The 3 Essential Benefits of In-Person Vs. Online Therapy

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Dozens of studies have shown that online therapy is as effective as in-person therapy. And it’s true; virtual therapy certainly is a powerful option, particularly for people who

• Don’t have local access to mental health services.
• Have an illness or injury that prevents traveling to an office.
• Want to continue an established relationship with a therapist who is no longer available in person.
• Need a consultation with a specialist outside of their area.

Under these conditions, online therapy is a lifesaver. Naturally, online therapy is the clear option when the choice is online or no therapy (see "Group Therapy in Your Living Room").

But is the emotional experience of online therapy the same as in-person?

The limits of online therapy

If viewing people or events on screens were truly the same emotional experience as live and in-person, there would be no reason to go to concerts, sports games, dance performances, or lectures; we could shut down theaters, museums, galleries, and schools, and switch entirely to screens.

We choose not to limit our experiences to online because in-person relationships and events are more intimate, personal, and satisfying. They simply can’t be recreated on a two-dimensional screen. For this reason, though online therapy has benefits, the emotional experience is quite different.

A New York Times article (“Should You Resume In-Person Therapy?”) reports that many therapists find online sessions fatiguing and have difficulty staying focused. Some patients express frustration that they can’t tell if their online therapist is listening or distracted. Some even wonder if their therapist is scrolling through their cell phone or the Internet during the session.

Professional boundaries also tend to become lax in online therapy. Recently, a teenager reported that her therapist was in her pajamas doing her session. Another couple was surprised to see their therapist in bed with her dog. Many have noticed their therapist eating, adjusting their clothes, or fixing their hair during the session, which caused them to wonder, Is my therapist looking at me or themselves during sessions?

My own online therapy experience

During the pandemic, I was thrilled to continue my work with clients online. I didn’t have to be in the same room with my patients to continue working with them. As a result, therapy sessions continued during the lockdown; online therapy during the pandemic was phenomenal for many clients.

When the pandemic waned, I restarted in-person sessions. I added protective measures, such as masks and air purifiers, and rented a large dance studio for my sessions, which would allow for social distancing.

When I met many online patients for the first time in person, I was stunned by how much I missed on the screen. Hidden in the shadows of their little boxes were visual, visceral, and tactile aspects of their way of being that I couldn’t pick up on the screen.

Here are some discoveries I made during my first week of in-person sessions:

• A young man, who looked confident on-screen, had nails bitten so severely that they were bloody.
• A middle-aged woman who appeared slightly overweight on screen was morbidly obese, had difficulty walking, and was gasping for air when she arrived.
• A young woman who had appeared upbeat and chatty on screen had scars on her arms from cutting—something she never discussed or revealed on screen.
• An older man who seemed upright on screen was bent over with scoliosis and smelled bad due to poor hygiene.
• A CEO of a start-up arrived at her first in-person therapy group intoxicated. She confessed that she had been drinking offscreen during group to manage her anxiety.

On-screen, people have fewer apparent symptoms of anxiety or depression. Their unspoken insecurities, destructive habits, and psychical attributions were well hidden.

What’s more, in-person sessions trigger more disruptive symptoms, such as anxiety and fear. Why is this so important? Working through complicated feelings is essential to the therapeutic process. If such feelings are muted or hidden, it’s difficult for therapists to diagnose accurately and design an effective treatment plan.

The in-person therapy experience

In my experience, the essential benefits of in-person therapy include these:

1. Therapists have greater access to nonverbal communication.

When a client enters a therapist’s office, the therapist observes how the person walks, sits, talks, makes eye contact, etc. How a person lives in their body is on full display in person; on a screen, it is limited.

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2. Therapists have a more visceral experience with their clients.

When a therapist and client come into contact, feelings flow between them. A well-trained therapist studies these feelings and harvests them for meaning. These feelings may result from transference, projection, or emotional induction. Understanding these unspoken feelings aids therapists in understanding their clients’ inner emotional life. A screen makes it difficult for therapists to pick up on these subtle communications and grasp a client’s core emotional issues.

3. Clients have a more intimate personal relationship with their therapist.

When clients enter a therapist's office, they enter an intimate personal space filled with meaning. For example, how is the office decorated? Are there paintings or photos on the walls? Bookshelves or plants? What’s the furniture like? The therapist will also notice how clients dress, the items that they carry with them, and if they had travel difficulties or anxieties about getting to the office. Such shared experiences are lost onscreen.

The convenience trap of online therapy

Virtual therapy is convenient. But should convenience be a therapeutic priority?

Last year, when I announced that I was returning to in-person, there was a backlash from my patients. For many, online was easier. They didn’t have to travel, could relax at home, and could jump in and out of sessions with a click of a button.

In my online therapy groups, the stakes were low as well. People took fewer emotional risks, challenged themselves less, and remained in their comfort zone. Sometimes they signed on while cooking dinner, folding laundry, or even walking their dogs. Such distractions drained the groups of vitality and spontaneity.

I also found myself constantly battling with distraction and focus, a problem that I never experienced in person. Once we returned to in-person sessions, we all felt re-energized and engaged.

The in-person therapy relationship

Since its inception, psychotherapy has been an in-person relationship, a face-to-face experience between a therapist and a patient. Online, therapists are frequently robbed of critical information. As a result, the effectiveness of therapeutic tools such as transference, counter-transference, emotional induction, or induced feelings is also compromised.

Since rebooting my in-person psychotherapy practice, my weekly therapy groups in particular have grown exponentially. Despite online therapy's convenience, I’ve found that people are hungering more than ever for real, intimate, human contact.