Pros & Cons of Online Therapy

Should You Consider Online Therapy?

Online therapy is a viable therapy option that should be on everyone’s consideration list until they rule it out as not a good fit for them. Online therapy is focused on delivering the same therapeutic process as in-person therapy via a more flexible and accessible medium.

It can be particularly helpful to look for an online therapist who specializes in the modality or issue you’re seeking help for, such as anxiety, trauma, or relationship challenges. It’s also important to find a therapist you connect with personally, as a strong therapeutic alliance is one of the key predictors of successful outcomes. Trying a few sessions with different therapists may help you discover the right fit.

What Is Online Therapy?

The process of online therapy is essentially the same as in-person therapy, but you meet with a therapist on a video-call platform. Sometimes, although less commonly used, a therapist may meet with you over a phone call, or via asynchronous communication like texting or apps. Due to the differences in delivery methods, you may see different terms used interchangeably with online therapy, such as teletherapy, telehealth therapy, or virtual therapy.

Pros of Online Therapy

There are many advantages to online therapy, and considering what you need from therapy to benefit you most can help you make the best decision. The biggest factors for many that choose online therapy are increased flexibility, comfort and accessibility. Many people also appreciate feeling increased ability to be vulnerable, easier after-session transitions, and sometimes even a reduced cost of sessions because they’re online.

Accessibility

One of the biggest draws to online therapy is that it makes mental health support more accessible. This increased support can be important geographically for people who live in rural areas with a lack of therapists or specialized care. It can reduce physical barriers to attending therapy  such as mobility challenges or lack of transportation. Online therapy can be more accessible for people with mental health challenges that make getting to in-person appointments difficult, such as those with agoraphobia.

Convenience

Seeing a therapist online is often far more convenient, particularly when it comes to adding therapy on top of other responsibilities. Online therapy reduces the time commitment of attending sessions by removing the commute to and from a physical therapy office space, which often means that scheduling is more flexible for individuals to find a time that truly works best for them.

More Therapists to Choose From

Online therapy increases the options for therapists to choose from, which means that you can choose to see a therapist who specializes in the topics you are wanting to address and are specific to your situation. For example, you may want to address LGBTQ+ issues or eating disorders that aren’t specialities available in local therapists. You can use a specialized therapist directory like Inclusive Therapists to filter for care under categories like provider identity, cultural knowledge, and advocacy focus.

Online therapy also means that you can be more selective about choosing a therapist with an approach or therapy modality that you are interested in. This could include personal preferences for how the therapist shows up, such as someone who is more directive, or your own preference for therapeutic modality the therapist uses, such as EMDR for trauma treatment over narrative therapy approaches.

Comfort & Privacy

For some people, online therapy is attractive because they may feel they have more privacy and discretion, since they get to choose the space in which they will be attending their therapy appointments. This choice is especially important for people who feel anxious about visiting a physical therapy office, due to wanting to protect their privacy and the fact they’re in therapy for many reasons.

Another draw for online therapy is that it often comes with a higher level of comfort than in-person therapy. You get to choose a space where you will be most comfortable, and even get to wear comfortable clothes. This comfort increases the likelihood that you will be more open during therapy.

Affordability

Sometimes online therapy can end up more affordable than in-person therapy. Online therapists might charge less in their fees due to having less overhead (such as office rent or furniture). Even if an online therapist does not charge less than in-person therapy, the cost of commuting, parking, and time away from other obligations usually makes online therapy overall less expensive than in-person therapy.

Digital Comfort With Vulnerability

For people who are nervous about therapy or have not been to therapy before, online therapy can be a good option because connecting through a screen can give a semblance of distance that makes opening up easier. Online therapists are still able to work with individuals just as effectively online, but the participants’ interpretation of this can make a difference in sharing.

Easier After-Session Transition

It’s unavoidable that some therapy sessions will be hard, and sometimes this continues after the therapy session has ended. While an online therapist should help you to close the session emotionally, sometimes it’s unavoidable that you will be shaken up afterward. Online therapy can make transitioning back to life easier because of the increased flexibility and comfort you have over where you join sessions.

Cons of Online Therapy

While there are many benefits to online therapy, there are also disadvantages to consider when choosing what fits best for you. Considering whether your presenting issues are a good fit for therapy, what you need in order to get the most from therapy, and understanding licensing restrictions of therapists, as well as your financial plan for therapy, can help you make this decision.

Not Ideal for Crisis Situations

While therapy can be a good fit for some mental health concerns, it is not a good fit for mental health concerns that include crises or complex psychiatric needs. These could include things like active suicidal ideation, risk of harm to self or others, or disorders that include psychosis. For these situations, seeking care through an emergency department or in-patient mental health is typically more appropriate.

Potential Technology Issues

Online therapy can reduce barriers to care, but that is only if you have the resources to make online therapy effective. These tools include having a good internet connection, devices to attend sessions on, as well as having a private location in which to have your sessions. Online therapy also requires a higher level of technology literacy and patience than in-person therapy requires.

Less Personal Connection

Although it isn’t the case for everyone, some people feel less of a personal connection with their therapist if sessions are virtual. This is especially true for individuals that have difficulty opening up to others, who feel hesitant or resistant to starting therapy, and for people who feel they need more non-verbal cues (such as body language) to build a connection.

Legal & Licensing Restrictions

While online therapy opens up more options for therapists, there are still limitations. Therapists are typically licensed by state or region, and typically clients can see only therapists that are licensed in the state they will be joining from for therapy sessions. It is best to talk with a therapist before beginning if you will be spending time in multiple states during therapy.

Health Data Protection

Every therapist in the United States must abide by HIPAA laws that are meant to protect client privacy, but not all therapy platforms that therapists use are created equal when it comes to protecting client data. It’s also important to remember that HIPAA is meant to protect your client data and personal information, individual therapist habits and systems greatly impact your information security.

Securing Your Own Space

Having the freedom to choose your own space for therapy can be a benefit, but it can be a drawback as well. If you do not have access to a space where you can talk confidentially or if you have a lot of distractions in your home, then you may not be able to process the things you need with your therapist.

Screen Fatigue

People now spend more time looking at screens than they ever have in the past, which means that it is easier for people to feel screen fatigue. Doing therapy online means that you will be looking at a screen for your therapy, and this can be a major drawback if you already spend a lot of time every day looking at screens.

Insurance Coverage Limits

If you are planning to use your insurance for mental health services, your plan may or may not include coverage for online therapy. Many online therapy platforms accept insurance but coverage for mental health varies from carrier to carrier and plan to plan, so be sure to check with your insurance before you begin your search if you want to use your insurance.

Is Online Therapy Effective?

Luckily, when deciding between in-person and online therapy, treatment effectiveness does not rule out online therapy as a viable option. Research shows that online therapy can be just as effective as therapy that is held in-person,² and this has been shown true even for less common mental health conditions.³ There have been many studies done on this, including one that compiled thousands of patients’ experiences to find that there are no statistically significant differences in symptom reduction and drop-out rates between online and in-person therapy.⁴

Who Benefits Most From Online Therapy?

While many people can benefit from online therapy, there are certain groups that find it especially helpful. People with certain presenting concerns such as anxiety, depression, social anxiety or introversion, often find it easier to address their struggles from their own space. Those needing flexibility, such as busy professionals, students, and parents or caregivers, can often access therapy online when attending in-person is not possible; this is also common for those living in rural or underserved areas.

Individuals who may benefit most from online therapy include:

• People who feel anxious about attending therapy in person
• People without local therapists who specialize in their concerns
• People who do not have reliable transportation to in-person therapy
• People who have conditions that prevent them from attending in-person, such as physical or mental health conditions
• People who already have a lot of responsibilities and time constraints
• People who want to ensure privacy around the fact that they are in therapy

Who Should Not Use Online Therapy?

While online therapy is a great resource and fit for many people, it is not ideal for everyone. Some people may be in demographics or have presenting concerns that therapy will not be helpful in addressing their presenting concerns, or they may have needs or preferences from therapy that do not align with what online therapy can offer.

Individuals who should not use online therapy include:

• People who are in immediate danger or crisis
• People with more severe mental health struggles
• Young children who need therapy
• People who struggle to connect with others virtually
• People who struggle to coordinate and have patience with technology issues
• Those who do not have access to a private and safe environment to meet
• People who are not invested in the therapy process

Searching for the Right Online Therapy

When considering online therapy, it is important to know that there are several options available to you. Most people will either go through an online therapy platform or choose an individual therapist that offers online sessions. Typically the factors that drive your final decision are going to come down to cost/payment options (insurance or out-of-pocket) and personal preference. Using insurance may limit your options.

Consider the following when choosing an online therapy platform:

• Insurance acceptance
• Cost
• Access to therapist – communication limitations and methods
• Frequency of meetings
• Therapist fit
• Control over choosing a specific therapist

Sometimes you are not able to choose your therapist if you opt to join an online therapy platform, but many will allow you to switch therapists if you do not feel the one assigned to you is a good fit. If you decide on an individual therapist that is not on a platform but do not feel it is a good fit, you can always let them know this and switch therapists as well.