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Online Therapy

In Defense of Telehealth

E-therapy has been a valuable resource for mental health providers.

A client participates in a telehealth session.
Source: filadendron/iStock

What Is E-Therapy?

During the COVID-19 crisis, the world is facing many problems that require fast, if not immediate, changes, and adaptations. Specifically, social distancing was identified as part of the universal quarantine strategy, which drastically increased the need for remote communication in all aspects of our lives, including healthcare services.

Subsequently, the demand for and consumption of technology-mediated service modalities (i.e. telemedicine and e-therapy) have significantly increased, emerging as the choice of delivery method for a variety of treatment services. In the mental health field, e-therapy is defined as the process of a licensed mental healthcare professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these (Suscala et al., 2012).

The Bias Against Telehealth Services

Despite its increasing demand and consumption, there is ongoing debate around e-therapy’s efficacy and its performance compared to traditional face-to-face therapy. Even with more reports pointing to its cost efficiency and clinical effectiveness (Berger, 2017), there is still an undercurrent of uncertainty about its legitimacy as a proper treatment delivery method in mental health services. Clients’ negative perception of e-therapy is documented in several studies (McClellan et al., 2020).

Aside from clients’ skepticism, another significant challenge apparent throughout research on the subject is the clinician’s or provider’s bias against this particular mode of therapy. More specifically, a key factor influencing the reservations of mental health providers to engage in e-therapy is the potential interruption to properly establishing a therapeutic alliance with their clients.

E-Therapy or In-Person Therapy?

In therapy, one gets to speak about what is “contextually appropriate,” meaning the same things can have different values depending on the situation. Likewise, there is a place in society for both traditional counseling and e-therapy. The verdict on whether telehealth is better than in-person treatment is not the most helpful question to ask today. Pitting the two types of therapy against one another may only elicit more division among providers, creating different camps with different interests. This lack of cohesion only creates further confusion and distress for clients and those most in need of help.

Instead, providers need to channel their efforts into further investigating the strengths and weaknesses of both approaches. Therefore, the bigger question becomes: how can this new medium be best utilized for health services in the most fitting way today?

The Strengths and Shortcomings of E-Therapy

As mentioned above, the most concerning weakness is the presence and rapport issue in e-therapy. However, the impact and function of therapeutic rapport and presence during the time of the pandemic are very different from what they were pre-pandemic.

The social presence theory asserts that the perception of the recipient is what really shapes the function of “presence.” This means that considering the circumstances, clients will be more likely to accept the idea of telehealth, especially when it is deemed to be one of the more viable options for treatment. For many providers, telehealth allowed for an easy switchover, enabling them to continue supporting their existing clients with the least amount of interruptions. Such flexible accessibility is one of the biggest strengths of telehealth.

In addition, telehealth has been historically noted for its innate ability to improve patient-centered care, as the service is brought to the client instead of the client going to an office to receive services. This capability accentuates the convenience of telehealth, with the client being able to enter treatment while remaining in their natural setting. With the increased anxiety surrounding COVID-19, ensuring clients are able to receive services, where it is most secure and convenient, is pivotal.

While e-therapy and traditional counseling are often considered to be at odds with one another, providers should consider the strengths of each delivery method to offer the highest-quality care possible to clients. E-therapy improves ease of access to mental health services, cutting down on common deterrents to treatment, including scheduling and transportation conflicts as well as time spent commuting to the provider’s office. Considering the present state of the world, e-therapy also adds another layer of safety by reducing in-person contact while still allowing at-risk individuals to connect with additional sources of support. For these reasons, e-therapy is a practical option for treatment and will continue to be as society navigates this “new normal.”


Berger, T. (2017). The therapeutic alliance in internet interventions: a narrative review and suggestions for future research. Psychotherapy research, 27(5), 511-524.

iSALT Team, "Social Presence Theory" (2014). iSALT Resources: Theories, Concepts, and Measures. 2.

McClellan, M. J., Florell, D., Palmer, J., & Kidder, C. (2020). Clinician telehealth attitudes in a rural community mental health center setting. Journal of Rural Mental Health, 44(1), 62–73.

Sucala, M., Schnur, J. B., Constantino, M. J., Miller, S. J., Brackman, E. H., & Montgomery, G. H. (2012). The therapeutic relationship in e-therapy for mental health: a systematic review. Journal of medical Internet research, 14(4), e110.