Octave Online Couples Therapy Review

An online therapy alternative to in-person couples therapy that's worth checking out.

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Young couple talking with their therapist on a video call

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Octave is as close to an in-person therapy experience as you can get online. With no large-scale digital presence, Octave returns to basics in an effort to encourage couples to gather around a screen and resolve relationship issues. In this, Octave succeeds; however, if you are a couple who prefers messaging, it may fall short.

Key Specs

  • Price: $190-$275 per 45-minute session
  • Is Insurance Accepted? Yes
  • Types of Therapy Offered: Individual, couples, family, group
  • Communication Options: Live video
  • HIPAA Compliant? Yes
  • Is There an App? No
  • Accepts HSA or FSA? Yes
  • Prescriptions Available? No
  • Billing Cadence: Pay per-session

Pros & Cons

Pros

  • Simple at-home therapy experience
  • Accepts insurance
  • Attentive customer service
  • 45-minute virtual sessions
  • Easy-to-navigate website

Cons

  • Limited availability (only six states plus Washington, D.C.)
  • No online portal for therapy or communication with a therapist
  • No app
  • Pricier than other online therapy providers (and in-person therapy)
  • Little to no input on therapist matching
  • Longer wait time to get started

Couples have been having a hard time lately, especially since 2020. Relationship discontent— increased by families spending months isolated at home trying to work and homeschool in one space—widened cracks in many already stressed relationships. Add to this spouses individually struggling with anxiety, depression, stress, and other mental health strains. This has fueled a rise in the need for therapy—and alongside it, a swell of new telehealth platforms designed to connect licensed therapists and counselors with those seeking an alternative to in-person therapy.

One of the newer entrants into this surging field is Octave. Its purpose is similar to other online therapy providers, except that it doesn’t want to compete in the same way. Instead, Octave wants to win over users who aren’t looking for the bells and whistles of a large platform; it wants to concentrate on offering quality over quantity. 

When it comes to providing counseling services for couples, how does Octave measure up? We surveyed 105 users of Octave, spoke with subject matter experts about the company, and my husband and I gave the service a try in the hopes of parsing out some of its strengths and weaknesses against 54 other companies we also evaluated.

What Is Octave?

Octave is an online therapy company. It offers couples counseling, as well as individual, family, and group therapy. It was founded by Sandeep Acharya, who, after watching a close friend go through struggles with mental health issues stemming from a traumatizing event, decided to do something about the discrepancies in availability of behavioral health services. In 2018, Acharya opened Octave Studio in New York City, with the intention to “not only make it easier to find a great therapist, but also create a place that would allow people to focus more deeply on their emotional well-being.” 

Since then, Octave has expanded from in-person therapy only to virtual offerings across six states and Washington, D.C., and it is just getting started. Since 2020, the company has struck deals with more insurance companies to make its services more affordable. What Octave provides is intriguing. It’s more of a boutique online therapy practice versus the technology-heavy offerings of other telehealth providers. With the absence of an app or any interface that allows clients to remain in digital contact with providers, Octave’s simplistic approach mimics in-person therapy experiences.

What Services Does Octave Offer?

Octave first opened as a single brick-and-mortar clinic in New York. Now, you can attend therapy sessions in person there and in California. Online therapy sessions run about 45 minutes but may go longer depending on the care plan developed by the provider. Our couples therapy sessions, for example, were booked for 55 minutes.

Licensed providers associated with Octave use a range of treatment modalities to service client needs. Each provider’s biography provides details about their preferred methods, including approaches for treating couples:

Although it has plans to expand further in the future, there are currently only six states where you can sign up for Octave:

  • California
  • Connecticut
  • Florida 
  • New Jersey
  • New York
  • Texas

Everywhere it is available, Octave provides virtual therapy sessions for couples, individuals, groups, and families. It also offers virtual workshops.

Who Is Octave For?

Octave serves adults, adult families, and couples, and aims to treat various clinical issues, including:

  • Attention-deficit hyperactivity disorder (ADHD)
  • Depression
  • Trauma and post-traumatic stress disorder (PTSD)
  • Phobias
  • Substance use
  • Bipolar disorder
  • Anxiety
  • Panic 
  • Self-harm
  • Personality disorders
  • Anger
  • Insomnia
  • Eating disorders
  • Chronic pain

However, you do not need a diagnosis to enlist the services of an Octave therapist, especially if you’re seeking couples counseling. If you need help with parenting advice and support, breaking unhealthy patterns, or relationship help, Octave maintains that it can match you with a therapist who can provide you with support and guidance.

How Much Does Octave Cost?

Octave gives a range of possible treatment costs for those paying out of pocket. Its website also provides a cost estimator tool to help you figure out how much services might cost in your state. 

According to the “Pricing” section on the website’s FAQ page, couples therapy costs between $190 and $275 per session. Your method of payment is charged within a day of completing a session. The price is relatively steep compared to other online therapy providers, such as BetterHelp, which charges approximately $60 to $90 per week.

Still, our user survey indicates that 32% of respondents found Octave affordable, and only 9% of those who stopped using the services did so because of cost. However, 15% said that their insurance changed, which may explain some changes in cost for those particular clients.

Does Octave Take Insurance?

Octave accepts several insurance providers. According to the Octave website, “most of our clients pay only a small copay fee.” The homepage gives a quick list of those insurance companies that Octave accepts, highlighting Aetna, Anthem, and Health Net.

Navigating the Octave Website

The Octave website is pleasant, with a soothing color scheme of white and pastel yellows and pinks, free of pop-ups. Fifty-four percent of the Octave users we surveyed found the website very easy or easy to navigate, and I agree that is a clear and easy site to explore.  

Homepage

Octave

Starting at the top of the page, you will find five drop-down menus: Our Services, Meet the Team, Insurance, Blog, and Locations. 

Continuing down the main page will bring you to an orange “get started” button, as well as a list of insurance companies Octave accepts. Underneath this are four short statements about what Octave has to offer. 

Why Octave

There is no sense of overwhelm when navigating the website. It was also easy to find answers to frequently asked questions, including pricing and the type of services Octave offers, through the options in the footer menu. The webpage is further evidence of Octave’s minimalist, boutique style. 

Octave

Octave

You can find therapist biographies in the dropdown menu. You can also access a list of providers by state. After I was matched, I returned to this menu and found the therapist’s biography.

I wanted to check out the blog portion of the website, which I accessed through the Blog dropdown menu at the top. It brought me to a page the company has named “Keeping Tempo.” It appears that Octave tries to publish at least one new blog post a month on a topic relevant to mental health and lifestyle.

At the top of every subsequent page accessed from the top menu or footer is an orange button to sign up.

Unlike some of the other companies we reviewed, Octave doesn’t have an app at this time. Our therapy sessions were conducted via Zoom, which does have an iOS and Android app.

How Do You Sign Up for Therapy at Octave?

From the homepage, you can start the process from either the “get started” button in the middle of the page or by choosing the type of therapy services you are looking for from the dropdown menu at the top of the page. Either of these lead to the sign-up page, which begins a series of questions used to match you with a therapist.

Octave signup

Octave

After providing basic personal information, such as your name and address, the site asks why you’re seeking care. You can only choose one option here, but below you can choose as many of the conditions or issues as you want that apply to your situation. Here, you also indicate if you have ever seen a mental health professional before.

octave intake

Octave

You continue down the page, proceeding into questions about your gender identity, race, sexual orientation, and whether your partner is seeking services with you at Octave or not. You then have a space to note your availability. This is essential in matching you to a therapist who can work within your time constraints. You are urged to list as many recurring available days and times per week as you can since Octave automatically signs you up for 12 appointments if you accept the therapist match and timeslot offered to you. Once you fill in your availability, the site asks if you plan on using insurance.

Next, you are prompted to answer seven questions on the generalized anxiety disorder scale, or GAD-7, and below it, the Patient Health Questionnaire-9, or PHQ-9, which measures depression. 

Then, another set of questions pops up asking about the severity of dangerous symptoms, such as cutting, suicidal thoughts, and substance use. Here, I was also asked about any kind of recent trauma. There are text boxes that allow the elaboration of symptoms at this point.

To finish the process, you sign a simple consent to treatment and review the terms and conditions you are agreeing to when you engage in the services provided by Octave. On this screen, you indicate Octave can bill your insurance.

After this process is complete, you are told to expect an email with further instructions.

I received an email within 24 hours, which noted that, due to the increased demand for services, I could expect to wait between 7 to 10 business days for the site to match me with a provider. The email also contained a link for my payment information. Until now, the site had not prompted me for a credit card.

Matching With a Therapist

The email confirmation of a match arrived within four days. It gave the name of the provider we were matched with and a link to her biography. It also gave the tentative appointment for the first session, and once I accepted it, the site sent me 12 emails, each confirming subsequent weekly appointments on the same day and time as the first. While I didn’t notice it at the time, the Octave homepage states that clients have reported a 37% decrease in symptoms of depression over a 12-week period.

How Do Therapy Sessions Work at Octave?

Our first couples session was scheduled for two weeks after sign-up. The day before it was scheduled, I received an email that contained a reminder and a Zoom link to follow.

Video sessions were conducted over Zoom. Following the link at the time of our therapy session brought us right to a room with our therapist. 

Our therapist explained how the session would work and that this intake was an evaluation to see if we had a good rapport with her. There were no issues with the technology and everything ran smoothly.

We were testing the couples therapy component of Octave. There was really no difference in this versus individualized therapy. My partner and I shared a computer screen and the therapist asked us each questions. 

I imagine that if necessary, there is a way that both my husband and I could participate from different phones or computers. Likely, this means using the same link on both.

What Happens If I Miss a Session at Octave?

Octave requires a minimum of 24 hours notice for all cancellations. Its policy states that if you don’t cancel within that window, the payment on file will be charged a $100 fee. You cancel by replying to the appointment confirmation email and copying support@findoctave.com, the Octave support email address.

Switching Therapists at Octave

After a couple of sessions, we decided to try and switch therapists. I responded to the next appointment email reminder and copied Octave support again. I was messaged back within a day, confirming I was switching and canceling all future appointments with the first provider. I was told that once the current therapist submitted an internal referral, we would be re-matched with a new one.

A few days later, I received an email from the original therapist wishing us luck. A week after requesting the switch, I went ahead and canceled the service.

Pausing or Canceling Therapy at Octave

Canceling Octave only requires you to send an email to support, expressing your desire to end treatment. Since Octave doesn’t bill until after your therapy session, there is no concern that any charges will appear after the fact.

I got a confirmation within 24 hours that support would discontinue trying to match us with another therapist.

There was no follow-up or exit survey as to why we were discontinuing the service. If asked for a reason, I would have definitely cited the price and the length of time between a request and a match.

Quality of Care and User Satisfaction

While I’ve attended in-person individual therapy in the past, I had never tried it virtually. I was intimidated by the prospect of how an online therapy session would work and what it all would entail. I wasn’t sure if I would feel comfortable talking to someone over my computer about my marriage, especially since I wasn’t sold on the viability of forging a client-therapist bond electronically. 

I also confess that I’m not the most tech-savvy person, so I was worried online therapy might be complicated and intimidating. 

However, Octave is neither of those things. Its simple website and interface serve really only one purpose: to get you to sign up. Beyond that, there is not a lot you ever need to return to the website for. All communication is conducted over email, and the video sessions occur over Zoom.

My first concern with any virtual therapy is privacy, and I don’t necessarily mean online privacy. To take part in a telehealth call or video, you have to feel comfortable enough in your sessions that you can speak freely without fear of anyone in your general vicinity eavesdropping. In my case, I have put off trying individual online therapy for this reason. As a freelance writer, I work primarily from home. My husband also has flexible hours and is home quite often. Even with rooms and doors, it would be very difficult to feel alone in our home.

Luckily, we were trying Octave as a couple, and so there was no need for privacy from each other. Our therapist was thoughtful, attentive, and very engaged. I could see her taking notes, which I appreciated. It felt like we were sitting in an office across from each other, and I was immediately at ease, especially since the technology went off without a hitch and we experienced no difficulties using Zoom.

Our sessions were thought-provoking. Our therapist engaged both of us in conversation. She encouraged us to take turns answering questions, and she often asked follow-ups or wanted to go back and revisit issues raised by one of us minutes after the fact. While she allowed one of us to take the lead, she never let the other one off the hook completely. My husband indicated during and after our sessions that he found our provider’s input valuable. She gave us a general idea of our future treatment and then challenged us to develop goals for our relationship that spanned one, five, and ten years.

At the end of one session, I asked our therapist if she believed online therapy was just as effective as traditional sessions. Namely, can a strong therapist-client bond be forged? She indicated that yes, she believed it could be, but there is something lacking for her with virtual sessions. She said one of her strengths as a therapist is reading body language, and depending on how you sit for an online session, there may not be much of that showing. This was not an element of therapy I had considered before, and once she pointed it out, it made sense.

One of our subject matter experts on this project, Amy Marschall, Psy.D., echoed the sentiment that a therapist and user could establish a strong relationship on a telehealth platform, saying that “good rapport is possible in digital or telehealth settings.” 

“For some clients,” she continued, “this method of service isn't the best fit, but for most they are able to establish rapport as well as they would in an in-person setting.”

Of the Octave users who participated in our survey, 71% rated the service overall as good, very good, or excellent. 

The most frequently cited mental health issue that drove users to Octave was anxiety (39%) followed closely by depression (37%). Two percent indicated they were considering a divorce, 13% said they had family problems, and 5% of users indicated they were seeking therapy for relationship or marriage issues. 

Eighty-two percent of users indicated that all or most of their needs were met by an Octave therapist, and 61% stated that they were very satisfied or satisfied with the therapist options available through Octave. 

When it comes to therapist qualifications, 74% expressed a generally positive rating, and 67% of users felt like there was an adequate number of licensed therapists in their area. Fifty-one percent of users who stopped using Octave stated that it was due to no longer needing counseling.

Privacy Policies at Octave

Octave has general privacy policies as well as HIPAA policies on its website. These are very easy to read and nothing stood out as alarming or out of context. There is some measure of legal verbiage, but nothing that is difficult for the average reader to interpret.

In short, the privacy policy states that while users do need to supply Octave with personal data for the provision of services, the company protects all sensitive information under the 1996 HIPAA laws (federal law protecting medical information). Octave does claim to only keep user data for as long as necessary for providing services, and say that the platform will only share information with other parties if a user requests Octave to do so. Anyone can opt out or unsubscribe from services and communication at any time. If you wish to have the company delete your data, you may request this and it will comply if it doesn't need to retain the data for legal reasons.

Octave vs. Its Competitors

If you are looking for a technology-driven experience, with regular access to your therapist, Octave may not be the best choice for you. Larger platforms such as BetterHelp and Talkspace offer live chat therapy along with video and audio sessions. They also have portals where you can exchange messages with your therapist. While Talkspace offers couples therapy, BetterHelp does not, but will instead send you to its sister site, ReGain.

Unlike BetterHelp and Talkspace, there is more of a boundary between therapist and user in between sessions at Octave. I asked our therapist about how we could get in touch with her outside the live session, and she said that emailing Octave customer support would work. They could get her a message if needed. In this way, Octave is much more similar to traditional in-person therapy.

Both Talkspace and BetterHelp scored higher in our user survey, coming in at 90% and 86% respectively in overall satisfaction rating. The fact that these platforms are available for use in every state, versus just the seven that Octave is in, may play a part in this result. 

More people indicated that navigating Talkspace’s website was easier than Octave users (82% versus 74%) and 50% of users at Talkspace (and 47% at BetterHelp) indicated that they would still be engaged in therapy in six months. Octave users responded to this question at a much lower rate, coming in at 31%. Eighty-three percent of Talkspace users and 77% of BetterHelp users indicated they were satisfied with the therapist options on the site and 92% of Talkspace users (87% on BetterHelp) had a generally positive impression of therapist qualifications. This is up from the same answers of 64% and 75% given by Octave users.

Also of note is the cost of Octave in comparison to these others. We paid $255 per 55-minute session. The average monthly cost of BetterHelp and Talkspace falls within the $200 to $400 range, but includes messaging with your therapist in addition to the live weekly session. While this might make either of those competitors seem like a better value for the amount and diversity of services they provide, if you’re looking for an easy-to-use, quality telehealth service that offers couples therapy, Octave may win out, at least, based on my experience. 

Final Verdict

As someone who was skeptical that online therapy could work, I was pleasantly surprised by Octave. My husband and I both agreed that between the therapist and the simplicity of the technology involved, Octave is a great alternative to in-person sessions with a local therapist. However, the cost seems higher than any traditional therapy I’ve attended. Unless you are using insurance, Octave may price itself out of the market in this movement toward online telehealth therapy. Even so, I left the platform with a favorable impression of the company and its movement toward a boutique virtual therapy experience.

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. 

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