Online Therapy vs. In-Person Therapy
Written by: Wilson College • Oct 31, 2023
Online Therapy vs. In-Person Therapy ¶
Demand for mental health services skyrocketed during the COVID-19 pandemic. This increase led to shortages, with 60% of psychologists reporting they had no openings for new patients, according to a 2022 survey by the American Psychological Association (APA). On top of that, 72% of psychologists said their waitlists have gotten longer since the pandemic.
The growing availability of online therapy can help address the need for mental health services. But how does online therapy work? Are the benefits of online therapy the same as the benefits of in-person therapy? And how can clients decide between online therapy vs. in-person therapy?
Understanding the difference between online and in-person therapy allows clients to make an informed decision about which delivery method best fits their unique needs and circumstances.
Similarities Between Online Therapy and In-Person Therapy ¶
There are many similarities between online and in-person therapy. Both remote and in-person therapy can treat many of the same mental health conditions, including:
- Anxiety
- Depression
- Post-traumatic stress disorder (PTSD)
- Substance use disorders
- Eating disorders
- Bipolar disorder
- Obsessive compulsive disorder (OCD)
- Borderline personality disorder
Similarly, licensed mental health providers use similar approaches when treating patients, regardless of the delivery method. The types of therapy offered both face-to-face and remotely include:
- Psychoanalysis: By developing a close partnership, therapists help clients examine the motivations behind their thoughts and behaviors.
- Behavior therapy: This approach examines the role of learning in behavior. For example, a behavioral therapist may use regular exposure to desensitize a client to a phobia.
- Cognitive therapy: Cognitive therapists focus on the role of thought patterns in driving emotions and behaviors. In this method, therapists encourage clients to change their thought patterns.
- Humanistic therapy: By focusing on people’s ability to make rational choices, humanistic approaches encourage clients to develop awareness.
Mental health providers may also blend different approaches to psychotherapy, depending on a client’s needs. For example, cognitive behavioral therapy (CBT), one of the most common forms of psychotherapy, combines approaches from behavior therapy and cognitive therapy.
Research demonstrates that both online and face-to-face therapy are effective. In a 2021 meta-analysis published in the journal Clinical Psychology Review, an examination of 57 empirical studies demonstrated that videoconference therapy reported equivalent outcomes to in-person therapy.
Regardless of the similarities, the experience of receiving treatment remotely vs. face-to-face can differ. Online and in-person counseling also offer different benefits and drawbacks.
What Is Online Therapy? ¶
Online therapy is a newer way to deliver mental health treatment. Also called teletherapy, online therapy uses technology to connect clients with therapists.
Remote therapy existed long before the pandemic. In the early 20th century, Sigmund Freud used letters to conduct psychotherapy. By the 1960s, providers offered therapy sessions by telephone. And in the 1970s, UCLA and Stanford University previewed how computers would eventually connect clients and providers for online therapy sessions.
How does online therapy work? Instead of meeting in a therapist’s office, clients connect with providers on their computer or smartphone. Some online therapy providers offer apps clients can use to track moods, journal about thinking patterns, and communicate with licensed providers.
Online therapy is becoming increasingly common. In 2022, 58% of psychologists surveyed by the APA said they provide remote services, and 96% of psychologists believe teletherapy is an effective therapeutic tool for clients.
How Does Online Therapy Work? ¶
Like in-person therapy, online therapy helps people work through challenges, manage stress, and develop healthy coping mechanisms. Therapists build trusting relationships with clients to understand their unique circumstances and set goals. Instead of meeting in person, online sessions take place remotely.
Online therapy can take several forms.
- Videoconferencing: Many providers conduct virtual sessions using videoconferencing technologies. Clients can interact with therapists in real time. The visual element of video can help people connect with providers while also allowing therapists another dimension to understand the client’s issues.
- Phone sessions: Online therapy can use phone sessions to connect clients with providers. While phone sessions lack the element of visual face-to-face contact, some clients may feel more comfortable opening up to a therapist over the phone.
- Online chats and voice messaging: Clients can speak directly with providers in live, online chats or exchange voice messages to discuss mental health issues. These formats are highly accessible, though they may not be the right fit for every person.
- Email and text sessions: Online therapy sessions can include emails and texting, which allows clients time to formulate their thoughts. However, these formats do not provide real-time connection nor an immediate response.
Patients can use online therapy to manage anxiety, depression, and other common mental health challenges. An online format may not be the best choice for more serious mental health issues.
Licensed mental health providers of various types can offer teletherapy. This can include professionals licensed in psychology, counseling, social work, and other fields. In some states, licensing rules restrict therapists from treating out-of-state patients.
What Is In-Person Therapy? ¶
Until recently, therapy has almost always been an in-person service. Licensed mental health providers meet face-to-face with clients to provide counseling and therapy.
In-person therapy offers the benefit of personal interaction between the client and therapist. Providers can use techniques that are only possible during an in-person session, such as somatic therapy, which incorporates physical components as a body-centered form of therapy.
Decades of research back the effectiveness of in-person therapy for mental health treatment. In traditional settings, therapists can use verbal and nonverbal cues to diagnose mental health issues, discuss emotional issues, and provide timely treatment. Research shows that in-person therapy improves mental health.
How Does In-Person Therapy Work? ¶
In-person therapy helps clients manage mental health challenges and develop healthy coping mechanisms.
During an in-person therapy session, clients discuss mental health issues with providers. In-person sessions can effectively treat common issues like anxiety and depression. Traditional therapy can also address stress disorders, substance use issues, grief, eating disorders, and other mental health issues.
Treatment approaches and goals vary depending on the type of therapy. For example, cognitive behavioral therapy techniques encourage clients to journal and record their thoughts. Therapists may also assign tasks for the client to complete before the next session.
Pros and Cons of Online Therapy vs. In-Person Therapy ¶
Those seeking mental health services have more options than ever before. Thanks to teletherapy, mental health apps, and other remote counseling options, clients can connect with licensed therapists in the way that is most convenient.
However, when considering online therapy vs. in-person therapy, it is critical to consider the benefits and drawbacks of both delivery methods.
What are the pros and cons of online therapy? What about the pros and cons of in-person therapy? Understanding the limitations of both delivery methods can help prospective patients make an informed choice about which is right for them.
Benefits of Online Therapy ¶
Online therapy offers many benefits, including convenience, comfort, and availability. For some clients, these pros outweigh the cons of online therapy.
Convenience ¶
Instead of traveling to a therapist’s office to meet face-to-face, online therapy sessions allow therapists and clients to connect virtually.
The convenience of an online format can make therapy more accessible. And because online therapy providers do not need to meet with clients in an office, they often offer greater flexibility for appointment times.
Comfort and Safety ¶
Meeting with a new therapist in an unfamiliar environment can increase anxiety for some patients. When participating in virtual therapy, clients may find it easier to open up because they feel comfortable in their home environment.
Virtual sessions can also help patients feel safe when sharing their emotions and thoughts. Similarly, the comforts of home can help with emotional regulation.
Selection and Scheduling ¶
With increasing demand for mental healthcare, finding an in-person therapist can present a challenge. Online therapy offers the ability to choose from more options and a larger selection of therapists. Particularly in remote areas, online therapy makes it easier to access mental health support.
Providers offering virtual services may also offer a greater selection of appointment times, since therapists are not limited by regular office hours. Similarly, online chats, emails, and texts provide access outside of business hours.
Benefits of In-Person Therapy ¶
Until the past few years, most mental health providers only offered in-person therapy. As a result, the benefits of face-to-face sessions have a long track record.
Focus ¶
Clients who meet face-to-face with therapists may find it easier to focus. Meeting in a professional environment can help clients access the right mindspace for in-depth discussions.
Because in-person therapy takes place in a controlled environment, it also eliminates the distractions that can disrupt virtual sessions.
Privacy ¶
An in-person format offers greater privacy when compared with a virtual format. For example, clients who do not have a private space to conduct online sessions benefit from the privacy offered by a face-to-face meeting.
Both providers and clients recognize the importance of privacy for successful therapy sessions. Psychologists ranked ‘finding a private place to connect’ as one of the most common challenges of teletherapy in a 2022 APA survey.
Multidimensional Connection ¶
A face-to-face format allows clients and therapists to connect on many levels. Subtle visual cues and nonverbal communication can get lost in an online format, particularly when using voice messaging, texting, or online chats.
In-person therapy allows for personal interactions, which can help develop the client-therapist relationship and build trust. For some clients, speaking in person can encourage a deeper connection.
Cons of Online Therapy ¶
As a newer form of therapy, teletherapy does have some downsides. Problems with technology, issues with insurance coverage, and the limitations of remote therapy can make teletherapy challenging for some people.
Issues With Technology ¶
Like teleconferencing and other virtual meeting tools, online therapy requires reliable internet access and technology. Whether video, chat, or text therapy, clients may need to troubleshoot their technology. In a 2022 survey conducted by the APA, 48% of psychologists reported internet access or connectivity problems with telehealth, while 46% reported technical difficulties.
The reliance on technology can also raise confidentiality and privacy concerns for those participating in online therapy.
Insurance Coverage ¶
While online therapy can be more affordable than in-person therapy, insurance coverage may vary for online sessions. Coverage levels may depend on the state, provider, and even the type of therapy. For example, insurance providers are more likely to cover individual treatment for a clinical diagnosis, while they are less likely to cover couples therapy or group therapy.
State laws also limit access to out-of-state therapists, which can complicate accessing care. In certain states, providers must hold a license in the state where the client resides as well as their own state.
Not Appropriate for Everyone ¶
An online format is not appropriate for every client or situation. Those who lack a safe, private space for online therapy sessions may prefer an in-person format. Similarly, lack of internet access or technology can limit the effectiveness of online therapy.
An online format may also not be appropriate for anyone experiencing a serious psychiatric illness or a mental health crisis.
Cons of In-Person Therapy ¶
In-person therapy comes with drawbacks that prospective clients should consider before pursuing care.
Inconvenience ¶
Meeting in person with a therapist can be inconvenient. Therapists and clients must travel to meet, and hours may be more limited. Long travel times can dissuade people from seeking support.
Some clients may also feel a stigma around visiting a mental health center. Teletherapy can reduce these barriers to receiving treatment.
Inaccessibility ¶
Accessing in-person services can pose challenges for people with mobility issues. Mental health practices may also not offer accessible facilities. For example, a therapist who has a home practice might not be accessible for clients with physical disabilities.
Similarly, some mental health conditions can make it difficult to leave home. In-person therapy may not work well for these patients.
Difficulty Finding Providers in Certain Regions ¶
Identifying mental health providers represents a significant challenge for many seeking services. In areas with high demand or limited providers, in-person sessions may offer limited availability and long waitlists.
In particular, those in rural or remote areas may struggle to find providers. Similar issues can make in-person therapy difficult in cities where there are provider shortages.
Online Therapy vs. In-Person Therapy: How to Choose? ¶
More than one in five Americans experience mental illness, according to the National Alliance on Mental Illness. That translates into nearly 58 million people. Unfortunately, less than half this population received mental health treatment. And people wait an average of 11 years between experiencing symptoms of a mental illness and seeking treatment.
Ultimately, receiving support matters more than the delivery method. Both online and in-person therapy show positive results in multiple rigorous studies.
People considering therapy, especially those researching mental health services for the first time, may wonder if online therapy or in-person therapy is right for them. Access, logistics, and personal preference can factor into finding the right therapy delivery method.
Consider the following questions when choosing between online therapy vs. in-person therapy.
- What environment will most put you at ease? Therapists cultivate their physical space to encourage a safe, comforting environment. However, some people prefer the comforts of home.
- What kind of care do you need? Certain forms of mental healthcare are better suited to a virtual format. For people who require more intensive care, an in-person modality may be better.
- What is your biggest barrier to receiving care? Issues like accessibility and cost can prevent people from seeking out mental health services. Teletherapy can make care more convenient for these people.
- What is your personal preference? Ultimately, the decision to pursue online or in-person therapy can come down to personal preference. Some people feel comfortable conducting sessions virtually, while others prefer a face-to-face option.
Both in-person and online therapy have a track record of success. In a 2022 study of college students experiencing anxiety published in the Journal of American College Health, online video counseling was found to be as effective as in-person therapy.
Similarly, a meta-analysis of video therapy compared to phone therapy found no significant difference in the effectiveness for treating less common mental health conditions.
People often find their mental health needs and circumstances evolve over time. Fortunately, both online and in-person services are available, and clients can switch between the two delivery methods.
Careers in Therapy ¶
Effective online and in-person therapy relies on the skills and knowledge of licensed mental health professionals. If you’re considering careers as a therapist, counselor, or psychologist, you can start your educational journey with a Bachelor of Arts in Psychology from Wilson College Online. Reach out to learn more about the program.
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Sources:
American Psychological Association, “Different Approaches to Psychotherapy”
National Alliance on Mental Illness, “Mental Health By the Numbers”
Psychology Today, “10 Essential Points About Online vs. In-Person Therapy”
