Psychotherapy Online or In-Person: What’s Your Personal Best?

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During lockdown, I was sure psychotherapy would take a hit. How could I possibly help clients through a screen? Selfishly, too, one of a therapist’s gratifications is to (literally) sit with people. There was no way two-dimensional therapy could work as effectively as 3D, right?

Wrong. And happily, very much wrong.

Research is beginning to show online therapy can prove just as effective as in-person. That became clear in practice, also, when people I worked with online—and had never met in-person—got better as quickly and substantially as those I’d seen in the office.

Like anything else, it turns out, benefits accrue with one form of therapy (in-person) or another (virtual). To consider the perks for yourself, consider these benes:

With virtual therapy:

• All of us gain greater access to care. 80% of us live in cities in the United States. In more rural states, like mine, a third of the population live rurally and it’s difficult to find health care, let alone mental health care. With telehealth, therapy became accessible to rural folks and just about anyone. For urbanites, they can now tune into therapy when they’re away from home, too.
• Online therapy is a time- and anxiety-saver. Not only do you not need to allow time (or self-soothe enough) to work your way across town to a therapist’s office, you needn’t allow time for parking—or any anxiety about that, either.
• Those with social anxiety or panic sometimes have trouble leaving home. Now they can access state-of-the-art care and work toward leaving the house as an anxiety treatment goal.
• Most therapists charge for no-shows, but if you forget an online appointment, it’s may not be too late. During the year(s) of living Zoom, no-shows decreased dramatically. People would remember appointments and tune in a few minutes late. I had a rule I’d see them until 15 minutes after, and we were both so glad they made it.
• It’s helpful to therapist and client to see where people live. I saw pets, kids, partners, parents, and friends trouncing across the Zoom frame. I saw clients’ decorative styles, desks, cars, and tchotchkes. This helped, viewing clients in lived environments and relationships. It offered context clues that benefitted therapy.

With in-person therapy:

• The human connection and interpersonal field (what is created in real-time between two humans in person) is beyond compare. Yes, we’re virtual experts now and can do almost anything online. But being with others in person is what our brains have been wired to do for millenia; it can’t quite be replaced.
• There’s an advantage to literally seeing the whole person. Clients may conceal issues they’re ashamed of online. Issues with eating or weight that continue to traumatize. Skin pallor or disorders pointing to psychiatric issues, such as picking or hair-pulling. (Twice, in person, I told clients they looked so pale they needed to check iron levels immediately. They both were so anemic they needed iron transfusions.)
• Leaving the house may be a big perk for parents who spend all day with kids, those challenging anxiety or agoraphobia with new experiences, or those who work from home and need the psychological reset a dedicated space and time provide.
• You have interlopers? Not here. While some may wish to virtually invite therapists into their homes or family members into a Zoom appointment, others crave privacy and a change of space. Therapy offices tend towards calm, quiet, and peaceful. In even an hour a week, that can be therapeutic.
• Need a silent break? We got you—in real life. People sometimes use therapy not to talk. Not for an entire session, no, but for long moments in a safe space, with a safe person, who they know they needn’t mask or perform for. That in itself is therapeutic, and not so easy to replicate on-screen.

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The great news? We have options—real-life or real-time—to engage in psychotherapy. Many people utilize both; showing up in-person in general but choosing online for extra busy days or out-of-town times. Others choose virtual, perhaps from a rural or semi-rural locale, but might visit the therapist in person when in town. It’s a boon to know both modalities work and more people have access to healing. Talk to your therapist or potential therapist about your unique needs and what’s best for you.

To find a therapist, please visit the Psychology Today Therapy Directory.