Text message intervention: Online therapy through text messaging could help millions

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  Quantumrun Foresight
• May 6, 2022

Insight summary

Text-based therapy, a form of teletherapy, is reshaping the landscape of mental health services by offering a more affordable and accessible medium for individuals to seek help, even encouraging some to later pursue face-to-face sessions. While it has opened doors for a broader demographic including those in remote areas, it faces challenges, such as the inability to create specific care plans and missing the nuanced understanding derived from facial cues and tone. The development of this therapy mode is accompanied by a range of implications including shifts in business models, educational curricula, and government policies.

Text messaging intervention context

Therapy or counseling services delivered via the internet are referred to as teletherapy or text-based therapy. The use of teletherapy can allow any person to communicate with a qualified professional counselor from any device connected to the internet, thereby making mental wellness services more accessible. 

The potential benefits of text-based therapy include providing patients with accessibility and convenience, as it reduces constraints on time and space. During the COVID-19 pandemic, such benefits became vital after patients’ ability to access practitioners face-to-face became impeded. Other benefits of text-based therapy include being more affordable than classical therapy; it can also be a highly effective introduction to treatment as some people prefer to express themselves through writing or typing.  

Several teletherapy programs allow a free trial. Others require a membership, while some still allow pay-as-you-go options with several service categories. For example, nearly all subscriptions feature unlimited texting, while others include weekly live sessions. In addition, several US states now mandate insurance companies to cover internet treatment the same way they cover traditional therapy sessions.

Disruptive impact

Text-based therapy is emerging as a viable option for individuals who find traditional therapy sessions financially burdensome or intimidating. By offering a more accessible entry point to mental health support, it opens up opportunities for a wider range of people to seek help, potentially democratizing access to therapy. Moreover, experiencing positive outcomes through this medium can encourage individuals to transition to face-to-face therapy, serving as a stepping stone to more intensive support if needed.

Therapist practices and healthcare companies could introduce teletherapy as an additional service alongside in-person therapy so it can meet a broader set of patient needs. Insurance companies may seek to include text-based therapy as part of their healthcare plans. At the same time, workplaces could add text-based therapy to the range of benefits offered to employees as part of their rewards and benefits packages. If used appropriately, this service can help to alleviate debilitating emotions, such as anxiety and stress, before they develop into burnout, depression, and other forms of mental illnesses. 

However, there are reported limitations of text therapy, which include being unable to develop a specific care plan for a patient and a lack of patient facial cues and tone to guide treating professionals during a therapy session. Further challenges include a possible lack of authenticity and missing that human connection that a therapist can form with a patient, which instills trust in patient-therapist interactions.

Implications of text-based therapy 

Wider implications of text-based therapy interventions may include:

• A surge in therapy adoption rates among middle and lower working-class families and individuals, fostering a society where mental well-being is more evenly distributed and not just a privilege for the affluent.


• The government crafting policies to ensure the ethical use and protection of sensitive data shared during text-based therapy sessions, fostering a safer environment for users and potentially enhancing trust in digital health services.


• A notable reduction in the stigma surrounding mental healthcare as text-based therapy normalizes seeking help, potentially leading to a society where individuals are more open about their mental health struggles.


• Persons residing in remote and rural locations, including in developing regions, gaining the ability to access mental wellness therapy.


• A spike in the demand for therapists and social welfare workers, encouraging governments to allocate more funds towards mental health programs.


• Businesses in the therapy sector adapting to a service model where text-based therapy is a primary offering, potentially leading to a more competitive market with a variety of options for consumers.


• A potential shift in the labor market where there is a surge in opportunities for individuals to work remotely as text-based therapists, possibly encouraging a more diverse range of individuals to enter the profession.


• Educational institutions possibly introducing courses and training programs specifically designed to equip individuals with the skills needed for text-based therapy, fostering a new branch of professional education that is more aligned with contemporary digital communication styles.


• Environmental benefits stemming from a reduction in the need for physical infrastructure for therapy centers, leading to a decrease in the carbon footprint associated with the construction and maintenance of such facilities.

Questions to consider

• Do you believe teletherapy is a viable mode of treatment?


• Do you think people should first attempt to use text-based therapy prior to going into in-person treatment as a means of grading the level of help they may need?