My Son Needed a Therapist, So We Tried Little Otter—Here's What Happened

Throughout the past three years, Verywell Mind has tested Little Otter, an online therapy service focusing on children and their families, numerous times. In this review, we will discuss our findings from our most recent test of this company in 2024. Then, Laura Leigh Abby explains her experience testing Little Otter's children's therapy in 2023.

Our Most Recent Testing

In the summer of 2024, we received insights about Little Otter from a mother and her son who have been using this company's services for the past year. These are their personal experiences.

Why We Chose Little Otter

We’ve been using Little Otter for over a year. My son (10 at the time, now 11) was having panic attacks at school and experiencing general anxiety.

We were searching for a therapist for my son, and since most NY therapists were only doing virtual appointments anyway (and are super expensive and don't take insurance), we decided that Little Otter was a cost-effective way to find a good therapist.

Signing Up for Little Otter

There were several questionnaires to fill out throughout the process. After I did a general one, Little Otter set up a virtual appointment for my husband and me to answer a lot of questions about our son. Based on our conversation, they sent more questionnaires about our family and our son. Throughout his therapy, we have been sent more questionnaires to help monitor his progress. We did give our payment information early on, but I can't remember whether it was before or after the initial meeting (this was more than a year ago).

We had a "kickoff session" with a care coordinator (also a licensed therapist) who then matched us with a therapist, I believe based on our needs and preferences.

We were EXTREMELY happy with their choice, and it felt like she was in sync with my son right away. It just so happened that she is also in NY, and I think that helped us connect to her in a lot of ways right away. Was it luck or was it based on their insight and our criteria? I don't know! The whole process took just about two weeks before we had our first appointment with the therapist. This is miraculous compared to NY providers who put you on months-long waiting lists.

There is an app through which we communicate with the therapist, make and change appointments, see her post-appointment notes, and have access to a library of info. My only complaint about this app is that it does a terrible job of remembering my password and makes me log in over and over. I found that it's much easier to log in from my computer instead. The actual sessions take place over Zoom, and they do send a regular email with the Zoom link every week.

Our Therapy Sessions

After the coordinator session, we had our first appointment with the therapist who talked to my husband and me alone and then talked to our son. We filled out more questionnaires at some point in this process, too. She then sent us a message with a diagnosis and outlined how her treatment plan would go forward. It was all very comforting to us and to our son. 

She used CBT (cognitive behavioral therapy) and explained her approach in detail throughout the year. I don't think she said it would be CBT until after our first session with her.

Our son had been reluctant to talk to a therapist at first, but loved her instantly. 

Throughout the year, she intermittently invited me to join in sessions—sometimes formally set up in advance, or sometimes in the middle of a session when my son wanted to talk to both of us. I appreciated this a lot. We were also able to message with her between sessions. 

I believe she was very good about getting our son to open up. As is probably typical with a child, he sometimes forgot what had been bothering him a few days before and neglected to tell her about it, even though it was fresh in my mind. I think it would have been helpful if she'd prodded him a little more to get those things out of him. But it's ok that I was able to step in every once in a while to make sure he talked about that stuff. 

This is where it would have been nice to have a phone number or something, rather than having to rely on the app to communicate. Once we knew that could be an issue, we made sure to look closely at which email link we were using and to follow up to make sure the session was underway before leaving my son in his room to talk to her.

I have no idea if we could have done sessions through anything but Zoom, but I don't think I would have wanted to anyway. We were able to have our appointments after school on weekdays, which was perfect for our schedule.

Cost of Little Otter

It cost $400 for the first 90-minute evaluation, and then $200 a session if you just paid per time. It costs as little as $165 per session if you book a package of 8 at a time. It was all out-of-network for us.

I really, really wish this had all been in-network for insurance. We have not had any of it covered, though I think I can submit some of it for out-of-network reimbursement. Still, I would do it again—it wasn't cheap, but also was about the same or less than what I would be paying for someone locally. And this is my son's mental health we're talking about. He has not had any real panic attacks since he started therapy. He still gets anxious at times, but I've watched him work through all the tools he's gained to handle his feelings, and I would pay 10 times this much to see this progress. 

How We Feel About Little Otter

I would recommend Little Otter to anyone having trouble finding immediate, somewhat affordable therapy for their kid. It does need to be a kid who responds well to video communication. I know some children don't feel like they're connecting to another human when it's over a computer. We're lucky that our son does.

Laura's 2023 Testing

In 2023, we asked Laura and her son to test Little Otter's children's therapy services to learn about the quality of care this company could provide. These are her firsthand insights.

Why I Chose Little Otter

When I was seeking therapy for my 5-year-old son, I was having trouble finding in-person options in my area. My personal experience led me to believe that my son didn’t simply need therapy for himself, but that his parents also needed to learn coping mechanisms and tools to help him cope with his anxiety. That led me to Little Otter, an online therapy company designed specifically for children and their families. I liked Little Otter’s message of “mental health support for the whole family.” It was founded by Helen Egger, MD, a renowned child psychiatrist, and her daughter Rebecca, and offers therapy for children from birth to age 14; parent training and support; couples therapy; and psychiatric services, including medication management.

We worked with Little Otter for just over a month, during which time we completed a welcome session, a psychiatrist assessment, and a follow-up session. The providers were professional, warm, and knowledgeable, but Little Otter does not accept insurance, and the out-of-pocket expense was quite high, so my family could ultimately not move forward with it. Read on to learn more about our experience and see if it might be worth it for you. 

How I Signed Up for Little Otter

Arriving on the homepage, I immediately saw the phrase “Mental health support for the whole family,” next to a picture of a parent hugging a smiling child. A green “get started” button was beneath. Scrolling down the page, there were sections describing the company’s approach in more detail, a review from a satisfied client, a biography of founder Dr. Helen Egger, and an explanation of “How Little Otter Works” with the steps for signing up for and receiving services.

Buttons to “get started with your personalized care plan” and “join our care family” were peppered throughout the page.

It felt like all my questions were answered before I had the chance to ask them. Pricing was listed clearly on the FAQ page and the mission of the company made me feel like I was on the right track.

At the top of the homepage is a “join now” button. I had the option to immediately sign up for my first appointment, or complete a free family health assessment, which I did. The assessment included a questionnaire for each member of my family. For my child, questions included how he feels in new situations, if he suffers from stomach aches, and if he bullies or is bullied. The assessment had over 30 questions about his behavior, and any concerns I might have, and provided some feedback as to what my family might need in terms of Little Otter’s services. This included links to its online resources and the option to book a welcome appointment to learn more. 

I was not asked any questions about the type of therapist I would like for my child, including gender and age, which I found a bit odd.

After completing the family health assessment, I was prompted to provide payment information. 

Little Otter does not accept health insurance, but will provide a superbill for patients to submit to their insurance provider for partial reimbursement. Payment must be made in full prior to each session, and invoices and receipts are sent directly to your email. Even if a family has the option for partial or full reimbursement from their insurance, they are still required to pre-pay for their appointments. This feature excludes families who are unable to front the cost of services.

As soon as I signed up, I had access to a private user portal that was easy to navigate and allowed me to send messages to my care team, check my appointment schedule, and view family resources like articles and blog posts. Little Otter also has an app that allows families to track their progress, with daily access to their care team when questions, concerns, or schedule changes arise. 

Our Welcome Session

I was matched with a member of the Little Otter team for my welcome session, which was scheduled for the following week.

I didn’t know quite what to expect or who I would be seeing for my initial welcome session, but my spouse and I were given a 30-minute session with a licensed mental health counselor who became our “care lead.” She walked us through what Little Otter can offer and asked us questions about our needs. At the end of the call, she scheduled a psychiatric assessment for us and our 5-year-old son. We did not choose the doctor ourselves but were assured that they would be the right fit for our family.

Founder Rebecca Egger has said, “We’re really focused on understanding each family’s unique story.” It did feel like our care team wanted to understand the needs of the entire family.

Little Otter does not list provider names or bios on its website. Instead, the “Our Team” page includes photos and blurbs about the Little Otter founder and its clinical advisors and lists its expert care team as licensed therapists, parenting experts, and child psychiatrists. 

How Our Therapy Sessions Worked

Little Otter offers teletherapy, but all of the appointments were in the middle of my child’s school day, forcing us to make accommodations including late arrival for class. When it was time for a session we could log into our patient portal and connect to our Zoom link from there. Our initial provider as well as our psychiatrist were easy to see and hear.

Our providers were punctual for each session, with no issues like background noise or grainy video.

She was warm and patient as we outlined our concerns and she began her conversation with our son using some personal information, asking him about his pet lizard and his younger brother.

How Our Son's Psychiatry Session Went

Our psychiatrist greeted us and our son for our 75-minute session with knowledge of our welcome session and the forms we had already filled out when we registered for Little Otter. This was an evaluation, not a therapy session, so the doctor had a chance to meet and interact with our son and ask me and my wife follow-up questions.

While my son was talking with the doctor, she was friendly but serious, and he exhibited some shy behavior when he was expected to answer questions. Overall, I think she was able to get a good sense of his personality and demeanor.

We discussed our goals and made a plan for a follow-up session—without our son—for the following week so that we could discuss a possible diagnosis.

I have personal experience talking to adolescent therapists, and, based on those experiences, I was impressed with our psychiatrist. I felt she immediately understood our situation and gave us plenty of time to talk about our concerns.

Little Otter also provides session recaps to make it easy to stay on top of your family’s “care journey.” 

Our Other Testers' Experiences with Little Otter

We also tested Little Otter two other times, from Pennsylvania and California, and our experiences were similar—excellent care with a too-expensive price tag.

Our Care Leads were welcoming and warm, explaining the Little Otter process to us in detail, and all of the therapists we worked with were incredibly professional and clearly skilled at working with families and children. We really liked one of the parent coaches we were matched with, who was well-trained and very thoughtful; however, our first 45-minute session with her ended up only being 25 minutes, and the following session—which we used to go over our treatment plan—felt a little redundant, as we could easily have read the plan ourselves without using an entire session to walk through it. Nonetheless, we appreciated her thoroughness, and we found her to be qualified, empathetic, and caring. The parent coaching she provided us felt useful and understanding.

Our therapist, who we picked from a short list of bios we requested from the company, asked thoughtful questions and seemed genuinely interested in the answers, leading us through a thorough examination of our and our family’s mental health. Questions like “What does our experience with anxiety look like,” “How often do our challenges with anxiety occur,” “In what situations does it occur,” and “What have we done about it” made us feel as though our provider was truly dedicated to providing us the best and most tailored care possible. 

We especially appreciated the fact that our providers were extremely accessible between sessions. We found that we could message our therapist any time through the patient portal and we always received prompt (and thoughtful) responses. This only increased the confidence we had in our providers and Little Otter as a service. However, the hefty price tag prevented us from continuing with Little Otter, despite our happiness with the clearly professional and informed care it offered us. 

Switching Providers

I did not have an opportunity or need to switch therapists. However, if you do need to switch providers, you must contact your Care Lead and ask for this change. Switching providers is not recommended by Little Otter, so you might receive some pushback. 

Additional Resources

Little Otter also offers some additional helpful resources, including a blog with articles and insights from its providers. There is a “family resources” section in each personal profile that recommends curated resources based on the child’s age and the family’s needs. I appreciated brief articles about hyperactivity, and reader submissions about sugar intake and screen time.

Pros and Cons

While I felt like the care we received from our providers at Little Otter was excellent, the cost was prohibitive. Here are the rest of my pros and cons.

Final Thoughts

Our Little Otter care team and the psychiatrist we met with were attentive and professional. Our psychiatrist, in particular, seemed very knowledgeable about every topic we discussed. She offered helpful insights and we felt like we were armed with useful information, even after our first appointment.

Personally, I would exhaust in-network and in-person therapy and psychiatry options for my child and family before turning to telehealth, but for a mental health company that does not offer in-person services, I believe Little Otter does a good job of connecting families with mental health experts and offering helpful resources. However, because Little Otter does not accept insurance, it would not be a viable option for many families looking for pediatric mental healthcare.

Overall, I would recommend Little Otter to families with young children who have the financial resources to receive continued care.