Below is a summary of how e-counseling is comparable to traditional face-to-face counseling sourced from an extensive study done by Berkeley Well-Being Institute and its references. Read more on the full study here.

Study 2 was conducted to examine user satisfaction with e-counseling. Read on the summary of Study 1 on changes in depression symptom severity amongst BetterHelp members from pre-treatment to 3-months post-treatment here.

Study 2

Given the potential accessibility, affordability, and effectiveness of e-counseling, Berkeley conducted a second study to gain insight on user experience with BetterHelp e-counseling. The present investigation reports findings from a survey that asked current members of BetterHelp to report their experiences with both e-counseling and face-to-face counseling. More specifically, it assessed whether BetterHelp e-counseling differs from face-to-face counselling with regard to:

1) Affordability

2) Convenience

3) Effectiveness

4) Fit

5) Accessibility

6) Progress

7) Satisfaction

8) Quality

9) Meeting needs

10) Therapeutic alliance




  • 48 participants (88% female)
  • Age: 22 – 65 years old
  • These participants responded to an account notification from BetterHelp inviting them to complete a survey post participation
  • Used BetterHelp for 3 months or more
  • To answer a series of questions with regard to their experiences on BetterHelp and also if they have been in face-to-face counseling
  • A subset of 38 participants (79%) had also been in face-to-face counseling and was asked the same series of questions regarding their experiences with face-to-face counselling



1) Therapeutic Alliance

The quality of the therapeutic relationship was assessed using the Working Alliance Inventory (WAI) –short form (Munder, 2010). Questions were phrased to assess alliance with BetterHelp counsellors or alliance with face-to-face counselors. The WAI has been shown to have good reliability and validity (α BetterHelp = .94; α face-to-face = .97 in the present sample).


2) Satisfaction with Counselling

To measure satisfaction with counseling, items were developed assessing a range of factors that tend to affect satisfaction with counselling (see Table 2 for questions).



Table 2

Comparing BetterHelp to face-to-face counseling

To directly assess whether participants preferred BetterHelp when they compared BetterHelp to their experiences with face-to-face counseling.



1) Therapeutic alliance

Using within group t-tests, ratings of therapeutic alliance were significantly greater for BetterHelp than face-to-face counseling.


2) Satisfaction

Descriptive statistics are used to clarify the percentage of people who were satisfied with each dimension of counseling for both BetterHelp and face-to-face counseling (see Figure 3). The results suggest greater satisfaction with BetterHelp e-counseling than face-to-face counseling. All analyses supported BetterHelp as being more satisfying than face-to-face therapy. In particular,

BetterHelp was found to be significantly more convenient, affordable, and accessible than face-to-face therapy.

Figure 3

Results for satisfaction with BetterHelp and satisfaction with face-to-face counseling shows that clients of BetterHelp are more satisfied with e-counseling than face-to-face counseling (see Figure 4).


Figure 4

Finally, when asked how likely one would be to recommend BetterHelp to a friend or colleague on a scale from 0 (Not at all likely) to 10 (Extremely likely), participants reported scores ranging from 5 to 10.

Comparing e-counseling to face-to-face counseling

Descriptive statistics were used to directly assess whether people found experiences with BetterHelp to be better or worse than experiences with face-to-face counseling.

First, Berkeley assessed whether people would choose BetterHelp (e-counseling) or face-to-face counseling in the future (see Figure 5). Next, Berkeley assessed how participants compared BetterHelp to face-to-face counseling on each of the dimensions of satisfaction. The strongest effects suggest that BetterHelp members find BetterHelp to be more convenient and accessible than face-to-face therapy, and all analyses supported BetterHelp as being more satisfying than face-to-face counseling (see Figure 6).


Figure 5

Figure 6

E-counseling appears to address a number of significant barriers (i.e. convenience, affordability, and accessibility) that sometimes prevent face-to-face counseling from being effective. Notably, the present data further suggest that therapeutic alliance for BetterHelp e-counseling may be even stronger than face-to-face counseling.

While there are many reasons as to why this may be the case, Berkeley postulate that these strong alliances are formed when using BetterHelp as a result of BetterHelp counselors’ flexible availability. Face-to-face counseling is often limited to a pre-determined number of sessions (as defined by insurance companies or by financial capabilities).

Research has shown that the national average number of counseling sessions available to an individual is less than 5, despite knowledge that between 8-13 sessions are needed to see improvement (Hansen et al., 2002). BetterHelp counselors are able to quickly respond to members’ needs, with an average response time of 10.6 hours, and have more frequent interaction with members as compared to a face-to-face therapist, with BetterHelp members receiving an average of 3.7 sessions over the course of a week.

This study, like most survey studies, may have been affected by sampling bias. Only participants who were already using BetterHelp for 3 months were included in analyses. Because individuals who terminated treatment before 3 months were not included in pre/post analyses, results exclude those who may not have found BetterHelp beneficial and sought other forms of therapy in that time. It was essential for Berkeley to focus on this group to ensure that all participants were familiar with, and had the time to benefit from, the service; however, this approach may have led to a bias towards including people in the study who favoured BetterHelp e-counseling.

That being said, we should not discount the positive impacts that BetterHelp had on the members who chose to opt in. No intervention approach will work for everyone. Given the affordability and accessibility of Betterhelp e-counseling, Berkeley’s findings suggest that Betterhelp e-counseling represents an opportunity to have a bigger impact, across a larger number of people, for a reduced cost.


Berkeley Well-Being Institute

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