May is Mental Health Awareness Month, but if you think you know what therapy looks like today, you might be in for a surprise. Forget Sigmund Freud, a box of tissues and a couch. Mental health care has gotten a refresh.
Mental Health ‘2.0’
Until the 1960s, most therapists were men, but in the 1980s, according to the American Psychological Association, women outnumbered men earning PhDs in psychology. Today, about eight out of 10therapists and mental health counselors in the U.S. are female.
The couch is out the window for many patients, as well. During COVID, researchers saw a huge surge in online treatment options. By 2022, APA notes that nearly all psychologists offered online therapy; by 2023, 89% of psychologists used telehealth (online therapy), and about seven out of 10 worked in a hybrid practice.
“Absolutely, telehealth is here to stay,” says Marie Ouellette, LICSW, who has been a therapist at Marblehead Counseling Center for more than 20 years, and in practice for more than three decades. Ouellette says online options offer clients unique ways to connect with professionals, both individually and in small groups. Telehealth is flexible for both the communities being served and the therapists who treat them.
“MCC has seen a surge in online therapy in the past two or three years, which we offer in hybrid as well as fully remote models,” she said.
She added that group therapy over online platforms is also growing. “Many MCC clients, about eight out of 10, have engaged in some type of online therapy, utilizing telehealth and hybrid approaches, even if only on an occasional basis.”
Mental Health America estimates 122 million Americans live in areas that are underserved by mental health care providers, making online one of the only sources of care. Online therapy is particularly promising for older clients who might be housebound or have trouble getting to appointments in person, too. The National Council on Aging reports nearly 15% of adults age 50 and up have some type of mental health disorder, Ouellette says, and that number is expected to double by the year 2030. “As America ages and becomes less mobile, we need to be sure that we can continue to offer mental health services where needed.”
Online drug therapy
Teleprescribing also took off in response to the COVID pandemic, when the Drug Enforcement Administration loosened remote prescribing restrictions for some controlled substances. The policy change, which has been extended through December 2026, allows health care providers to issue clinically appropriate controlled substances prescriptions via telehealth without first conducting an in-person medical evaluation.
A nationwide shortage of local, in-person clinicians who can prescribe for conditions such as anxiety, depression and attention deficit hyperactivity disorder has kept this policy change intact, and gives people with mental health conditions who cannot meet with a clinician better treatment options. Over the past two years, telehealth and online pharmacy start-ups that offer quick, convenient access to pharmaceutical treatment have become increasingly popular nationwide.
“In theory, this is an important step to getting much needed medications to patients who might otherwise not have access,” says Dawn Williamson, DNP, RN, and a board member at Marblehead Counseling Center. Williamson is licensed to prescribe for mental health patients in her role as a psychiatric clinical nurse specialist. According to the Department of Health and Human Services, more than 7,000,000 prescriptions for controlled medications were issued via telemedicine without a prior in-person visit in 2024.
Though it fills a void, Williamson has concerns that short-form evaluations may not uncover underlying conditions, nor include a comprehensive psychiatric history, and that a lack of oversight, regular monitoring and potentially missed side effects, or over-prescribing could cause serious harm.
“In-person mental health providers have to follow strict regulatory procedures around prescribing,” she notes. “Teleprescribing is still relatively new. We don’t know yet what additional rules we should have in place. As clinicians, we also strive to take a more individualized approach to treatment.”
AI in the therapy room
Another growing trend in the rapidly changing mental health landscape is therapy via artificial intelligence. Harvard Business Review reports that going online for therapy and companionship is the most popular use of generative artificial intelligence tools today. The good news is that AI can instantly access a wide range of data for coping with mental health issues, including cutting-edge research and expertise from around the world. It is available where there are shortages of qualified mental health experts, and offers instant access to people who are struggling.
But a number of high-profile cases — including suicides by young people who were involved in extended conversations about their mental health with chatbots — are giving people pause. Critics note that the $500-billion mental health industry is growing and worry it’s increasingly being ‘financialized’, with Wall Street and Big Tech hoping to cash in. Mark Zuckerberg, Facebook and Meta founder, has publicly stated that he thinks most people should have a therapist, and he thinks AI is the perfect solution.
Risk factors
All this leaves many in-real-life therapists feeling queasy. In March of this year, more than 2,000 Kaiser Permanente mental health therapists in California held a one-day strike to protest the increasing use of AI in therapy. They argue that Kaiser is replacing professionals who perform the critical job of patient intake, assessment and triage with both AI bots and untrained, unlicensed lay operators who simply read from scripts when they ‘assess’ the mental health needs of new clients.
Those scripts are another concern. Danny Freed, CEO of the therapist enablement platform Blueprint says that six months after launching AI Notetaker in 2024, the company was processing millions of therapy session minutes each week. They’re used in two ways: for billing and creating electronic records, and to offer therapists real-time therapeutic recommendations on responding to clients while in session — in effect, allowing bots to advise professional therapists on how to counsel clients as they’re in the middle of a session.
Some argue that AI chatbots may not be ready to tell anyone what to do, period.
Researchers from Brown University, working with mental health professionals, found bots showed repeated patterns of problematic behavior, mishandled crisis situations, and their responses reinforced harmful beliefs about users or others. Bots used language that created the appearance of empathy — called deceptive empathy — without genuine understanding. Even when instructed to use established psychotherapy approaches, the systems consistently failed to meet professional ethics standards set by organizations such as the American Psychological Association. Analysts say they uncovered 15 distinct risk groups with AI counseling, including everything from lack of crisis management to unfair biases, steering the conversations too forcefully and overlooking the client’s unique background and answering in generic terms.
Here to stay
In response to the growth of online therapy, the APA put out a first-ever publication called Guidelines for the Practice of Teletherapy. Number one in the guide: Competence of the therapist. Ouellette and Williamson whole-heartedly agree that whatever or whomever a client consults, it’s critical to seek competence. “There are a lot of pros to new forms of therapy and therapeutic interventions; it can be more cost-effective and offers access to people who simply don’t have in-person options,” Ouellette maintains. “And it’s not an all or nothing proposition. There are hybrid models that ameliorate some of the concerns.”
Williamson says that as more people seek mental health assistance online, practicing mental health professionals need to stay involved. She refers to a list of client questions from the National Institute of Mental Health: Is it effective? Is it supported by scientific evidence that shows it works as well as traditional in-person methods? Does it have a limited audience? Does the app work equally well for all the people it is meant to help? What about privacy? How does the app maker guarantee users’ privacy, considering many apps deal with sensitive personal information?
Williamson believes therapists and lawmakers have an important role to play, too. NIMH says we should be asking how people determine if an app is effective when there are not standards for evaluating quality? Who should regulate mental health technology, and the sensitive data that it generates? And is the technology overselling and overpromising, turning people away from more effective therapies?
“The people who understand the mental health profession best are those of us in practice, and the people who regulate what we do provide further protections,” Williamson notes. “Our job has always been to care for and safeguard our clients, and that extends to all these new and emerging trends.”
Pamela Wheaton Shorr is a Board Member of Marblehead Counseling Center and a former print journalist.
