Online or in-person therapy? Which is best?

Online therapy is as effective as in-person therapy for various mental health concerns.

When therapists were mandated to work with clients online only because of the COVID 19 pandemic, I was one of the last therapists to get on board with this transition. I was reluctant to conduct online therapy, particularly when working with couples. I didn’t think I could provide the same quality of care. Fortunately, I was surprised to learn I was able to gain more insight into a client’s environment, distractions, patterns and priorities in a way I could not in a controlled, in-office setting.

With more people today looking for mental health services, they may get discouraged because online therapy is the only option that fits with their availability and busy schedule. You can find comfort in knowing studies have shown online therapy is as effective as in-person therapy for various mental health concerns.

Let’s examine each:

In-Person Therapy

People often feel they need to be on their best behavior in an office setting. As a result, it can take longer for clients to begin sharing their feelings openly and honestly. However, some clients prefer a neutral location away from the distractions of their home, while others find they have no privacy at home and feel more comfortable speaking freely in an office setting.

I also have found that in-person therapy is the best first step when people are facing social anxiety. It gets individuals out of the house and into an emotionally supportive environment.

Logistically, in-person therapy removes the problem of a poor internet connection and provides an opportunity to step away from technology for a short time.

I want to emphasize that I strongly urge couples dealing with domestic abuse to meet in an in-person setting.

Online Therapy

In an online session, clients control their environment. Those who are neurodivergent or have sensory triggers such as certain lighting, smells, sounds or temperatures, can control these in their chosen environment, which reduces distractions and anxiety.

For therapists, the benefits are being able to observe natural behaviors and gain insights from a home setting and also identify barriers to progress, which may not be seen as quickly in a controlled, in-person setting. In addition, direct eye contact is more difficult to avoid in online therapy.

Often, when individuals are in their own environment, they are more relaxed and more open, similar to reality television shows. Cast members often forget the cameras are on. For adolescents in an online setting, avoidant resistant behaviors tend to go down significantly.

I also have learned that privacy-conscious people may worry about the waiting room setting and seeing someone they know. They find comfort in controlling their visibility, especially if they already are resistant to therapy.

I also have observed “balance of power” struggles in an office setting simply by seating arrangements that unintentionally can reinforce an imbalance of power.

Online therapy eliminates the “excuse” of time. Travel time to and from an office no longer is a barrier, and clients can connect with me anywhere (eg, home, office, car).

Those with physical disabilities, chronic pain or transportation issues now can obtain the needed mental health services they need online. So too can those attaching to shame (eg, infidelity). They may be more agreeable to therapy in a home setting where they have more control and less visibility.

I have found that with couples, the avoidant tendencies of a partner – they try masking – present sooner through online sessions.

If you choose online therapy, please make sure you have a strong internet connection.

I would like to point out that I recommend in-person therapy for young children. Therapists can learn a great deal through play therapy and movement modalities, which are instrumental to progress.

Before I see any couple online or in-person, I tell them I first will see them individually. I want to hear what each person expects and wants out of therapy, and I want to provide a neutral setting where they can speak freely. I always remind clients to take each session one step at a time. If they look at therapy as a big commitment, they can get overwhelmed; that is why we focus on one session at a time. If they want to meet once a week, twice a month, or sometimes in-person and other times online, I will set up a schedule that accommodates them.

I want to reiterate that online therapy can bring you the results you are looking for. I was skeptical at first, but I have gained valuable insights about individuals and couples from their natural environment.

The question remains: online or in-person therapy? Both can have a positive outcome; consider your personal preferences and comfort level, and take the first step.