What Parents Need to Know About Octave Online Therapy

Octave is an online therapy company that offers individual, couples, and family therapy to residents of six states and Washington, DC. Its sessions are 55 minutes long. 

Pros & Cons

Pros

• Easy and fast sign-up
• Flexible scheduling 
• Personable therapists
• Specializes in family therapy
• Therapist bios available online

Cons

• Intake process felt impersonal and incomplete 
• Not allowed to choose your therapist
• Some therapist matches not trained in family therapy 
• Octave does not work with patients under 18, so family therapy involving children isn’t an option 

One study has found that virtual therapy appears as effective as in-person therapy for treating most common mental health needs, including anxiety, depression, and trauma, and a review of 17 studies found that online cognitive behavioral therapy (CBT) for depression may be even more effective than face-to-face counseling.

My husband and I had been talking about signing up for family therapy for years, ever since our now-kindergartener was diagnosed with a disability. We needed help negotiating the stress that managing his educational and medical care was putting on our marriage. We hoped a professional could help us communicate with one another, as well as with our children so that we could solve problems more effectively. The only time we had, really, was in the evenings when both children were asleep. So, when the opportunity arose, I jumped at the chance to review Octave.  

In addition to testing the service myself, we also surveyed 105 Octave users and worked with three subject matter experts to evaluate the company. I liked that Octave promised to match us with a therapist who specialized in family therapy and that we could get started right away from the comfort of our home.   

What Is Octave?

Octave bills itself as a “modern mental health practice”—a company that is both high quality and accessible. It was founded in 2018 by Sandeep Acharya, the former head of strategy at One Medical, one of the largest independent primary care practices in the United States. Acharya was inspired to launch the company after seeing a close friend suffer from anxiety and depression following a traumatic experience. He saw a huge gap in access to high-quality behavioral health services and sought to streamline the process of finding a great therapist.  

Unlike other online therapy companies we’ve reviewed, Octave is not very active on social media. The company has fewer than 200 Twitter followers and only around 4,000 likes on Facebook. It has over 8,000 followers on Instagram, but it’s only posted there less than 250 times. I was impressed, though, by the engagement that the company got on the articles it shared on Facebook from its blog. Some posts had hundreds of comments and just as many shares.  

The review site Relief Seeker complained that Octave is relatively pricey for a company that claims accessibility as a goal, but also praised its services, and the company rates high on Indeed as a wonderful place to work. 

What Services Does Octave Offer?

Octave offers individual, couples, and family therapy. It also used to offer group therapy and workshops, though those services are on hold as of November 2022. 

Our couples sessions lasted 55 minutes each, and we met a therapist once a week.  You schedule your sessions individually; the company does not offer a subscription. 

Who Is Octave For?

Octave says its services are suitable for people with a variety of issues. 

For individuals, it says its services can help with anxiety, depression, burnout and stress, body acceptance, racial trauma, breaking patterns, and finding a purpose. 

For couples, it offers help with:

• Communication and fighting
• Power dynamics
• Financial conflict
• Parenting or caretaker stress
• Challenges with intimacy
• Repairing after infidelity
• Premarital counseling

When working with couples, Octave therapists use the Gottman Method, integrative behavioral couples therapy (IBCT) and emotionally focused therapy (EFT). “Each of these modalities has been extensively tested with and incorporated into couples or relational therapy, making them good evidence-based choices for therapeutic techniques for couples,” says Hannah Owens, LMSW, a therapist and subject matter expert.

Octave has a reputation for being specifically committed to providing care to members of the LGBTQIA+ community by helping with dating and romantic relationships, coming out, navigating systemic oppression, queer family building, and more. 

How Much Does Octave Cost?

Octave is not a subscription therapy service; you pay per therapy session. 

Out-of-pocket, individual therapy costs $170 to $250 per session, couples or family therapy costs $190 to $275 per session, and group therapy (when available) averages $75 per session. 

These rates may not be affordable for everyone, but they are on par with the national average of $100 to $200 per session that most therapists charge.

Does Octave Take Insurance?

Yes, Octave accepts some insurance plans, which means you may pay less than the out-of-pocket prices listed above.

As of November 2022, Octave accepts:

• Anthem Blue Cross of California (CA)
• Aetna (all states)
• Health Net and Managed Health Network (MHN) (CA)
• UnitedHealthcare UMR plan for Mount Sinai employees (NY)

Navigating the Octave Website

Octave’s homepage is well laid out and modern, though I found it to be a bit generic. When you land on the homepage, you’ll see the words “mental health built around you” along with a photo of an armchair and a bright orange button inviting you to “Get Started.”

There are five main options on the navigation menu at the top of the page: Our Services, Meet the Team, Insurance, Blog, and Locations. 

If you scroll down (I admit I didn't realize this was an option at first), you’ll find information about which insurance plans the company is in-network with, what the company thinks sets it apart, and profiles of some of the therapists that work at Octave.

A little further down, you’ll find testimonials from Octave clients, press mentions, and a call to action to sign up for updates about the company and other information about mental health.

At the very bottom of the page, you’ll find a footer with links to navigation pages, the locations it operates in, and links to its social media accounts. 

There is also a note stating that “If you or someone you know is experiencing an emergency or crisis and needs immediate help, call 911 or go to the nearest emergency room,” with links to some additional crisis resources.

It’s worth noting that unlike many of the other companies we reviewed, Octave does not have an app. 

How Do You Sign Up for Therapy at Octave?

Signing up on Octave was fast and easy. You start by clicking on the orange button on the homepage, which will take you to a page with the words “Welcome to Octave!”

This page will walk you through the steps involved in signing up, as well as an email to reach out for additional support. 

Then once you’re done reviewing this information, you can click the (now brown) “Get Started” button, which will take you to an intake form. 

It asked for my personal information and my insurance info (or if I wanted to pay out of pocket), then I took a brief survey that assessed my personal mental health over the past week. It asked me if I was seeking mental health care for an eating disorder or substance abuse issue. It asked what time/days I would prefer to meet.

It finished with two optional questions: if the survey missed anything about my mental health, and if there was anything in particular I wanted in a provider. I left these questions blank, assuming I’d be asked more questions to follow, or perhaps get a phone call from a company representative, but this didn’t happen. Instead, some days later, a representative from the company emailed to let me know it had made a match. Instead of a list of potential therapists. I was given one therapist’s name, and his availability.   

Matching With a Therapist at Octave

On the intake form, there is one open-ended question asking if there’s anything in particular that you’re looking for in a therapist. I didn’t realize this was the extent to which the company would solicit input on matching the patient to a provider and so I left the question blank, fully expecting a person would call after this initial intake. Instead, I was surprised when the company used this limited information to assign me a therapist.

After completing the initial intake survey, a representative from the company emailed me the name and availability of a therapist. My husband and I were also available on that specific night and time, and so I emailed back that we were interested in proceeding. I immediately received nine emails indicating the representative had booked me for nine consecutive weekly appointments. I emailed her back and asked that she cancel all but one, which she did.  

In our survey of Octave users, 64% said they were satisfied with the therapists options the company provided, and 69% positively rated its overall helpfulness at connecting them with a therapist.

How Do Therapy Sessions Work at Octave?

Save for the company representative making the match, there was no difference between my sessions with our therapist assigned through Octave and the traditional therapist I’d been meeting with for years. The company sent an email reminder on the day of an appointment.  

In both cases, I followed a Zoom link that had been sent to me by email and chatted with this person for 55 minutes. Octave offers no messaging or live chat options—just the weekly video sessions. When I signed up, I clicked a link from the “family therapy” section of the website, but beyond that, at no point in the intake process did it ask me what my goals were, and so I was not connected with a therapist that specializes in this field. 

I could have switched then to another therapist that specializes in family therapy, but learned from our first therapist that Octave didn’t work with patients under 18 years old, and so, even with another provider, it would not have been an option to include my young children in the session.

We stayed with the therapist we were assigned to because my husband and I were eager to get started, and ultimately we did like his style and how quickly we developed a rapport. I did wonder, though, what actual “family therapy” would have consisted of. 

What Happens If I Miss a Session at Octave?

You can cancel or reschedule a session 24 hours in advance at no charge. If you need to reschedule or cancel within 24 hours, there is a $100 fee.

Switching Therapists at Octave 

To switch therapists, you email the company representative that initially reached out and they will make a new match. After two sessions with our first therapist, I emailed the representative and said that we wanted someone trained in family therapy. Within a day, they reassigned us to a different provider who could meet with us the following week. However, we weren’t able to schedule an appointment with the newly assigned therapist because the review period was up before this other therapist could see us.  

Pausing or Canceling Therapy at Octave 

Canceling was super easy. I just emailed the same customer support person and said I needed to discontinue services. She said OK and that was that. 

Quality of Care and User Satisfaction

According to the therapist I interviewed, most Octave patients attend therapy for a certain period of time, then discontinue treatment once their needs have been met. This was reflected in survey data by a number of former patients who said they began therapy for a specific reason and then ended treatment when that issue was no longer a concern and/or they and their provider felt their treatment had reached a natural conclusion. This information was surprising to me based on my experience with an Octave therapist, and therapy in general. Our therapist was personable, and I enjoyed chatting with him, but after two sessions, I did not get a clear sense of what our goals were and how we’d achieve them.  

Survey data also revealed 14% of surveyed Octave users preferred in-person sessions, and this is the reason why they discontinued services. I am more like those users who love an online approach for its convenience. In total, 82% of surveyed users felt their needs were met by the service, and 56% rated their therapists’ qualifications as “excellent” or “very good.” In addition, 66% of respondents said they were likely or very likely to refer the service to a friend, and 56% would use the service again to find a new therapist, if needed. 

Privacy Policies at Octave 

The privacy policies were written in legalese, and nothing really stood out to me in the terms of use/privacy policies. From what I could tell, the company was HIPAA compliant (the federal law protecting personal health information). I did notice that the Zoom interface looked slightly different than my typical Zoom session, so I imagine there was an extra layer of protection there, but I’m not a particularly private person and so this wasn’t one so much a concern.  

“Many therapy seekers are nervous about the security of online therapy,” says Owens, “and in some cases, they have every right to be concerned.” She explains that “some online therapy companies admit that they sell clients’ personal information for advertising purposes, so it’s important to understand a company’s privacy policies and practices before signing up for services.”

Octave vs. Its Competitors

Not all online therapy companies are created equally. When I hear online therapy, I expect texting and messaging options—and some companies do provide this. At worst, I feared the service would feel impersonal and time-consuming. But with Octave, it’s just like traditional therapy, only all the sessions occur virtually, and with an online service that matches you to a provider. 

When asked how Octave compared to other, similar services they’d tried in the past, 50% of our survey respondents said it was better or much better, 38% said it was a little better, and 13% said it was about the same.

Talkspace, a leader in the online therapy space, provides the client with a list of therapist matches. On reflection, I think that this is what I'd hoped for: a bit more choice when it came down to who we’d be working with. However, if you would prefer to let an algorithm match you to the best therapist fit, Octave will work well for you. 

When it comes to overall satisfaction, 70% of our respondents felt their Octave experience as a whole was good, very good, or excellent. However, when compared to its competitor Wellnite, with 80% of its users overall pleased with its services, Octave falls a little short. Another area where Octave fell short of a few competitors was when it came to value for their money: 72% felt the value was at least good, where 80% of Regain’s users felt the value of the services rendered were at least good.

Final Verdict

People come to therapy in search of different things. For me, a therapist's office, virtual or otherwise, is where I go to feel seen, heard, and understood. For the most part, I was hoping family therapy would be a place my husband and I could hash things out in front of an objective mediator. In general, I think of therapy as a place to vent and get it all out, just as I would do a journal (an activity I used to love prior to becoming a parent). It's more about hearing myself talk, so an insightful comment or two from an actual living breathing human being is just an added bonus. This absolutely happened during our two sessions. 

Our Octave therapist was funny and insightful. It was so easy to talk to him that my husband and I were diving into some of our most challenging marital issues within the first session. It can be difficult and intimidating to find a therapist, so I was surprised at how fast and easy the service was at linking me up with a provider. I love virtual therapy because I'm a busy parent. The fact that you can simply stop what you’re doing, log on for therapy and then log off when you’re done and quickly get right back to your life is appealing.

I do wish, however, that the company had taken more time at the start when gathering my personal information and had more thoroughly interrogated my therapeutic goals. I was cynical, at first, that online therapy would feel impersonal and robotic. Instead, it was just like traditional therapy—but from the comfort and convenience of my home. My husband and I were able to meet with a therapist together in the evening after the kids had gone to sleep, which ultimately saved us hundreds of dollars in child care. I would definitely work with this company in the future, and just anticipate that it’s my job to provide the matchmaking algorithm with more information upfront if I need a more tailored match. 

Methodology

To fairly and accurately review the best online therapy programs, we sent questionnaires to 55 companies and surveyed 105 current users of each. This allowed us to directly compare services offered by gathering qualitative and quantitative data about each company and its users’ experiences.

Specifically, we evaluated each company on the following factors: website usability, the sign-up and therapist matching processes, therapist qualifications, types of therapy offered, the service's quality of care, client-therapist communication options, session length, subscription offerings, client privacy protections, average cost and value for money, whether it accepts insurance, how easy it is to change therapists, overall user satisfaction, and the likelihood that clients would recommend them.

We also signed up for the companies in order to get a sense of how this process worked, how easy to use the platform is, and how therapy takes place at the company. Then, we worked with three subject matter experts to get their expert analysis on how suited this company is to provide quality care to therapy seekers. 

Key Specs

• Price: $85 to $225 per session 
• Is Insurance Accepted? Yes 
• Types of Therapy Offered: individual, couples, family, group, medication management, psychiatry, substance use treatment, eating disorder treatment
• Communication Options: Video only 
• HIPAA Compliant? Yes 
• Is There an App? No 
• Accepts HSA or FSA? No 
• Prescriptions Available? Yes  
• Billing Cadence: Weekly