Though online therapy existed before 2020, the COVID-19 pandemic swung open the door for more providers to offer web-based therapy sessions.
Not only can online therapy serve as a more flexible and convenient option for many individuals, but it’s often more affordable than in-person therapy. However, is online therapy effective? Research is on its side, showing that it can be just as effective as in-person sessions. Though there are a few disadvantages to consider, online therapy may fit your lifestyle and budget much more comfortably.
Read on to learn more about the effectiveness of online therapy, including pros and cons, what experts say and more.
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What Is Online Therapy?
Online therapy, also called teletherapy, is therapy conducted through web-based technology. Using a device like a computer or tablet for video conferencing or a telephone for texts or calls, you connect virtually to speak with a licensed therapist.
While online therapy can be used for a variety of mental health conditions, it’s important to note that most of the existing research on online therapy focuses on its usefulness for conditions like anxiety and depression, particularly with cognitive behavioral therapy (CBT), a popular type of talk therapy commonly used for anxiety and depression.
Even though using a phone to text or call one’s therapist is readily available, some experts believe that the best modality—besides in-person therapy—is therapy via video.
“Given that humans thrive when they are able to connect visually—particularly in the case of more serious mental health issues—it makes sense that video therapy (alone or in combination with other modalities) will be the most effective online form of therapy,” says Carla Manly, Ph.D., a clinical psychologist in Santa Rosa, California.
Pros and Cons of Online Therapy
Online therapy has some significant advantages, like convenience and flexibility. Still, it’s not without a few pitfalls, like dealing with a fickle Wi-Fi connection or struggling to find a private place to hold your session.
Here are some major factors to consider when deciding about online therapy.
Pros of Online Therapy
- More flexibility overall: This is one of the biggest perks of online therapy, as many individuals prefer to save time by not traveling to an office location. After the therapy sessions end, they can quickly attend to a child’s bedtime, prepare dinner, finish work if they work from home and so on. “I have seen couples who don’t have to hire a sitter to watch their children,” says Lee Phillips, Ed.D., a psychotherapist and certified sex and couples therapist. “They’ve been able to put their children to bed and then attend their sessions.”
- May increase a sense of comfort: The comfort of being in your own space while discussing personal and sometimes challenging topics is a significant benefit for some people, notes Dr. Goldman. “The physical space of not being in the same room as the therapist allows some clients to feel less vulnerable, and they can be more willing to be open.” Some anxiety disorders make it challenging to physically go into an appointment or to be around doctors, and online therapy allows for people to be able to move at their own pace, she adds.
- Beneficial for people with physical limitations or disabilities: Accessing therapy remotely is a huge advantage for many, especially those with physical restrictions. Dr. Phillips sees many clients who deal with chronic illness and pain. “Accessing therapy from the comfort of their own home has been an advantage in treatment,” he says. “Some have reported less stress and pain because they do not have to travel.”
- Convenient for those in remote or rural areas: Driving long distances can only add more stress for the client, says Dr. Phillips. There’s also an advantage for the clinician because they can provide services for clients within the entire state they hold a license, as opposed to just one area of that state, he explains.
- May be more affordable: Online therapy can sometimes be more affordable than traditional in-person therapy thanks to reduced overhead costs for therapists, says David Tzall, Psy.D, a licensed psychologist in New York City.
Cons of Online Therapy
- Technology isn’t always reliable: Since you’ll need an internet connection for online therapy, you’ll also need a backup plan if your internet service is spotty and your virtual appointment is dropped, points out Dr. Goldman.
- Insurance coverage can vary: Insurance coverage may depend on your state, says Dr. Phillips. “Some policies may not cover online therapy, or they have restrictions. Some mental health professionals don’t accept insurance, which can be advantageous if the client has out-of-network benefits,” he explains.
- You need a private, quiet space for your session: For those who live with family or roommates, finding a truly private space can be tricky and it may impact your session. For example, Dr. Goldman points out that a partner may walk into the room if it’s a shared space, or a child may be present, and these variables can hinder the way one may open up and share like you might in a therapist’s private office.
- Non-verbal cues are limited: Typically, a therapist is unable to see a client’s entire body while using video conference platforms like Zoom. “This means that the therapist might miss certain cues about body language,” explains Dr. Goldman. “There truly is no replacement for the sacred space created by an in-person therapeutic interaction,” says Dr. Manly. The more important a conversation is, the more dimensions of communication (body language, etc.) may be required to make it effective, says Alex Dimitriu, M.D., a consultation psychiatrist at Park Psychiatry and Sleep Medicine in Menlo Park, California.
- May not be suitable for severe psychiatric illnesses and crises: According to Dr. Phillips, mental health conditions like schizophrenia and bipolar disorder usually need to be monitored closely, and getting a read on these conditions can be difficult when you’re not in person. “In crisis situations, online therapy might not be as effective as in-person sessions, especially if immediate intervention or physical assistance is required,” says Dr. Tzall. This is not to say that clients in crisis cannot or should not receive online counseling, adds Dr. Goldman. “It does, however, mean that the approach will need to be different, and the coordination between the client and provider might look different,” she explains.
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Is Online Therapy as Effective as In-Person Therapy?
Studies suggest that live online therapy by video is just as effective as in-person therapy, particularly for CBT.
A 2018 review suggests that CBT delivered online was just as helpful as in-person therapy for a handful of mental health conditions, including panic disorder, social anxiety disorder and generalized anxiety disorder (GAD)[1]Andrews G, Basu A, Cuijpers P, et al. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. Journal of Anxiety Disorders. 2018; 55,70-78. .
Additionally, one 2020 review examining 17 studies found that online CBT was more effective than in-person therapy in easing the severity of depression symptoms[2]Luo C, Sanger N, Singhal N, et al. A comparison of electronically-delivered and face to face cognitive behavioural therapies in depressive disorders: A systematic review and meta-analysis. eClinicalMedicine. 2020;24. .
“Ultimately, the research regarding therapy (in-person versus online) indicates that both formats are an effective means in facilitating growth and change,” says Michele Goldman, Psy.D., a licensed psychologist in New York City and Hope for Depression Research Foundation media advisor.
Primary reasoning boils down to how similar the methods are, says Dr. Goldman. Relationships with therapists can be formed both in person and online through certain treatment modalities, including interpersonal psychotherapy (centered on present-day issues instead of childhood experiences) or narrative therapy (focused on reinterpreting one’s life story in a healthy way), CBT or more treatment-specific interventions for certain mental health conditions like Eye Movement Desensitization and Reprocessing (EMDR) for post-traumatic stress disorder (PTSD), for example, are all able to be adapted in an online format, she notes.
Although research shows that both forms of therapy are effective, individual preference is still a factor and that some people might have a strong desire or preference for one format over the other, notes Dr. Goldman. “Therapy is not a one-size-fits-all approach and needs to be adapted to the specific person,” she adds.
What Experts Say About the Effectiveness Online Therapy
“As a clinician, I’ve found that online video therapy is very popular with my clients as they enjoy the convenience and flexibility it offers them,” says Dr. Manly. Dr. Dimitriu agrees that online via video is certainly convenient and can save travel time and cost. “This, in turn, can increase adherence and compliance to the treatment program,” he explains.
Before the pandemic, Dr. Manly only provided online therapy under certain circumstances, like if a client had health issues or significant travel, saying those factors gave her concerns about efficacy. “However, due to the constraints imposed by the pandemic, I immersed myself in online therapy and was incredibly pleased by the results,” she says.
Not only did her clients find the sessions as helpful as in-person therapy, but Dr. Manly says she saw several upsides of video sessions that she hadn’t considered initially.
“For example, in-person sessions in my office have a highly controlled environment that limits what I can observe. Video sessions allow me a window into a client’s actual world, including pets, home environment and stressors—this information is incredibly helpful in understanding each client and supporting their overall progress,” explains Dr. Manly.
On the downside, Dr. Manly says she misses seeing her clients in person, including having the opportunity to offer them a sacred private space, which not everyone has access to in their homes.
One important caveat Dr. Dimitriu has about online therapy is that individuals should try and have some silence before and after the session to reflect on intentions and learning, maybe even some note-taking if possible.
“Too many people grab their phone or get on with their life right after their therapy session, and a lot of thoughts can get lost. Telemedicine can make it especially easier to ‘jump right back in’ to your life or work—and therapy, like a meaningful dream, needs some time for reflection to get the most out of it,” says Dr. Dimitriu.
How to Choose The Right Therapy For You
“It’s important for clients to slow down to ascertain their therapeutic needs, personal preferences and expectations,” says Dr. Manly.
Weighing the following elements, she adds, can help you choose the right therapy for you:
- Your mental health diagnosis, if any: Does your mental diagnosis require you to attend frequent sessions? Does it also require more intense forms of therapy rather than talk therapy?
- Your physical location: How near or far do you live relative to your mental health care provider? This may be the most significant factor in whether it’s more realistic for you to attend online sessions rather than routinely commuting to a distant office.
- Childcare restrictions: If you need to stay home with your child, it may be easier to use online therapy. However, if a child is in the room during your session, you may find it restricts what you share with your therapist, ultimately limiting your experience.
- Your daily schedule: Does your schedule limit when and how often you can attend therapy? If this is the case, online therapy may offer more available time slots for you.
- Your budget: Is there an extra cost for online therapy where you live? Or, is it more affordable for you to attend online therapy? Costs and insurance coverage can vary depending on the state you live in.
Dr. Manly also suggests a trial-and-error approach, saying it’s often necessary in figuring out what method works best. In many cases, she says it’s best to allow a few sessions to see if a new therapy approach or new psychotherapist is a good fit.
By allowing yourself to determine your best-suited therapy route mindfully, you’ll gain the most from your psychotherapy journey in the short and long term, says Dr. Manly. “It’s never a failure if you try a particular method and find out it’s not right for you,” she adds.