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Key points
- 96 percent of psychologists now see patients virtually.
- Studies find teletherapy is comparable to in-person treatment in efficacy, patient satisfaction, and more.
- Anecdotally, therapists state that subtle behaviors that can only be noticed in-person can improve care.
With the arrival of coronavirus, therapy changed dramatically, and possibly forever. In a matter of months, therapy went from an in-person experience to a digital one. In 2022, the American Psychological Association (APA) found that 96 percent of psychologists reported treating patients virtually. In this new world of virtual therapy, what are the limitations? What are the benefits? Should patients go back to seeing their therapist in person?
Studies have broadly shown that teletherapy has similar outcomes in most cases to in-person therapy. A recent systematic review and meta-analysis found that telemedicine was comparable to in-person treatment in efficacy, patient satisfaction and dropout rates. But many of these studies also note the limitations of their scope: teletherapy has only existed in its current form for a few years and it takes time to set up a study, analyze results, and publish, not to mention the fact that adequate measurement of therapeutic outcomes can take years.
Therapists and clients report mixed feelings about teletherapy, and it may be that the differences in its efficacy have to do with specific factors.
Advantages of Teletherapy
Accessibility and convenience rank among the top reasons for the current prevalence of teletherapy.
“The biggest pro of video therapy is convenience,” says Vaile Wright, a director of the Office of Health Care Innovation at the APA. “Patients don’t need to take the time to travel to an office, take time off from work, or find a babysitter.”
And given that mental health care is in high demand, teletherapy allows clients to connect with providers they might not be able to get to in person.
“The pool of clinicians is now much wider, and accessibility is important,” says Robert Taibbi, a therapist with nearly 50 years of experience, based in Charlottesville, VA. “I treated an elderly couple last week. The woman was in a wheelchair. It would have been a major difficulty for them to drive to the office and climb the stairs.”
Those with particular conditions or who belong to minority or underserved groups may also benefit from the expanded choices available.
“Online therapy allows me to see clients from around the state, especially in areas without much access to mental health support. Some LGBTQ+ clients report that they’ve struggled to find affirming therapists in their area, but can find many online,” says Andrew Fishman, a therapist based in the Chicago area.
Some clinicians note additional, unanticipated benefits to video sessions.“I find that working with couples virtually is often actually more successful because you can tone down the tension more easily on a video call than you can in person, even when the couple is on video in the same room,” says Diane Barth, a psychotherapist in private practice in New York.
“Couples work can escalate quickly and when you’re all in the same space it’s harder to keep emotions from snowballing. When you’re visually separated, it’s easier to get some emotional distance, for the couple as well as the therapist.”
Benefits of In-Person Therapy
Every therapist interviewed for this article spoke of the non-verbal cues they are able to perceive during in-person therapy that are lost in teletherapy.
Steven Reidbord, a psychiatrist in California, says that his goal is to get back to in-person sessions for as many of his clients as possible.
“You get less information over the screen. You can’t see if the patient is tapping their foot or fiddling with their fingers or if there’s alcohol on their breath. You can miss micro facial expressions or the momentary darting of eyes,” he says.
For patients in crises, or with severe conditions, in-person therapy provides a human connection that might be absent over a screen.
“If you have a suicidal patient, do you really want to be seeing them online?” asks Sean Grover, a psychotherapist in New York. “If looking on screen were as good as being in person, there’d be no reason to go to a concert or an art museum or travel.”
“I think it’s important to see acutely psychotic people in person; keeping it as real as possible is very important if they have trouble with reality,” Reidbord said.
Another benefit of in-person therapy is fewer distractions. There are no pets or children or spouses in a therapist’s office.
“People were signing in while they were cooking dinner or while they were walking their dog,” said Grover. “In some cases, I could see in their eyes that they were scrolling online as we were talking.”
The privacy of a therapist’s office also helps a practitioner more effectively communicate with a patient. “People don’t really want to talk about trauma from their living room couch,” says Amy Morin, a therapist and writer based in Florida. “Some patients I work with couldn’t find a place to speak at home and were actually whispering during sessions.”
On the whole, therapists seem to think in-person therapy is a slightly better clinical experience than teletherapy, but if the trade-off is therapy vs. no therapy, then teletherapy is a much better course of action.
The most important factor is finding a therapist with whom a patient is able to build a strong, trusting relationship, through whatever medium. Some patients may also benefit from a hybrid approach, coming into the office when needed and staying home for more routine check-ins.
“The work we do is relational and part of that is whatever communication we transmit through our bodies,” says Barth. “That’s when it matters if we’re in the same space together. I don’t think you need to be in person every time, but you need it sometimes. Therapy will probably be hybrid forever.”
To find a therapist near you, visit the Psychology Today Therapy Directory.
