Why Some of Our Therapists Do Their Best Work Online: A Look at Online Therapy in Missouri and Kansas‍ ‍

I want to tell you about something one of our therapists did a couple of years ago.‍ ‍

Ashley Elder had a few teenage clients she'd been working with for a while. Real progress. The kind of trust that takes months to build. Then those teens started heading off to college, and some of them landed at schools across the state line in Kansas.

Here's the problem. A therapist can only see a client who is physically located in a state where that therapist is licensed. Ashley was licensed in Missouri. Her clients were about to be in Kansas during the school year.

A lot of therapists would have said, "I'm sorry, you'll need to find someone new at school." It would have been the easy thing to do.‍

Ashley got licensed in Kansas instead. It’s not an easy process. She had to make calls, gather paperwork, submit things, wait, etc. She had to learn the rules and laws of a second state. It’s a bit time consuming and frustrating to go through that process of getting licensed in another state.

But Ashley has said repetaedly since then that it was worth it.

She did it so her clients didn't have to start over with a stranger right as they were starting college, which is hard enough on its own. That tells you something about who she is. It also tells you something about how seriously the therapists here take online work. This isn't a backup plan for us. For some of our clinicians, it's where they do some of their deepest work.‍ ‍

So I wanted to write about that. Not "does online therapy work" (we've covered that). Not a list of benefits. Just an honest look at why specialized, experienced therapists choose this, in their own words.

What makes online therapy different from in-person therapy?

The biggest difference is where you are. In online therapy, you're in your own space, the place where you actually live your life. That changes the work in ways that can make it more personal, not less. You're processing hard things and practicing new skills in the same rooms where the hard things show up.

Ashley, Mikayla Wichern, and Jill Hasso have all done therapy both ways, in person and online. All three are specialized, experienced clinicians. And all three have seen the same thing: meeting a client in their own environment can be a real advantage.

Think about it. If you're working on anxiety, the anxiety usually doesn't live in a therapist's office. It lives in your apartment, your dorm, your car before a hard conversation. When we meet you there, we're working in the actual place you need the skills.

Mikayla put it this way. When she's online, she often gets to do exposures with clients in their real environment instead of being stuck in an office. For her OCD clients, that flexibility matters a lot. The compulsions happen at home. So that's often the best place to practice doing things differently.

Can you really build a strong connection with a therapist through a screen?

‍ Yes. A good therapist won't make it feel like you're just talking to a screen. As Ashley says, you'll know pretty quickly whether it's the right fit. Some of the deepest, most meaningful therapy work she's done has been with clients who are 100% online. ‍

I asked Ashley how she does it. She told me she treats her online clients exactly the way she treats the people sitting in her office. Same focus. Same care. From the first session, she's working to understand who you are, what you value, and what you want to change. She knows a strong connection helps clients make progress faster, so she works to build that with everyone she meets.

Mikayla had an interesting take on this. She thinks being in your own space can actually help you connect faster. When you're online, you'll probably see more of who she really is. She's at home too, usually with a blanket in her lap. Sometimes a pet wanders into the session. When both people are in their natural environment, she finds they both show up a little more like themselves. That can build trust quicker, not slower.

Is online therapy better than in-person therapy in some situations?

‍ Sometimes, yes. Online therapy is often the better choice when getting to an office is the thing standing between you and care. That includes busy schedules, long drives, living somewhere without a nearby specialist, or needing a family session when everyone is in a different place. ‍

Ashley made a point that made a lot of sense and reflects what I’ve seen in the online clients I’ve personally worked with. She said nobody wants to add stress just to get to a therapy appointment that's supposed to help with their stress. When you add up drive time there and back, plus the session itself, therapy can become one more thing you can't fit into a lunch break or a gap between classes. Online therapy takes that barrier away.

She also pointed out something I hadn't fully considered, because she does a lot more family work with teenagers than I do given that preteens, teenagers & college students are her specialty. Family sessions get a lot easier online. Say a teen is at college and a parent is back home. In the past, you'd have to wait until everyone could be in the same room at the same time, which often meant putting off the session for weeks. Online, everyone just logs in from where they are. The work keeps moving.

This is also why finding a specialist matters. Mikayla treats OCD, and there aren't many therapists trained to do that well. Online therapy means she can help people in parts of Missouri where the right specialist simply isn't available locally. The same is true for a lot of rural areas, where the nearest trauma or OCD specialist might be hours away.

Jill noticed something similar from the practical side. When you take away the commute and the traffic and the scheduling headaches, people tend to come more consistently. And consistency is a big part of what makes therapy work. ‍

Is online therapy a good fit for college students?

Often, yes. College students move between home and school, sometimes across state lines, and their schedules rarely sit still. Online therapy lets a student keep working with the same therapist through the semester, over breaks, and through all the moving around, as long as licensing allows it.‍ ‍

This is exactly the situation that led Ashley to get licensed in Kansas. A student might go to school in Kansas and come home to Missouri for the holidays. Or grow up in Kansas and head to Mizzou. With Ashley's licenses in both states, that student doesn't have to choose between staying close to home and keeping their therapist.

I will say that when I personally have worked with college students we have, at times, had to talk about confidentiality in sessions. My college students have loved that online sessions can fit in between classes, part time jobs and other obligations without the hassle of leaving campus. However, some have needed to make arrangements with roommates to ensure privacy during that hour or have found study rooms where they feel comfortable talking about the sensitive topics that come up in counseling sessions.

We work with a lot of students at schools across both states. If you want to read more about how we support teens and young adults across the Kansas City metro and both sides of the state line, we go deeper into that on our teen therapy page.

Who might not be a good fit for online therapy?

Online therapy isn't right for everyone, and we'll tell you honestly if we think you'd be better served in person. Younger children, anyone whose symptoms get worse with technology, and people who don't have a private space or steady internet may do better meeting face to face.

I asked a couple of our clinicians who see a lot of clients online and I liked what Mikayla had to say. She said she'd be cautious about online therapy for young kids. She'd also be careful with anyone whose symptoms, like certain experiences of psychosis, get triggered by technology. And of course, a stable internet connection matters.

One thing she mentioned is that some people don't feel safe talking openly about their mental health when others are home. There can be many different reasons for this. But the important thing is to notice it and name it if it happens for you. If that's you, online might feel harder, not easier. Though Mikayla has a workaround she uses all the time: plenty of her clients do their sessions from their car, where they finally have some privacy.

If you're weighing this for yourself, we wrote a whole post on it: Who Should Not Use Online Therapy?

‍ How do you make an online session actually work?

Get comfortable and get private. Pick a spot where you feel at ease and won't be interrupted. Grab a drink or a snack. Then treat that time as fully yours. The goal is to remove distractions so you can focus on the work for 45 minutes.

‍ I love how Ashley describes this. Be somewhere you feel at ease. Make sure no one is going to walk in or knock on the door. Grab a drink and a snack, because she'd be offering you one in her office anyway. Then let the outside world wait for 45 minutes while you focus on yourself.

Mikayla gives her clients basically the same advice, and she practices it herself. She's got her AirPods in, a blanket, and at least two beverages within reach for every session. If you live with people who'll be home, she suggests planning ahead for a private spot, or yes, sitting in your car. And eat a snack if you need one. There are snacks in the office, so there should be snacks at home too.

Working with Ashley, Mikayla, or another specialist at Aspire Counseling

Here's what I hope comes through in all of this. The therapists here don't see online work as a lesser version of "real" therapy. They've watched it help people heal. They've seen how powerful it can be to work with someone in the very space where they face their hardest moments.

Ashley sees clients in person at our Lee's Summit office and online across both Missouri and Kansas. Mikayla works fully online and specializes in OCD. Jill sees clients in person in Lee's Summit and online throughout Missouri. Each of them brings deep training and a genuine belief in this work.

If you're a student heading off to school, a busy professional who can't add a commute, or someone in a part of the state without the right specialist nearby, online therapy might be exactly what makes care possible for you.

Whenever you're ready for effective care and lasting change, we're here. You can reach out online or call us. In the Kansas City and Lee's Summit area, call 816-287-1116. In Columbia and mid-Missouri, call 573-328-2288. We'll talk with you about what you're looking for and help match you with a therapist who fits.

The Clinicians Behind This Post

Thank you to Ashley Elder, MSW, LCSW, LSCSW, Mikayla Wichern, MSW, LCSW and Jill Hasso LPC for sharing their experience and insight about online therapy for this post. They are three of our therapists who most frequently see clients online. And, their honesty about what this work is really like made this piece possible.

Written by Jessica Oliver, MSW, LCSW and Aspire Counseling director.