a bad parent.

Consistency is often the turning point. Therapy gives the person a regular place to speak honestly, reflect on what is happening, and try a different response the next week. A flexible format cannot solve every scheduling challenge, but it can make ongoing care more realistic for people whose responsibilities leave little room for themselves.

Healing After a Relationship Ends

Breakups, divorce, and estrangement can make people question their judgment and identity. One client may come to online therapy after months of rereading old messages, blaming herself for everything, and withdrawing from friends. The privacy of a session at home feels less intimidating than entering a waiting room while she is emotionally raw.

In therapy, she starts separating facts from self-blame. She explores why certain patterns in the relationship felt familiar and what she wants to do differently next time. She reconnects with friends, returns to hobbies she had stopped enjoying, and learns that loneliness does not mean she should accept treatment that hurts her.

The success is not that she never feels sad again. Grief has its own timeline. The success is that she stops treating her pain as evidence that she is unworthy of care, respect, or a healthier future.

Why the Right Match Matters in Online Therapy

The strongest success stories of online therapy usually have one thing in common: the client feels understood by their therapist. Credentials matter, and so does connection. A therapist can be highly qualified while still not being the best fit for a particular person’s communication style, cultural background, goals, budget, or concerns.

A good match does not mean every session feels easy. Therapy can bring up discomfort, especially when someone is addressing trauma, loss, shame, or long-standing patterns. It means the client feels respected enough to be honest, ask questions, and say when an approach is not working.

Before committing, it can help to ask a prospective therapist about their experience with your primary concern, their approach to treatment, fees, insurance or sliding-scale options, and how they handle telehealth sessions. You can also ask what progress might reasonably look like in the first few months. No ethical professional can promise a specific outcome, but they should be able to explain how they work and invite your input.

TheraConnect is built around that need for fit. Clients can sign up at no cost and connect with vetted mental health professionals based on the care, availability, and budget that make sense for them. The goal is not simply to find any appointment. It is to reduce the friction between needing support and finding a provider who feels like a workable match.

The Trade-Offs Are Worth Understanding

Virtual therapy has clear benefits, but being realistic about its limits helps people make better decisions. Privacy can be difficult if you share a home, have thin walls, or do not have a reliable place to talk. Some clients use headphones, sit in a parked car, or schedule sessions when the home is quieter. Still, a private setting is an important part of feeling safe enough to speak freely.

Technology can also be frustrating. An unstable connection interrupts the flow of a vulnerable conversation. It is wise to have a backup plan with your therapist, such as switching to phone audio if video fails.

There are also situations where online care may not provide enough support on its own. A person in immediate danger, experiencing a mental health crisis, or needing intensive treatment should seek urgent local help or contact emergency services. A qualified therapist can help assess the appropriate level of care, but telehealth is not a substitute for emergency intervention.

For some people, in-person sessions simply feel better. They value the physical separation between home and therapy, nonverbal cues that are easier to notice in person, or the routine of going to a dedicated office. Choosing in-person care is not a failure to embrace convenience. It is a preference, and preferences matter in mental health care.

How to Give Online Therapy a Fair Chance

The first session is often more about orientation than deep healing. You may be asked about your history, current concerns, goals, and practical needs. It is normal to feel uncertain or to struggle to explain what is wrong. “I do not know where to start” is a completely acceptable place to start.

Try to protect the appointment as much as possible. Choose a private location, silence notifications, and give yourself a few minutes afterward before jumping into another obligation. If you can, keep a brief note between sessions about moments you want to discuss. That could be a conflict, a recurring feeling, a small win, or a question you did not know how to ask in the moment.

Most importantly, speak up about fit. If you need more structure, want clearer feedback, prefer a different pace, or do not feel comfortable after several sessions, say so. Sometimes a therapist can adjust. Sometimes changing providers is the healthier choice. Finding the right support can take effort, but it is effort directed toward your well-being.

A meaningful change may begin with something as simple as attending one conversation from a place where you feel safe. When you are ready, check your options, ask the questions that matter to you, and let the next small step be enough for today.

Postpartum depression can affect anyone, and it often sneaks in quietly, like a shadow in the corners of a new mother’s life. It presents significant challenges for around 1 in 7 new mothers, affecting their emotional well-being and overall quality of life and that of the newborn.

Many – if not most – women experience the “baby blues,” or generalized feelings of sadness, worry, unhappiness and exhaustion, in the initial days after giving birth. In most cases, these mood changes are resolved in the first two weeks after having a baby. In contrast, the symptoms of postpartum depression endure for more extended periods, sometimes lingering for up to three years.

The symptoms can also start during pregnancy. Research shows that more than half of women who experience depression symptoms during pregnancy will develop postpartum depression too.

A much more rare and severe psychiatric disorder following delivery is called postpartum psychosis. Its onset is rapid and severe, with hallucinations, delusions and emotional distress, along with bizarre and sometimes dangerous behaviors. About 1 or 2 in 1,000 women experience postpartum psychosis after giving birth.

We are a clinical nurse specialist and a licensed mental health counselor, and together we have over 45 years of experience as educators and clinicians.

With proper awareness, education and intervention, perinatal mood disorders are nearly 100% treatable. We want women to realize that they are not alone, they are not to blame, and with help they can be well again.

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Crying, sadness and lack of bonding

Following pregnancy, many women experience normal changes that can mimic symptoms of depression, such as sadness, worry and exhaustion. The transition to motherhood, particularly with a new baby in the home, can be overwhelming. However, it’s essential to distinguish between these common adjustments and more concerning signs of depression.

If you or someone you know finds themselves experiencing any of the following symptoms persistently for over two weeks after giving birth, it’s crucial they reach out to their doctor, nurse or midwife. Here are some of the most-reported symptoms of postpartum depression:

• Lack of bonding and feeling disconnected from the baby or experiencing a lack of interest in them.
• Restlessness or moodiness and feeling unusually agitated or irritable.
• Persistent feelings of sadness, hopelessness or being overwhelmed.
• Experiencing physical symptoms such as persistent headaches, other body aches and pains or digestive issues that don’t resolve.
• A profound lack of energy or motivation, making daily tasks feel daunting.
• Significant changes in appetite and either eating too little or too much.
• Disturbed sleep patterns, such as sleeping too much or too little, even when given the opportunity to rest.
• Difficulty concentrating or making decisions, or experiencing memory problems.
• Overwhelming feelings of guilt, worthlessness or inadequacy as a mother.
• A notable decline in interest or pleasure in activities previously enjoyed.
• Isolating from friends and family, avoiding social interactions.
• Thoughts of harming the baby or themselves. These should be taken extremely seriously and warrant immediate attention.

Some risk factors associated with higher likelihood of postpartum depression include life stress, depression history, maternal anxiety, lack of social support, infrequent exercise, unintended pregnancy and intimate partner violence.

Real-life examples

People dealing with depression not only have to manage their symptoms but may also face the stigma and discrimination that these conditions often bring. There is an expectation that new parents will be happy after delivery. Sadness, stigma, shame or guilt greatly affects a person’s willingness to seek help. Studies show that many people opt not to seek treatment to avoid being perceived as unfit parents by health care providers or family.

As a nurse and a mom who has experienced postpartum depression, I (Nicole Lynch) frequently share my story with others. Years ago, another mom shared with me how helpful it was to hear that she wasn’t alone. Knowing that other women – dedicated parents who love their children – can feel this way and that things can get better gave her hope.

Throughout my career, I (Shannon Pickett) have worked with several mothers and prospective parents who have struggled with postpartum depression. For instance, I worked with one woman for several years about her anxiety and her struggle to conceive. After years of trying, she finally became pregnant. Both she and her husband were overjoyed and could not wait to become parents.

The pregnancy went smoothly and there were no complications. She had never shown any signs of depression previously, but once the baby was born, that changed. My client had trouble bonding with the baby and did not want to hold or console her new son when he needed soothing.

Her husband would often step in to comfort the infant and would ask my client, “What is wrong with you?” It caused frustration within their marriage because the father felt as though he was doing the caregiving alone and that my client was withdrawn. She had planned to take a break from therapy for a bit after the baby was born, but her husband encouraged her to reach out to schedule an appointment.

I could tell right away that she was struggling with postpartum depression. She barely smiled, had difficulty engaging in and concentrating on our conversation and cried throughout most of the session.

We talked a lot about the guilt she felt over not wanting to be around her son or hold him, even though she had fought for so long to become a mother. After receiving a proper diagnosis and starting an antidepressant medication, my client was able to recover and bond with her son. The medication did take a few weeks to get into her system, so the results were not instant. Maintaining her sessions and using her support system were important for her recovery as well.

Heightened risk

While postpartum depression can affect anyone regardless of their socioeconomic status or their background, some women affected by social inequalities have increased risk of many common postpartum mental disorders and their adverse consequences.

One study found that new mothers with low incomes, those who had not earned a college degree, were unmarried or were unemployed were 11 times more likely than women with no risk factors to have clinically elevated depression scores three months after having a baby.

Inadequate support

The Centers for Disease Control and Prevention estimates that about 20% of pregnant women were not asked about depression during a prenatal visit, and more than half of women with postpartum depression remain untreated for their symptoms.

What’s worse, there is a lack of access to mental health services for women after delivery. Many promising treatments are underexplored, especially in scientific studies. While more people are talking about postpartum depression, there is still stigma around seeking help.

A new medication offers hope

It’s vital to remember that postpartum depression is a treatable condition. Seeking help from health care professionals is a courageous and necessary step.

In August 2023, the Food and Drug Administration approved the first oral medication, Zurzuvae, specifically intended to treat severe depression after childbirth. It holds promise for addressing the complex array of symptoms associated with postpartum depression and offers newfound hope for affected mothers and their families.

If you are experiencing symptoms of postpartum depression, consider finding a therapist in your community for either telehealth or in-person sessions.

There are also postpartum support groups that meet in person and online.

Supportive therapies, including counseling, medication and lifestyle adjustments, can significantly alleviate symptoms and improve overall well-being. Early intervention is key to a faster and more complete recovery, ensuring that mothers can enjoy the precious moments with their baby and find fulfillment in motherhood.

By Peg O Connor

We tend to shrink ourselves and our world when we lack self-respect.

ey points

• Active in our addictions, we shrink ourselves so that we and our use may go unnoticed.
• We may believe that we do not deserve to take up space in the world, which is a deficit of self-respect.
• Self-respect is an achievement of moral development that depends on love, care, and support.
• Addictions can cause us to lose self-respect. Does a deficit of self-respect contribute to addiction?

Active in our addictions, our worlds often shrink. We prune people from our lives who question our use. We remove ourselves from events and activities that once brought us joy. We become less willing to do or try new things. Where before possibilities had seemed like opportunities, now they just feel daunting and even threatening.

We make ourselves smaller. We start to take up less space in our own lives. As someone once said, I felt like a mouse running around the trim board of my own life. Our making ourselves smaller goes hand in hand with our social and physical worlds contracting; they aid and abet each other.

Why do we skitter around the margins of our own lives?

Some of us want to go unnoticed. We may tell ourselves, better to stay off the radar screen than have people judging us. We may take our not being noticed as evidence that we aren’t doing so badly.

If people do notice us and our use, we may automatically assume that they are judging us in the same harsh ways that we judge ourselves. Of course, there are plenty of instances when this is true. We cannot even imagine that they are standing by us and offering their support because, well, we don’t deserve it.

Others of us believe that we do not deserve to take up space in anyone’s life, including our own. This is especially true for people who lack self-respect.

Self-respect

Self-respect is an achievement within moral development; it is a lived conviction that a person has intrinsic worth and dignity. It is a basic sense that “I matter.” Self-respect is created against a background of care, love, and security. A person develops self-respect through having the opportunities to engage with others. Self-respect is not innate.

A person with self-respect understands that she deserves to be treated respectfully by others because she has the same moral worth as everyone else. She also understands that she needs to treat herself in ways that recognize and preserve her dignity and autonomy.

Self-respect is what enables a person to judge that she is measuring up not just to others but to her own standards. When a person with self-respect recognizes that she is not meeting her own measure, she may change her actions so that she preserves her self-respect.

Self-respect and addiction

Self-respect is easily lost in addiction. There are many cases where a person has had self-respect but has lost it, often through their own actions. Someone who has had a good, meaningful, and happy life may lose respect for himself when he develops an addiction later in life and begins to act in ways that are out of character.

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We may start trading away our values and commitments. We may do things that cut against our grain. Instead of seeing ourselves as having dignity and worth, we come to see ourselves as insignificant and worthless. We start to treat ourselves this way.

The more we feel worthless, the more we contract into ourselves. In the worst throes of addiction, the world is reduced to us and our substances and behaviors. Our minds and the entire world may seem like a hellscape.

Some people have only ever had a very small degree of self-respect because they never had the opportunity to develop the skills and arts that underpin self-respect. Where love, care, and security are missing, it becomes far more difficult for a child to develop the arts and skills that are necessary to create, reinforce, and cherish self-respect.

Children who have been traumatized may have had many of the opportunities necessary to develop self-respect foreclosed. A child who has never been treated with love and respect or treated in ways that twine abuse with love will not have the opportunities to learn how to create, act on, and protect their self-respect. They have not been treated respectfully by others, so it is challenging to learn how to treat themselves and have a clear sense of what they rightly deserve.

Traumatized children, and later adolescents and adults, are more likely to develop an addiction than children who have not been traumatized.

While a loss of self-respect is a consequence of addiction, I believe a lack of self-respect is also a driving force of addiction. People who have experienced childhood trauma and haven’t been able to practice self-respect have already known a world of pain, insecurity, and uncertainty. They may already have a sense of just how unfair the world is along with a fatalism about their place in it. They understand what it is like to have few good opportunities available to them. They see others around them suffering and can’t even imagine their lives going differently.

When a person believes she has no value and that people like her deserve no better, the allure of addictive substances and behaviors may seem great. She may know that her world is full of pain and suffering; shrinking that world and finding some relief from the suffering makes sense.

Those addictive substances and behaviors can also ignite a sense of being alive, having fun, and making connections to others, all of which childhood trauma hinders. The addictive substances and behaviors most often bring us something we want or need in the beginning. Their bill comes due at some point, putting whatever shards of self-respect a person has at risk.

In recovery, we begin to gain or regain self-respect, which is crucial to flourishing.

A lot can happen before you ever say a word in therapy. You may open a search tab, compare a few profiles, close the tab, and tell yourself you will try again later. If you are wondering how to start therapy online, the goal is not to make a perfect decision on the first try. It is to take one informed, manageable step toward support that feels right for you.

Online therapy can make care more available when commuting, schedules, mobility, cost, or privacy concerns have made traditional appointments difficult. It can also feel unfamiliar at first. Knowing what to look for can help you move from “maybe someday” to a first appointment with more clarity.

Start With What You Want Help With

You do not need a diagnosis or a polished explanation to begin therapy. “I have been anxious lately,” “my relationship feels strained,” or “I cannot get out of this rut” is enough to start. A therapist can help you put language to what is happening and identify practical goals together.

Still, taking a few minutes to reflect can make matching easier. Consider whether you are looking for support with anxiety, depression, grief, trauma, stress, family conflict, life transitions, identity concerns, or another challenge. Think about what you hope will feel different in a few months. You may want better coping skills, a place to process difficult experiences, stronger boundaries, or simply the chance to be heard without judgment.

Your preferences matter, too. Some people feel more comfortable with a therapist who shares part of their background or identity. Others want someone with experience in a specific concern, such as postpartum mental health, substance use, LGBTQ+ affirming care, or couples counseling. There is no wrong preference. Naming what matters to you helps narrow the search.

How to Start Therapy Online: Check Credentials and Fit

A warm profile is a good start, but qualifications should come first. Look for a licensed mental health professional who is authorized to provide therapy in the state where you are physically located during sessions. Depending on their training and state, this may include a licensed professional counselor, clinical social worker, marriage and family therapist, psychologist, or psychiatrist.

Credentials alone do not guarantee a personal connection, but they help establish that a provider has completed required education, supervised experience, and licensing standards. A trustworthy matching platform should vet providers and clearly present their qualifications, specialties, availability, and approach to care.

Then consider fit. Therapy is personal, and it is reasonable to want a clinician whose communication style works for you. Some therapists are more structured and skill-focused. Others are more reflective and exploratory. Many blend approaches based on a client’s needs. If you are unsure what you prefer, that is okay. You can ask a prospective therapist how they typically work with people who are facing concerns similar to yours.

A short consultation can be useful when it is available. You might ask whether they are accepting new clients, what a typical session looks like, how they approach your main concern, and what they expect from clients between sessions. You are not interviewing them to find a flawless answer. You are listening for whether you feel respected, understood, and comfortable asking questions.

Understand Cost Before You Book

Cost is often one of the biggest barriers to care, so it deserves a direct conversation. Ask about the session fee, whether the provider accepts your insurance, what your copay may be, and whether they offer a sliding scale based on income. Some therapists have reduced-fee openings, while others can provide documentation you may submit to an out-of-network insurance plan for possible reimbursement.

Online therapy is not automatically less expensive than in-person therapy. The price depends on the clinician’s credentials, location, specialization, insurance participation, and session length. But virtual care can reduce indirect costs, such as travel, parking, childcare, or time away from work.

Be cautious about choosing based on price alone. Affordable care needs to be sustainable, but the lowest fee is not always the best value if the therapist’s expertise or availability does not meet your needs. A good match balances clinical fit, access, and a cost you can realistically maintain.

TheraConnect helps clients begin this process at no cost by connecting them with vetted providers based on their needs, preferences, and budget. You can get started by sharing what kind of support you are seeking and reviewing matches that fit your situation.

Set Up a Private, Realistic Space

You do not need a picture-perfect home office for online therapy. You do need a place where you can speak as freely as possible and hear your therapist clearly. A bedroom, parked car, private office, or quiet outdoor space may work depending on your circumstances. Headphones can add privacy if other people are nearby.

Before your first session, test your internet connection, camera, microphone, and device battery. Keep a charger nearby. If video does not feel accessible because of bandwidth, disability, or personal comfort, ask whether phone sessions are an option. The best format is the one that allows you to participate consistently and safely.

It also helps to make a plan for interruptions. If you live with family or roommates, you might let them know you need uninterrupted time without explaining why. If privacy is limited, tell your therapist. They may be able to adjust pacing, discuss practical options, or help you create a plan that protects your confidentiality.

Know What to Expect in the First Session

The first session is usually an intake. Your therapist may ask about your current concerns, history, relationships, work or school, physical health, past therapy experiences, and what you hope to gain. They should also explain privacy, payment, cancellation policies, and the limits of confidentiality.

You are allowed to ask questions at any point. If a question feels too personal too soon, you can say that you are not ready to discuss it in detail. Therapy involves honesty, but trust is built over time. You do not have to tell your whole life story in one hour.

You may leave the first appointment feeling relieved, tired, emotional, hopeful, or uncertain. All of those reactions can be normal. Therapy can bring attention to experiences you have been carrying quietly, and change rarely happens in a straight line.

Give the Relationship Enough Time, Then Reassess

One session can tell you whether a therapist is respectful and whether the logistics work. It may take several sessions to know if their approach is helping. Unless there is a serious concern, consider giving the process a little room before deciding it is not for you.

At the same time, you are not obligated to stay with a provider who repeatedly feels dismissive, judgmental, unprepared, or mismatched to your needs. If something is not working, bring it up directly if you can. A good therapist will welcome feedback. If the fit still does not improve, changing therapists is not a failure. It is part of finding care that serves you.

Keep Safety in Mind

Online therapy is valuable support, but it is not designed for immediate emergencies. If you are in immediate danger, thinking about harming yourself or someone else, or unable to stay safe, call 911 or 988 in the United States, go to the nearest emergency room, or contact local emergency services. Tell the therapist or platform about urgent safety concerns as soon as possible.

For everyday privacy, use a secure device when you can, avoid shared passwords, and review the platform’s privacy practices. Your therapist should explain how they protect your information and what to do if a connection drops during a session.

Taking the first step can feel vulnerable, especially when you have been handling a lot on your own. You do not need to wait until things get worse or until you can explain everything perfectly. Check your options, choose a qualified provider, and book the conversation that gives you room to be human.

A $150 session can feel out of reach. A $25 copay may be manageable, but only if you can find a therapist who takes your insurance, has availability, and feels like the right fit. That gap is why asking what makes therapy affordable is more useful than asking whether therapy is simply “expensive” or “cheap.” The real cost depends on how care is delivered, paid for, and matched to your needs.

Affordable therapy should not mean settling for unqualified care, rushing through sessions, or choosing the first option you find because it is the lowest price. It means having a realistic way to access consistent, quality support without creating a financial strain that makes it hard to continue.

What Makes Therapy Affordable for Different People

There is no single price that makes therapy affordable for everyone. A college student with limited income, a parent managing a high-deductible health plan, and a working professional without insurance may all need different options. For some people, affordability means using insurance. For others, it means a lower self-pay rate, flexible appointment times, or virtual sessions that reduce the cost of travel and time away from work.

The most sustainable option is usually one you can maintain over time. Therapy often works best when you have room to build trust, practice new skills, and return to the issues that need attention. A low introductory rate that rises beyond your budget after a few sessions may not be as helpful as a predictable rate you can plan for each month.

Cost also needs to be considered alongside fit. A therapist may have a reasonable fee, but if their approach does not match what you are looking for, you may spend time and money without feeling supported. Finding a provider with relevant experience, appropriate credentials, and a communication style that feels comfortable can make each session more worthwhile.

Insurance Can Lower the Price, With Some Limits

Insurance is one of the most common ways people reduce out-of-pocket therapy costs. If a therapist is in your plan’s network, you may pay a copay or coinsurance rather than the full session fee. That can make weekly or biweekly care more realistic.

Still, insurance coverage is not always straightforward. Many plans have deductibles, which means you may pay the full contracted rate until you have met a certain annual amount. Some plans limit which providers are covered or require you to use a specific network. It is also possible to find a therapist you like who does not accept your insurance.

Before scheduling, ask practical questions: Is the provider in network? What is the expected cost per session? Have you met your deductible? Is telehealth covered at the same rate as in-person care? A quick check can prevent an unexpected bill later.

If you choose an out-of-network therapist, your plan may still reimburse part of the fee. This option can expand your choices, but it usually requires paying upfront and submitting paperwork. Whether it is worthwhile depends on your benefits, the therapist’s rate, and how much flexibility you need in choosing a provider.

Sliding Scales Make Fees More Flexible

A sliding-scale fee is adjusted based on factors such as income, household size, employment status, or financial hardship. Instead of one standard rate for every client, the provider offers a range that makes room for people with different budgets.

Sliding scales can be especially helpful if you are uninsured, underinsured, self-employed, between jobs, or facing a temporary financial change. However, availability may be limited because each therapist can only offer so many reduced-fee appointments. Ask directly whether a provider has sliding-scale openings and what documentation, if any, they require.

It is reasonable to be transparent about what you can afford. You do not need to share every financial detail to ask a simple question such as, “My budget is around $60 per session. Do you have a rate in that range or a referral you would recommend?” A good provider or matching service should treat that question as a normal part of finding care.

Why Online Therapy Can Change the Total Cost

Virtual therapy is not automatically less expensive than in-person therapy. Licensed clinicians bring the same training, ethics, and clinical responsibility to online sessions, and fees can reflect that. But online care can lower the total cost of getting support in ways that are easy to overlook.

You may save on gas, parking, public transit, child care, and time away from work. You can also search beyond the immediate area where you live, as long as the therapist is licensed to provide care in your state. That broader choice can be especially meaningful in communities with few local providers or long waitlists.

Convenience has value, too. When therapy fits into a lunch break, a quiet hour at home, or a schedule with caregiving responsibilities, it may be easier to attend consistently. Regular attendance is not the only measure of progress, but it gives you and your therapist a steadier foundation.

Online care does have trade-offs. You need a private place to talk and a reliable internet connection. Some people simply feel more comfortable meeting face to face. If privacy at home is difficult, an in-person office may be the better choice even if virtual sessions cost less overall.

The Right Match Prevents Wasted Time and Money

Choosing therapy based only on price can lead to a frustrating cycle of starting, stopping, and searching again. Affordability includes the likelihood that a provider can actually help with your goals. A therapist’s specialty, therapeutic approach, availability, and experience with concerns similar to yours all matter.

For example, someone seeking help with panic attacks may want a therapist who regularly uses evidence-based approaches for anxiety. Someone navigating grief, relationship stress, trauma, or identity-related concerns may benefit from a provider who understands the specific context involved. You do not need a perfect match on day one, but you should feel heard and able to ask questions.

This is where thoughtful matching can make a difference. TheraConnect helps people connect with vetted mental health professionals based on needs, preferences, and budget considerations, without charging clients to sign up. The goal is not to make therapy one-size-fits-all. It is to reduce the guesswork that can make finding care feel overwhelming.

Ask About Frequency, Not Just the Session Rate

When comparing options, look at the monthly cost rather than only the price of one appointment. A $75 weekly session costs differently from a $110 session every other week. Neither schedule is universally better. The right frequency depends on what you are working through, your therapist’s recommendation, and what you can realistically sustain.

Some clients begin with weekly sessions to establish momentum, then move to every other week as they gain stability or meet specific goals. Others may need more frequent support during a difficult period. It is okay to discuss budget openly with your therapist. They may be able to help create a plan that respects both your clinical needs and your financial reality.

Be cautious with services that promise very low prices while offering little clarity about who provides the care, how providers are licensed, or what happens if the fit is not right. A lower fee is meaningful only when the care is ethical, qualified, and appropriate for your situation.

A Practical Way to Compare Therapy Options

Start with the amount you can comfortably spend each month, not the highest amount you could possibly stretch to during a good month. Then check your insurance benefits, including your deductible and telehealth coverage. If insurance is not an option, look for providers who offer sliding-scale rates or payment flexibility.

Next, compare the full picture: credentials, specialties, appointment availability, session format, and location or state licensure. Ask about cancellation policies, because missed-session fees can affect your budget. If you are unsure whether a therapist is a fit, ask whether they offer a brief consultation before the first full session.

You deserve care that respects your time, finances, and reasons for reaching out. Start where you are, ask clear questions, and choose the option that gives you the best chance to keep showing up for yourself. When you are ready, Get Started and look for support that feels both attainable and right for you.