It’s a very common question to ask – online or in-person therapy? Which is more effective, more helpful? The COVID-19 pandemic exploded its frequency of use. However, online therapy was already slowly gaining in stature and popularity even before 2020.
What’s going to be best for you?
In short, the research says yes, online work can be just as effective for commonly treated therapy problems like anxiety, depression, or low self-worth (e.g., Howes, Gorey and Charron, 2023). It is comparable with in-person therapy on important qualities like establishing a good therapeutic relationship [e.g., Anderson et al., 2012]. More severe or immediate mental health problems like psychosis however are best addressed in-person, problems more likely to be addressed in clinical or medical settings.
What is most important for you as a potential therapy client however? Start with consideration of your own feelings about working online. Research shows us that it’s vitally important to believe your online therapy will be effective (Dias et al., 2023). If you don’t ‘buy into it,’ it’s probably not going to prove effective! So, how do you feel about it? Here are some key questions to help you reflect on your needs and the different benefits and drawbacks of online therapy vs. in-person therapy.
Meeting the needs of your personal circumstances
Online therapy is often preferable for accessibility and convenience. If you live in a more remote or suburban area, you may realistically be miles away from the therapy room. The commute might also take extra time that you don’t have. Working online may best support a physical disability, childcare challenges, or a busy life schedule. In contrast, in-person therapy does create a routine that structures and separates the work from the rest of your life. Many find the travel time to and from therapy an important part of processing what you explore, learn, and experience in your therapy hour. It is helpful to consider the same kind of ‘buffering time’ around the beginning and end of online sessions, especially if you complete them from your home environment.
‘Connecting’ with your therapist
The personal connection with your therapist is a crucial experiential part of therapy. There are mixed feelings about how effective this can be in the online space. Empathy and compassion have an undoubtedly embodied quality and are likely to be experienced more totally in-person. If you are heavy with emotional pain however, some feelings leave us wanting to hide. Being online can often therefore feel like it offers a bit more safety. In fact, you can almost feel ‘too safe’ online; the disinhibition effect (Suler, 2004) refers to the very common tendency to reveal a lot online, moving a bit too quickly into the core of the pain, in a way that needs good awareness from your therapist to help you manage the pace of explorations.
The limits of technology
The virtual world introduces technological barriers out of the therapist’s control. Technical issues like poor internet connection or lag can occasionally interrupt the flow of conversation, and this can make it harder to build rapport. Annoying updates for Teams and Zoom can kick in unexpectedly and delay access to sessions! Activities that require a lot of ‘screen sharing’ (e.g., perhaps you’re using the screen to draw, or sharing images for reflection) can sometimes feel a bit impersonal as you lose a lot of the visual connection with each other. A knowledgeable therapist can work around this, however. So, just ensure ahead of time you have reasonable tech to access your online therapy with. Also make sure you can create a safe, private space each time you have an online session. You most likely don’t want to be overheard. Even feeling like you might be will impact your ability to concentrate, to let go into a session. Therapists usually guarantee that kind of privacy within their physical therapy room.
In closing
I hope these observations give you a sense of the differences between in-person and online work. It may even be that a mix of the two is best for you. Ultimately, if you are unsure about whether it’s best to be in-person or online, discuss it with your therapist in relation to your unique circumstances. A related question for you might be about finding a therapist that works well for you. You can read some brief thoughts about that here.
