Is Virtual Therapy as Effective as In-Person Therapy?

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The less-than-satisfying answer to whether virtual or in-person therapy is best for you is it depends. Though research outcomes indicate that telepsychology (phone and video therapy) and in-person therapy tend to be equally effective, the experiences are different. So, if you want therapy and you are not constrained by being unable to get to in-person sessions or by an aversion to doing treatment virtually, you have an important decision to make.

As a therapist who began doing telehealth before the COVID-19 pandemic, I have given a lot of thought to how the difference between in-person and virtual therapy (including texting) can affect the therapeutic alliance between the therapist and the patient and how it can also affect the therapy.

Four Forms of Communication

To help you think about this, consider these four forms of communication and their use in therapy:

Texting: We can all agree that texting can be a very helpful way of communicating, but it can also fall short in many ways, especially because you can’t read nonverbal cues. As most of us have discovered, although texting can be extremely convenient, it can also lead to some big miscommunications.

Texting in therapy can be problematic for navigating the highly emotionally charged topics that people often talk about in therapy. However, if the “text therapy” focuses specifically on offering practical advice, it might be helpful. Or, if the texting is an adjunct to other therapy, then the support it offers can also be helpful.

Conversing on the telephone: When someone is not physically close by, it can feel good to hear them when you chat. Though you can hear someone’s tone of voice and other verbal cues (e.g., pauses, “ummm”), you are still missing nonverbal cues, which can create misunderstandings.

Telephone therapy helps many patients, as therapists can verbally guide them through their struggles. Still, the communication and interpersonal connection are constrained by the lack of nonverbal cues. A therapist would miss their patient blinking away tears, and a patient would miss the look of concern in the therapist’s eyes. Also, the lack of a shared experience of being in the same physical location can weaken their connection.

FaceTime call: Especially given how much is communicated through facial expressions, FaceTime calls can give you the sense of being closer despite your physical distance. And being able to see what each other is seeing also increases the sense of being together.

FaceTime (or video conferencing) therapy has exploded since the pandemic, and research has shown that it is effective in helping many people. However, cues that we receive during conferencing are still more limited than during in-person interactions, and this impacts the therapy in many subtle ways. For instance, as a therapist, I cannot see when a patient is anxiously shaking their foot even though they are speaking calmly. And when I work with a couple in person, I sometimes lean in to interrupt the partners arguing by bringing their attention to me—something I cannot do virtually. Also, when someone is really upset, I can more easily offer a sense of quietly being there with them as they cry when we are in the same room.

In-person conversations: While virtual forms of communication allow for much greater flexibility, being physically with people doesn’t limit interpersonal cues. So, the actual conversations can be deeper, richer experiences. I liken this to watching live theatre versus watching a movie.

In-person therapy allows for the full human experience to be part of the treatment. I have found that the more deeply someone is struggling emotionally, especially when they are wrestling with attachment issues, the more helpful it may be for the person to feel that the therapist is right there with them. If you struggle with anxious attachment, rejection sensitivity, other relationship issues, shame, or emotion regulation, doing virtual therapy can feel safer. Maybe you need that safety to even enter therapy, but as you heal, it will be helpful to experience being emotionally vulnerable in the physical presence of someone you can trust.

Virtual vs. In-Person Therapy: Decide for Yourself

Considering the differences in therapy venues can help you decide which one is the right fit for you. Of course, there are many factors to consider when entering therapy, such as choosing a therapist, the venue of therapy, and the type of therapy that might be best for you. But if you are trying to decide between in-person and virtual therapy, I suggest you consider the importance for you of the richness of the therapy experience in each session.