10 Essential Points About Online vs. In-Person Therapy

COVID has given us a solid run with online therapy. I’ve heard many therapists say they prefer virtual work and are “never going back” to offices. I’ve seen many articles that declare that online therapy is as effective as (or even superior to) in-person. And, that might be true.

Supporting the claims, 2020 research revealed that thus far, online video treatment—mostly utilizing cognitive behavioral therapy (CBT)—has been shown to be as effective as in-person. Further, a 2020 meta-analysis concluded that electronically delivered CBT might be better than in-person CBT. However, before we accept that remote and in-person sessions are, at minimum, comparable in success, we need to look deeper. So here are 10 considerations.

1. Your experience

If you have attended online therapy, how was it for you?

2. The therapy type

The modality (the way therapy is administered) may affect whether online is as effective as in-person. CBT is a well-researched therapy modality, and according to David and colleagues, the “best standard we have in the field at the moment.” So, it makes sense that a majority of the remote versus in-person research has utilized CBT. However, many therapists practice using modalities other than CBT. Thus, realistically, what is probably happening during virtual therapy lacks research that measures the same things.

3. Readiness

Some people start therapy eager to do the work—willing to share openly and try new ways of thinking and doing. Others attend with hesitancy (e.g., as a favor to a loved one) and, thus, are typically less open. Still, others may not realize their level of illness or want to recover. For example, someone with an eating disorder or a substance use disorder may not recognize the severity of their condition. Consequently, a person’s readiness for change can influence in-person versus virtual therapy. For example, if someone doesn’t want to talk or becomes upset during a session, think about the effort it takes to physically walk out of a face-to-face in-person meeting versus the ease of ending a video call. (Yes, I heard about this happening a few times during COVID.)

4. Privacy

Some individuals don’t have a private space for their Internet-based meetings. Whispering from a closet and hoping the clothing absorbs vocal sounds is not ideal for deep therapeutic work. (Yet throughout COVID, many people had to do that.) To speak without concern of being overheard, someone may need to visit an office. A sense of safety is a cornerstone for potentially effective treatment both online and in real life.

5. Diagnoses or symptoms

As a therapist, I often prefer to see people in person, especially if they struggle with a more acute diagnosis or symptom. I'm not schooled on micro facial expressions, so I want to see more than a face on a screen. Toe-tapping and finger-strumming inform, and I can miss those kinds of cues and fuller contexts when I see a head on a screen only. A whole picture, including these smaller expressions, helps me to see what's not being verbally said and to provide the most effective care I can.

6. A person’s preference

Recently, people have been reaching out, asking if I work in person. Reasons provided have included the following: They miss the connection with a therapist, need privacy, want to get out of the home, dislike virtual, feel in-person face-to-face is the fullest form of relationship, or experience online fatigue from seemingly endless video meetings.

7. The therapist’s comfort level

Suppose your therapist feels uncomfortable or doesn't believe in something and does it anyway. In that case, I suspect your sensitivity will vibe their “off” energy. Yes, this includes using technology, especially since some therapists didn’t use computers or tablets for sessions prior to the pandemic. Even now, some still feel overwhelmed by the amount there is to learn about using technology, which can loom as a potential session distraction.

8. Internet access/speed

Not everyone has high-speed internet or can afford it, which can get in the way of effectively communicating. Reiterating, “Sorry you froze. Can you repeat that?” generally does not create an environment for successful therapy.

9. Access and convenience

Regarding remote therapy, not commuting can be unquestionably valuable. That piece alone can heighten the potential for effective therapy for those with limited mobility or chronic illnesses, who experience anxiety leaving their familiar areas, and even those who live in overly populated metropolitan areas filled with traffic gridlock and road rage that disrupts the regularity of in-person meetings.

10. Possibility

It's essential to recognize that the nine prior thoughts are based on having a full range of available resources, options, and choices (aka levels of privilege). However, that isn’t the “always.”

Remote therapy allows those with physical or geographical limitations to attain support they may not otherwise get. Online therapy can be the best option for people with limited resources and access to therapy. The good news is this: Existing studies show that virtual therapy—typically using CBT—can be incredibly effective for improving various mental health diagnoses.

Bottom line

Before accepting the widely publicized generalization that internet therapy is just as good as—or better than—in-person therapy, think about your individual factors. As some therapists return to offices and some stay virtual completely, what are your options? If you have the ability for in-person therapy, online treatment, or a combination of both, which do you feel might best serve your or your loved one’s healing? Advocate for that.

This post is for informational purposes and does not provide therapy or substitute for professional advice.

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