In-person therapy is an approach to the treatment of mental illness and everyday life concerns that has been studied for more than 100 years with demonstrated effectiveness. Online therapy is a newer, technology-assisted approach to therapy that follows the same theories of traditional therapy, with the provider and client virtually connecting instead of sharing the same space.
Whether provided through online means or in-person treatment, understanding what modality best meets each client’s needs is important for successful outcomes and sustained mental health.
What Is Online Therapy?
Those interested in participating in online therapy have several options to choose from. There are many private therapists who are providing services through their own electronic record management systems as a part of their private practice. In addition, there are several subscription services that allow the user various means of contact with a therapist for a weekly, monthly, quarterly, or yearly price.
There are also some providers who contract with Employee Assistance Programs (EAP) that provide services using the organizational platforms but often follow the same approach as traditional private practice.
Both private practice and EAP providers offer services online that are similar to what are traditionally provided through face-to-face, in-person therapy (i.e. weekly, 50-minute sessions) using video technology equipment for visual connection during the meeting.
In contrast, weekly subscription services often offer other modalities of treatment such as chatrooms, messaging services, telephone sessions, and video-assisted treatment. While subscription services offer the traditional model of weekly face-to-face online sessions, this service can cost an additional fee depending on subscription service identified.
What Are the Benefits of Online Therapy?
There are several benefits to online therapy, most notably convenience and accelerated outcomes. Many individuals chose to sign up for online therapy as a result of having limited providers in their area, not having the freedom to leave the home to seek services, or requiring a non-traditional approach to treatment. Online therapy allows the user to receive services from the comfort of their own home without the need to travel, find daycare, or even get out of their pajamas.
In addition to the vast convenience afforded through online therapy, services provided through this modality are often shorter than a traditional in-office approach. Due to the limited nature of treatment, there tends to be a decreased overall cost associated with online therapy.
In addition to decreased cost and reduced time in treatment, online therapy provides the ability to access services outside of traditional business hours and can allow for more frequent contact with a therapist.
Is Online Therapy as Effective as In-Person Therapy?
Research has existed for more than a century that indicates traditional psychotherapy is an effective intervention for mental health concerns. Online therapy has been shown to be effective with a variety of disorders and issues.1,2,3,4,5,6,7
Online therapy has been shown to be as effective as in-person therapy for the treatment of depression.7 When speaking specifically of Cognitive Behavioral Therapy (CBT), research has found online therapy to be as effective as traditional face-to-face therapy for the treatment of depression, panic, and anxiety disorders.1 Online CBT treatment is showing no significant difference in effectiveness compared to in-person treatment.6 Further, online Solution-Focused Brief Therapy (SFBT) is indicating effectiveness in helping clients with anxiety.5
In addition, online-based therapy services appear to be as effective as in-person for children and adolescents with anxiety disorders3 and for increasing resilience in adolescents.6 Also, online family therapy for certain disorders is showing promising results.2
This trend continues with many populations and diagnoses. However, in order to ensure good outcomes through online therapy, it is essential for the consumer to be mindful of the education-level and licensure of their online provider.
The Pros of Online Therapy
There are many benefits to online therapy that must be considered. Client’s accessing providers through this modality are able to meet with therapists with minimal effort in seeking, establishing, and attending services and may be afforded more frequent contact. In addition to ease, there are several benefits to online therapy.
The pros of online therapy include:
Convenience
When accessing services virtually, clients are able to meet with their therapist without leaving the home. Turning on a computer to connect with a therapist is vastly easier than getting in your car, battling traffic, waiting in a waiting room and repeating it all again at the end of the therapy hour.
Comfort
When accessing online therapy services, clients are able to meet with providers from the comfort of their own homes or rooms. Those who are meeting with therapists from their own living space are able to be surrounded by objects and items that may help the client to emotionally regulate or cope during difficult conversations, such as a pet or blanket. Having coping objects readily available may help some clients feel more comfortable with sharing difficult stories and emotions.
Access to Skilled Providers
Individuals living in rural or remote areas often struggle to find access to quality mental health services, especially when their need falls within a specialty population. Online therapy allows clients who would not typically have access to skilled therapists with various specialties to receive treatment from these providers with minimal effort involved.
Limited Resources Required
In addition to being easy to access and convenient, online therapy does not require the client to need additional resources, such as transportation, child care, or additional time. The lack of additional resources or support needed to seek services may allow some to access treatment they would not be able to obtain otherwise.
Confidentiality
Traditionally, therapy is a confidential service with very limited reasons for breaking that confidentiality, such as for suicidality or protection of a vulnerable population. When seeking services in person, clients must go to an office, and potentially, see others in a waiting room or office parking lot. Online services allow the client to receive treatment without anyone else being aware.
Variety of Connection Potential
When utilizing online therapy services, clients are often presented with more connecting options than with traditional in-person therapy, such as messaging services, telephone sessions, and chatroom features. The more comfortable a clinician is with managing protected health information in a HIPAA-compliant fashion using technology, the more potential for greater connection with clients.
Ability to Find Affordable Services Without Requiring a Diagnosis
Due to the potentially high cost of traditional therapy services, an individual seeking mental health treatment and desiring to pay for these services with insurance must receive a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis for insurance reimbursement. These diagnoses can range from mild (i.e. adjustment disorder) to severe (i.e. psychotic disorders).
Regardless, the high cost of in-person therapy makes it difficult to pay out-of-pocket without receiving a diagnosis. Online therapy can be a more affordable option allowing clients to obtain services without a diagnosis.
Cons of Online Therapy
While online therapy has many benefits, there are some considerations that must be made regarding who might not benefit from the services and the issues involved in this form of care. Individuals seeking online therapy must be aware that, while this modality is very similar to traditional in-person therapy, there are downfalls to keep in mind.
Some potential cons of online therapy include:
Loss of Holistic Experience
One of the most reported cons of online therapy is the perceived lack of connection the client reports with the provider. Because they are not sharing the same space, clients can struggle to experience empathy from the therapist the same way they might if they were sitting together.
Issues With Technology
When connecting virtually, the therapeutic relationship becomes dependent on the reliability of internet connection and the trustworthiness of electronic devices. As such, there may be times when connection is interrupted or not possible.
Insurance Coverage
Due to the relative newness of online therapy, some insurance providers may not cover this modality of service. Insurance companies provide coverage for evidence-based therapy practices, and due to advancements in technology that allow for ease of video connection being comparatively new, research to support this modality is just now flooding the journals and popular media.
Not Appropriate for Everyone
Some individuals may not be suitable for online therapy. Individuals with severe mental health disorders such as schizophrenia, intellectual disabilities, or high suicidality may not be appropriate for some online therapy services.
Irreputable Providers
Some online therapy services are provided by minimally-skilled and under-educated clinicians. Some online therapy providers may not be as reputable as those found in-office.
Pros of In-Person Therapy
The research into positive client outcomes as a result of in-person therapy provides clients with a solid understanding of what to expect and what the intended benefits of services might be. Clients seeking treatment from traditional in-person therapists often have a good idea as to what therapy might look and feel like.
While the benefits of in-person therapy are vast, some of the biggest pros of in-person therapy include:
Multidimensional Connection
Sharing space with others and telling difficult stories from your life can be hard. Therapists are highly trained in forming therapeutic alliances that promote client well-being and positive counseling outcomes. By and large, the training therapists receive is related to connecting with clients in-person rather than with the use of technology. When seeking in-person therapy services, clients often report forming a meaningful connection with their therapist—which is essential for growth.
Years of Evidence-Based Research
In-person therapy for the treatment of a variety of disorders has been shown to be effective, and there are decades worth of studies to assure the consumer of the efficacy of this modality.
Systematic Approaches to Improve Outcomes
Through in-person psychotherapy, clients are able to work from several different modalities and theories during the therapy session. When services are provided in-person, clients are able to experience interventions on a spectrum of senses, and it may be easier for clinicians to deliver certain interventions such as movement-based treatment, EMDR, psychodrama, etc.
Holistic Assessment of Mental Health
A more thorough assessment of clients can be made when meeting with someone in-person. A clinician is more able to use all senses in the evaluation process, inevitably leading to a more thorough and accurate description and analysis of the presenting concerns.
Cons of In-Person Therapy
While traditional in-person therapy is often beneficial to the consumer, there can be barriers and potential issues involved in attending in-person therapy services. While these concerns might seem insignificant to some, they can be dramatically impactful to the individual experiencing the issue.
Some potential cons of in-person therapy include:
Inconvenience
Some clients struggle with access to services in a traditional therapy approach. It can be hard to find an available therapist, especially when requiring services outside of traditional business hours. It can be difficult for clients to not only access, but potentially drive to and attend therapy services. Traditional therapy can be difficult to obtain and follow through with simply due to the barriers inherent to leaving the home for appointments.
Difficulty Finding a Skilled Provider
While there are numerous therapists in many metropolitan places, it can be difficult for those in remote areas or in more rural settings to find providers. This is particularly true when the client requires a specialized approach or has a unique need.
Stigma Associated With Treatment
There can be a social stigma associated with attending therapy. Often, parking in a clinic parking lot and waiting in a waiting room with other clients can feel exposing to clients, especially those with social anxiety.
Not Accessible to Everyone
There are many clients who are not able to attend in-person counseling services for a variety of reasons. There are several presenting concerns a client might share such as agoraphobia, social anxiety, or a physical disability that could prevent them from seeking and attending potentially helpful therapy sessions.
High Cost
Traditional psychotherapy can require a large time commitment at a high cost of service. Many specialized psychotherapists charge more than $200 an hour for therapy services and the cost can be weekly for many months or years.
Final Verdict: Online Therapy vs In-Person Therapy
Those who are comfortable with technology and are willing to give online therapy a try shouldn’t hesitate to access these services for a variety of reasons. As technology improves, our ability to connect with individuals with limited interference grows. Improved technology is a significant consideration involved in making the decision to seek online therapy services.
There is no doubt that many clients find psychotherapy to be an effective intervention for a variety of mental health concerns. Offering online therapy services allows easier access and more options for the general public in seeking these services.
Online therapy has grown significantly over the past five years. With the increase in access and fluidity of online services, the general public is becoming more and more comfortable seeking multiple care options virtually. As comfort with technology and service options grows, online therapy will likely continue to increase in efficacy and choices. Those desiring the help of a therapist without leaving the comfort of their home should consider this option of mental health care.
